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Summary Background Medical tourism, where patients travel abroad intentionally to access medical treatment, is a growing trend. Some of these patients travel to undergo organ transplantation. This study aims to quantify the number of UK patients who undergo liver transplantation abroad, assessing their motivations and management. Methods Questionnaires were sent to all seven UK liver transplant units enquiring about liver patients receiving transplant abroad. Included were questions on destination, motivation, and pre and post-transplant care. Results Responses were received from six of the seven transplant centres (86%). A total of 12 patients were identified as having undergone liver transplantation overseas. The top destinations were India, China and Egypt. Four units responded to questions regarding pre-transplant screening. One unit reported Hepatitis B and C screening not taking place. Four units responded to questions regarding post-transplant antimicrobial therapy. This revealed examples of patients inappropriately not receiving valganciclovir, co-trimoxazole, anti-fungal treatment and Hepatitis B immunoglobulins. Conclusions UK patients are undergoing liver transplant abroad, albeit in small numbers. Pre and post-transplant management of these patients is of a lower standard than that provided to those undergoing transplantation in the UK. Information transfer between overseas and UK based transplant teams is poor. [ABSTRACT FROM AUTHOR]

Palestine has a short history of medical education: the first medical school opened in 1994 and a further three have opened since. Doctors are trained against a backdrop of military occupation and ineffective governance, complicating the development and delivery of effective education. Postgraduate education is a particular weakness, with disorganised residency programmes prioritising service provision over the training of specialists, leading to poorer patient care and low morale. This unfavourable learning environment leads into a situation where opportunities for continuing professional development are scarce. Links between healthcare and education providers in Palestine and countries with advanced health systems have great potential for allowing best practice in medical education to be shared and to provide high quality training opportunities that address gaps in Palestine's health education system. [ABSTRACT FROM AUTHOR]

A shortcut review was carried out to establish which inhaler with spacer technique provides the greatest improvement in symptoms in children with acute asthma. Four relevant papers were identified for inclusion using the reported search strategy. The author, date and country of publication; group studied; study type; relevant outcomes; results and study weaknesses of these papers are tabulated. It is concluded that a 'tidal breathing' technique, with a minimum of three breaths per inhaler activation, is likely equivalent in efficacy to a 'single breath and hold technique', and easier for a breathless child to perform. [ABSTRACT FROM AUTHOR]

Drag-cloth sampling is the most commonly used method to sample for ticks. A cloth is dragged along the ground and checked for ticks at regular intervals to count ticks before they drop off. The distance between drag-cloth checks differs between studies, which could result in lower density estimates for studies with greater distances between checks. Here, we measured this effect by 1) calculating the rate at which nymphal and adult Ixodes scapularis Say ticks drop off the cloth per meter dragged and 2) measuring tick density by drag-cloth sampling with three different drag-cloth check interval distances. We found a higher drop-off rate for adult ticks, 0.083/m, than nymphal ticks, 0.047/m. The estimated density of ticks decreased with increasing check interval distance. Our results not only highlight the importance of accounting for check interval distance when estimating tick density, but also provide the first estimate of nymphal I. scapularis drop-off rate., (© The Author(s) 2019. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

A shortcut review was carried out to establish which inhaler with spacer technique provides the greatest improvement in symptoms in children with acute asthma. Four relevant papers were identified for inclusion using the reported search strategy. The author, date and country of publication; group studied; study type; relevant outcomes; results and study weaknesses of these papers are tabulated. It is concluded that a 'tidal breathing' technique, with a minimum of three breaths per inhaler activation, is likely equivalent in efficacy to a 'single breath and hold technique', and easier for a breathless child to perform., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)