An analysis of patients presenting to primary and secondary care with dermatological conditions in south-east Scotland with reference to the dermatological training of general practitioners

Cutaneous disease is thought to account for 10 -15% of patient consultations with general practitioners, but relatively little is known about the demography of dermatological conditions in primary care. The primary care study aims were to assess the proportion and diagnostic profile of dermatological conditions seen in primary care in the southeast of Scotland, and to draw comparisons with secondary dermatological care. General practitioners in 13 general practices serving a population of approximately 104,621 were asked to note all skin -related consultations during a two -week period. The case notes of these patients were reviewed, and diagnosis and treatment was recorded. Patients who had consulted for the same skin disorder on >/ =3 occasions during the previous year were invited for assessment by a consultant dermatologist. Where possible, the case notes from 10% of all consultations during the two -week study period were examined to assess accuracy of recording. The percentage of consultations relating to cutaneous disorders varied between practices, ranging from 3% to 18.8 %, with a mean of 8.4 %. Eczema accounted for 22.5 %, infections 20.3 %, and benign tumours for 11.4% of consultations with a dermatological basis. In contrast, in secondary care, benign tumours accounted for 23.8 %, malignant tumours 16.4% and eczema 16.3% of dermatological consultations. Dermatological disorders make up a significant proportion of general practitioners workload. The diagnostic profile of primary -care dermatology differs markedly from that of hospital practice. General practitioners may benefit from training specifically tailored to the common primary -care dermatological conditions.In order to plan appropriate delivery of dermatology services we need to periodically assess the type of work we undertake in secondary care and to examine changing trends in the numbers and type of referrals and the workload these referrals generate. The secondary care study aims were to quantify outpatient workload in hospital - based and private practice; to assess reasons for referral to secondary care and to examine the changes over 25 years in the diagnostic spectrum of conditions referred. During November 2005, all outpatient dermatological consultations in the south -east of Scotland were recorded. Demographic data, source of and reason for referral, diagnoses, investigations performed, treatment administered and disposal were recorded, and comparisons made with four previous studies. During the 1 -month study, attendances were recorded for 2118 new and 2796 review patients (new/ review 1:1.3, female / male 1.3:1, age range 0 -106 years). Eighty -nine per cent of new referrals came from primary care and 11% from secondary care. Fifty -seven per cent of referrals were for diagnosis and 38% for management advice. Benign tumours accounted for 33.4 %, malignant tumours 11.6 %, eczema 16% and psoriasis 7.4% of new cases. For return patients, 20% had skin cancer, 16.5% eczema, 13.4% psoriasis and 9% acne. The referral rate has risen over 25 years from 12.6 per 1000 population in 1980 to 21 per 1000 in 2005, with secondary care referrals increasing from 61 in Nov 1980 to 230 in November 2005. Attendances for benign and malignant skin tumours have increased six -fold since 1980. Patients with eczema and psoriasis account for one third of clinic visits. New referrals have risen by 67 %, with those from other specialities almost quadrupling since 1980 to 11% of the total in 2005.The following chapter examined the dermatological training received by local general practitioners. There is an absence of compulsory vocational training in dermatology for general practitioners and the core medical curriculum in some UK universities is lacking in adequate dermatology training. An anonymous postal questionnaire was circulated to 583 Lothian GPs, with a response rate of 67 %. A qualitative approach was used to detail GPs' experience of dermatology training in the locality both at undergraduate and postgraduate levels, and a quantitative approach to determine: (i) how important doctors consider postgraduate training in dermatology relative to training in other specialities, some of which are compulsory during their vocational training; (ii) what factors prevent doctors from pursuing post- graduate training in dermatology; (iii) how do GPs perceptions of the importance of dermatology training relate to their basic characteristics (type of GP, length of experience as a GP and gender): and (iv) how do GPs experience of their own competence in managing dermatology conditions relate to the length and type of training they have received. From all of these questions, an attempt was made to make some recommendations regarding the future of dermatology training for general practitioners.In total, 71% concluded that dermatology was not only an essential part of the medical core curriculum but should also be taught at postgraduate level. Most GPs concluded that dermatology training at postgraduate level was very important (40.3 %) or important (56.6 %), and 79.5% suggested that clinical training during ST years followed by regular (e.g. 5- yearly) updates would be optimum. GPs rate dermatology on a par with other specialities that are compulsory attachments for their vocational training. No statistical reason for failure to pursue postgraduate training was isolated. GPs' perception of the importance of dermatology was not significantly predicted by their individual characteristics. Receiving postgraduate training in dermatology was positively associated with doctors' perceptions of their own competence at managing skin conditions. Men felt more competent than women.Dermatology should remain an essential part of the undergraduate medical curriculum it should be encouraged as a useful clinical attachment during GP vocational training. Good clinical teaching ran perhaps jointly by a dermatologist and general practitioner should be our aspiration

The Structure of Yohimbine and Other Organic Molecules by X-Ray Crystal Analysis

This thesis describes work carried out under the supervision of Professor J. M. Robertson since October 1962. It is divided into two sections. Section I describes two structures solved by the heavy-atom method. In both cases, it is the actual structure of the molecule in the chemical sense and the stereochemistry that is of interest, and for this reason refinement was terminated at a fairly early stage

Can diagnosis-based capital allocation facilitate more appropriate, sustainable and innovative acute care?

