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BackgroundTrauma readiness is a Department of Defense requirement for military healthcare providers. Surgeons must maintain readiness to optimize surgical care on the battlefield and minimize preventable death. The objective of this study was to validate a predictive model for trauma operative exposure by applying the model prospectively.MethodsThe predictive model for operative trauma exposure was prospectively applied to predict the number of emergent operative cases that would be experienced over predetermined time periods at four separate trauma sustainment military–civilian partnerships (TS-MCP). Notional courses were designed to be 2 or 4 weeks long and consisting of 5 and 12 overnight call periods, respectively. A total of 51 separate 2-week courses and 49 4-week courses were evaluated using the model. The outcome measure was the number of urgent (occurring within a day of arrival) operative trauma cases.ResultsTrauma/general surgery case volumes during call periods of notional courses were within the predicted range at least 98% of the time. Orthopedic volumes were more variable with a range of 82%–98% meeting expectation depending on the course length and institution.ConclusionThe previously defined model accurately predicted the number of urgent trauma/general surgery cases course participants would likely experience when applied prospectively to TS-MCP; however, the model was less accurate in predicting acute orthopedic trauma exposure. While it remains unknown how many cases need to be performed meet a trauma sustainment requirement, having a model with a predictive capability for case volume will facilitate metric development. This model may be useful when planning for future TS-MCP.Level of evidenceEconomic and Value Based Evaluations Level II

Aim To determine the association between Viagra (sildenafil) and Cialis (tadalafil) and non-arteritic anterior ischaemic optic neuropathy (NAION). Methods A retrospective matched case-control study was conducted. 38 cases of NAION in males were identified from an academic ophthalmology practice in Birmingham, Alabama, and matched (on age) to 38 controls without a history of NAION. Self reported information regarding past and current use of Viagra and/or Cialis was obtained via a telephone questionnaire from interviewers who were not blind to case status. Results Overall, males with NAION were no more likely to report a history of Viagra or Cialis use compared to similarly aged controls (odd ratio (OR) 1.75, 95% confidence interval (CI) 0.48 to 6.30 and OR 1.82, 95% CI 0.21 to 15.39). However, for those with a history of myocardial infarction, a statistically significant association was observed (OR 10.7, 95% CI 1.3 to 95.8). A similar association was observed for those with a history of hypertension though it lacked statistical significance (OR 6.9, 95% CI 0.8 to 63.6). Conclusions For men with a history of myocardial infarction or hypertension the use of Viagra or Cialis may increase the risk of NAION. Physicians prescribing these medications to patients with these conditions should warn them about the potential risk of NAION.

Aim: To test the hypothesis that individuals with age related macular degeneration (AMD) have increased C reactive protein (CRP) levels. Methods: A cross sectional study design using data from the Cardiovascular Health Study (CHS), a longitudinal study that enrolled older adults from four communities in the United States from 1989 to 1990, was employed to investigate the existence of an association between AMD and CRP levels in this population. Fundus photographs from 1997 and 1998 were used to identify individuals with (n = 390) and without AMD (n = 2365). The association between AMD and CRP levels (measured at baseline) was compared, adjusting for the potentially confounding effect of demographic, lifestyle, and health related characteristics. Results: Among the 2755 CHS participants with gradable fundus photographs, 390 were identified as having AMD. Overall, median CRP levels among those with AMD (1.76 mg/l) were similar to those without AMD (1.77 mg/l). CRP levels were categorised into quartiles and compared between those with and without AMD. Relative to those in the lowest quartile (0.07–0.93 mg/l), the odds ratios (OR) in the higher quartiles, adjusted for demographic, lifestyle, and health related characteristics were increased but not statistically significant (0.94–1.77 mg/l: OR = 1.14, 95% CI 0.82 to 1.60; 1.78–3.04 mg/l: OR = 1.24, 95% CI 0.88 to 1.75; >3.04 mg/l: OR = 1.24, 95% CI 0.87 to 1.78). Conclusions: In the CHS, there is no evidence that CRP levels are associated with AMD. These data do not support the theory alleging non-specific systemic inflammation in the aetiology and natural history of this disease.

