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Oropharyngeal cancer (OPC) remains a significant health burden and about 15–30% of these have been attributed to the human papillomavirus (HPV). Human papillomavirus-related oropharyngeal cancer (HPV OPC) includes tumours which are detected to be p16INK4A positive or have the HPV DNA detected by in situ hybridisation or polymerase chain reaction. HPV OPC is generally believed to have a relatively good prognosis. More recently, there is a recognised pattern of atypical spread in a highly aggressive subset of HPV OPC. These are HPV OPCs which develop distant metastasis or recurrence. This review raises awareness of this subset of HPV OPC and factors associated with poor outcomes. A review of the literature available on HPV OPC was carried out. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. Factors associated with highly aggressive HPV OPC include nodal stage and nodal morphology, alcohol and tobacco use, age and biological characteristics. Treatment options in cases of disease recurrence include salvage resection radiotherapy and/or chemotherapy and management options vary depending on the nature of recurrence and initial treatment. Recent updates in HPV OPC staging have made staging and treatment of tumours more accurate. While HPV OPC overall carries a relatively good prognosis, it is important for clinicians to be aware of potentially highly aggressive cases of HPV OPC and to be aware of factors that should prompt close monitoring.

Background Otolaryngology (ENT) is a craft surgical specialty, which presents significant challenges for the novice surgical trainee (NST), when managing patients with potentially life-threatening conditions. We assess current evidence behind intensive, simulation-rich training programmes or "boot camps". We outline an ENT emergency-safe boot camp for NSTs and the impact this can have on trainees' competence when dealing with ENT emergencies. Methods We designed a standardized "ENT emergency-safe boot camp", aimed at NSTs with a view to up-skilling them in the management of 3 critical clinical scenarios namely post-thyroidectomy haematoma, post-tonsillectomy haemorrhage and epistaxis. All core surgical trainees (CSTs) (n = 54) on the National Surgical Training programme at the Royal College of Surgeons (RCSI) were enrolled on the boot camp. A pre- and post-boot camp anonymised self-assessment was completed by all participants. Results Trainees' self-assessment demonstrated an increase in median competence scores from 3/5 to 4/5 for management of post-thyroidectomy haematoma and epistaxis. There was a greater increase in self-assessed competence scores from 2/5 to 4/5 for the management of post-tonsillectomy haemorrhage. Ninety-two percent of respondents said the course added to their previous knowledge, 70% of respondents said it improved their technical skills and 85% of participants said the course gave them more confidence with handling ENT related on-call problems. Conclusion Study participants expressed an increase in confidence when dealing with specific ENT emergencies, following boot camp training. This correlates with published data. Patient safety should be enhanced, as a result of participation in this dedicated ENT emergency-safe boot camp.

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Deep venous thrombosis (DVT) remains a leading cause of morbidity and mortality in the bariatric patient. We review the current non-invasive modalities—Doppler ultrasound (DUS), computed tomographic venography (CTV) and magnetic resonance venography (MRV)—for the detection of DVT in the post-bariatric surgical patient. CTV and MRV are highly sensitive non-invasive imaging modalities with improved capability over DUS of detecting proximal, especially pelvic, DVT. MRV has recently been shown to be capable of detecting asymptomatic pelvic DVT in post-bariatric surgical patients. The clinical significance of these findings remains uncertain. Invasive contrast venography, while remaining the gold standard, has been supplanted by DUS in routine clinical use. However, DUS has technical limitations in the morbidly obese patient. CTV and MRV remain highly accurate in this population and warrant further investigation for routine clinical use.