Australians value access to public hospitals with technologically-appropriate clinical care. However, the Australian system of capital funding for public hospitals is not appropriate, effective, equitable, clinically-responsive, patient-centred, evidence-based or sustainable. A new model to effectively fund patient access to efficient public hospitals was developed from international evidence, Australian standards, clinical guidelines and expert clinical interviews. Capital was costed by patient diagnosis group to enable comprehensive funding for public hospital clinical care, for the first time

Vegetation Changes in Four Study Areas at Indiana Dunes National Lakeshore

The sampling transects at Indiana Dunes were established to show the pre-burn condition of the vetetation and to monitor the long term effects of burning. However, one year of monitoring showed changes in vetetation that further substantiate the need for the burning program. Miller Woods (Transect A) has burned frequently in recent years. The one year without fire showed little change in the herbaceous layer. The few notable herbaceous changes might indicate a transition to a more mesic community, but should be viewed skeptically because of the wet season in 1982. Nearly half of the small shrub species at Miller Woods are low blueberries (Vaccinium angustifolium and Vaccinium vacillans). Blueberries decrease rapidly in the absence of fire. In one year without fire the blueberries decreased 60,000 stems/ha at Transect A. This dramatic decrease of the dominant meant an over-all decrease of small shrubs even though there was an increase of other species. Inland Marsh (Transect B) was chosen for its undisturbed condition. There was little change in herbaceous vegetation. An increase of cattails (Thypha latifolia) and purple loosestrife (Lythrum salivaria) would be expected in a marsh without burning. Significant increases were not shown along the transect in one year, probably because deep water along the transect limits the species. Buttonbush (Cephalanthus occidentalis), the only woody species did increase by about 25% density. Inland Savanna (Transect C), of the transects sampled showed the least change. The slight herbaceous changes reflect the increasingly mesic conditions caused by the extending canopy. The slight decline of small shrubs further demonstrates the loss of light to the understory. The shrub species which did increase are commonly found in mesic woods, not sand savannas. Dune Acres (Transect D) was once so open a savanna that it is variously called Lois Howe prairie, Lupine Lane Prairie, and Dune Acres Prairie. This area shows the greatest effects of fire suppression. There was an increase of woodland and wetland herbaceous species that might have been caused by the wet season, but which was probably caused by increasing shade. There was a corresponding decrease of prairie and dry-savanna species caused not only by the wet season, but also by the increased canopy and duff. Small shrubs increased 43,000 stems/ha showing the rapid transition of the area. This overall increase encompassed a decline in such prariie or savanna species as low blueberries and black oak (Quercus velutina). The areas vary in their current need for fire. Miller Woods shows no immdeiate need for fire. Inland Marsh shows no herbaceous imbalance due to fire suppression. Inland Savanna has sufficient canopy that without burning soon it will begin to change rapidly. Dune Acres is now in danger of loosing floristic diversity. If fire does not soon remove shrubs and duff, it could become a dense community of shrubs with few surviving herbaceous species. The savanna species would be greatly reduced and the prairie flora lost

Pathways to Employment for Young New Zealanders: Effects of Social Capital

The Pathways to Sustainable Employment (PAS£) research programme is a five-year programme aimed at determining the supply-side and demand-side parameters of employment-seeking and career development of New Zealanders aged 15-34, and developing policy implications. In an initial phase of the project, 866 participants sampled from four geographical areas and representative of different age, gender, and ethnic groups took part in a Computer Aided Telephone Interview (CAT/) concerning their employment experiences to date and their aspirations for the future. This paper reports on the experiences of participants in respect of seeking and finding their current job, their last job, and their first job and the role social networks play in supporting career decision making. The data, which demonstrate the key role that social capital plays in these regards, raises issues about such things as the expertise of network members, their objective understanding of others' capacities and interests, and their knowledge of the labour market. We suggest that the importance of social capital is underestimated and policy makers could do well to take this into account when considering developing strategies for sustainable employment

Communication & Interventions for People with Alzheimer’s Dementia

A powerpoint for a presentation given at the Illinois Wesleyan University Wakeley Gallery, November 18, 2015 as part of Pursuing the Ephemeral, Painting the Enduring: Alzheimer\u27s and the Artwork of William Utermohlen, Exhibition and Scholarly Reflections.https://digitalcommons.iwu.edu/utermohlen/1003/thumbnail.jp

A Case Study of Five Urban Middle School Teachers Involved In A Culturally Responsive Teaching Teacher Study Group

This qualitative study examined urban middle school teachers' participation in a teacher study group (TSG) focused on culturally responsive teaching (CRT) content. Specifically, the researcher investigated the professional development experiences of five urban middle school teachers participating in a TSG on CRT and examined how these urban middle school teachers described their learning experiences of the CRT content. A purposeful sample of five teachers was used. Data collection was done with open-ended surveys, semi-structured interviews and field notes during the interviews and TSG sessions. The data were transcribed and analyzed using constant comparison. Data were continuously shuffled, sorted and re-organized as part of the constant comparative method. Through this method, key themes about TSGs and teachers' learning experiences emerged and were reported. The data analysis for research question one produced three overarching themes: changes in perception of staff development, building relationships and impact on instruction. Each theme had descriptors that further explain more specific aspects of the data results. The second research question was designed so the researcher could report descriptions of each participant's learning experiences of CRT content from the TSG experience. Two major themes emerged for research question two: personal and professional development. The discussion offers considerable support for the findings of existing research on TSGs and the positive attitude towards this design of professional development. The importance of building relationships in TSGs and the impact this TSG had on instruction are contributed to the literature. In this study the findings are reported in the voices of the participants, which is lacking in the current literature. Also, two major themes of the participants' learning of CRT are presented, personal and professional responsibilities, which are new to the existing literature. In conclusion, this research produced two important results for the educational realm: 1) the tremendous need for schools and school districts to offer our current practitioners better and more meaningful staff development, 2) Trained and certified teachers have little to no understanding of the tenets of culturally responsive teaching methods. CRT practices that are proving meaningful, validating and effective need to be further studied and reported

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