Background The use of mobile devices is commonplace among young people. 1 There is scope to develop this technology to support the needs of those with long-term health conditions (LTCs). Young people need support to become independent and be able to self-manage their condition. The mobile app would be a valuable tool in this process. However, there is little reliable research on the development or evaluation of this technology that actively involves young people as equal partners. Objectives To establish a Manchester-based research team, consisting of young people with LTCs, parents, researchers, technologists and healthcare professionals (HCPs) as equal partners. The team will develop a plan of work that focuses on the use of mobile technologies for children and young people with LTCs 2 , using the design and methods of our previous National Institute for Health Research, Research for Patient Benefit funded project. 3 Methods A group involving a patient with juvenile idiopathic arthritis (JIA), a parent, HCPs and researchers have established a Manchester-based research and development programme on mobile technologies for young people with LTCs. We have fostered strong partnerships with other national groups to help us agree on research priorities in this important area, and a plan of work to help us achieve these. Qualitative research was carried out in the form of an electronic survey, completed by a small population of 14 young people with JIA. Results 86% of young people living with JIA felt there was a need for the mobile app, with 14% unsure about the benefit. Children and young people felt that they would use the app most at home or at the hospital. There was an observable lack of interest to use the app whilst at school, with friends or when shopping. Young people suggested that the app should be a tool to improve skills in disease self-management, as well as providing a safe and secure environment for social interaction and mutualistic data collection with HCPs. Conclusions The development of mobile app technology for supporting disease self-management is important in an environment driven by technology and innovation. However, such tools must be developed, for and with, children, young people and their families, in order to be effective and promote long-term retention of such software. Following a systematic review of the literature regarding mobile apps in health, the project will continue to work with young people, parents and HCPs to produce a detailed software specification for a prototype application to test with young people. References Ofcom. (2014). The communications market. Available from http://stakeholders.ofcom.org.uk/binaries/research/cmr/cmr14/2014_UK_CMR.pdf. [Accessed August 2014]. Dennison L, Morrison L, Conway G, Yardley L. (2013). Opportunities and Challenges for Smartphone Apps in Supporting Health Behaviour Change: Qualitative Study. J Med InternetRes. 15(4); Swallow V, Carolan I, Hall A et al. (2014). A novel Interactive Health Communication Application (IHCA) for parents of children with long term conditions: Development, implementation,feasibility assessment. Informatics for Health & Social Care. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25119067. [Accessed 19 October 2014]. Acknowledgements MobAPP Steering Group, The University of Manchester Disclosure of Interest None declared

Background/aims We developed a novel, long-term condition-specific Interactive Health Communication Application, the on- line parent information and support (OPIS) to promote parents’ home-based management ability. We aimed to assess feasibility of a future full-scale randomised clinical trial (RCT) of OPIS in terms of recruitment, retention and data collection procedures; and investigate trends in change on outcomes in a small-scale preliminary RCT in parents. Methods Parents were randomly assigned to: usual support (control) or usual support plus OPIS access for 20 weeks (intervention). Both groups completed study measures at study entry (T1) and exit (T2). We assessed feasibility between groups. Results 55 parents of 39 children enrolled in the RCT;19/26 (73%) of intervention parents and 22/29 (76%) of control parents completed T2 data collection. The overall retention rate was 41/55 (75%). Data collection was judged to be feasible. All intervention parents showed evidence of having accessed OPIS, indicating complete uptake. The intent-to-treat analysis showed greater improvement in self-efficacy to manage their child’s condition for intervention parents when compared to control group parents (3.21 v 1.09, 95% CI -1.27 to 5.51, Cohen’s d =.41). Conclusion A full-scale RCT of OPIS is feasible. OPIS has the potential to beneficially affect self-reported outcomes including parents’ competence to provide home-based clinical care-givin. ll-scale RCT that is sufficiently powered to detect the effects of OPIS on outcomes is indicated. Our design and methodology could potentially be transferred to the management of other conditions. Acknowledgements Families and professionals who participated and the National Institute of Health Research for funding support.

The authors present the case of 6-month-old, non-identical twin brothers who attended our department with ‘cup ear’ deformities. Twin 1 displayed an indentation of the conchal bowl (figure 1) and Twin ‘2’ a widened …

The decline in basic knowledge of anatomy is an area of widespread concern in the UK undergraduate and postgraduate medical curriculums. Robert Acland’s video atlas series represents a powerful force against this perceived dumbing down and has set about reinvigorating the subject through its crystal clear presentation of human anatomy. Broken into six volumes, the atlas covers the body in its entirety, with sections on the upper limb, lower limb, abdomen, and spine and thorax, and two on the head and neck. After title sequences set to classical …

The Lucifer Effect explores questions that society would rather not ask: “What makes previously moral individuals act immorally?” Or, in Philip Zimbardo’s attention grabbing prose, “How can good people become evil?” This topic proves pertinent to medical practice in the wake of modern scandals from Rugby Union’s “bloodgate” furore ( BMJ 2009;339:b3873, doi:10.1136/bmj.b3873) to research falsification. The first section of Zimbardo’s book engages the reader with a synopsis of the Stanford prison experiment of 1971 from the first person perspective of its lead researcher, one Philip Zimbardo. Through his eyes we witness the developments of a psychology research project that runs horribly awry. He describes how groups of volunteer students behaved when split into two randomised …

Objective To estimate the effectiveness of delivering an anthelmintic through a community child health programme on the weight gain of preschool children in Uganda. Design Cluster randomised controlled trial. Setting Eastern Uganda. Participants 48 parishes participating in a new programme for child health: 24 offered children an additional service of anthelmintic treatment. The outcome is based on measurements from 27 995 children. Intervention Treatment of children aged between 1 and 7 years with 400 mg albendazole added to standard services offered during child health days over a three year period. Main outcome measure Weight gain. Results The provision of periodic anthelmintic treatment as a part of child health services in Uganda resulted in an increase in weight gain of about 10% (166 g per child per year, 95% confidence interval 16 to 316) above expected weight gain when treatments were given twice a year, and an increase of 5% when the treatment was given annually. Conclusion Deworming of preschool children in Uganda as part of regularly scheduled health services seems practical and associated with increased weight gain.