Psychosocial factors related to children’s active school travel : A comparison of two European regions

Peer reviewedPublisher PD

Maximising the acquisition of core communication skills at the start of medical training

Background Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. Aim To explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students. Methods As part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. Results Quantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. Conclusion Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching. Keywords: Real patient contact, Communication skills training, Early years curriculu

Network Resources for Astronomers

The amount of data produced by large observational facilities and space missions has led to the archiving and on-line accessibility of much of this data, available to the entire astronomical community. This allows a much wider multi-frequency approach to astronomical research than previously possible. Here we provide an overview of these services, and give a basic description of their contents and possibilities for accessing them. Apart from services providing observational data, many of those providing general information, e.g. on addresses, bibliographies, software etc. are also described. The field is rapidly growing with improved network technology, and our attempt to keep the report as complete and up-to-date as possible will inevitably be outdated shortly. We will endeavor to maintain an updated version of this document on-line.Comment: 53 pages; uuencoded compressed PostScript; includes one table, no figures; Lyon-41 (Aug'94) and ESO-1033 (Sept'94), to appear in PASP, November 1994 issu

Spectral Classification of Galaxies

We investigate the integrated spectra of a sample of 24 normal galaxies. A principal component analysis suggests that most of the variance present in the spectra is due to the differences in morphology of the galaxies in the sample. We show that spectroscopic parameters extracted from the spectra, like the amplitude of the 4000 \AA~ break or of the CN band, correlate well with Hubble types and are useful for quantitative classification.Comment: 7 pages uuencoded compressed PostScript file. To appear in Vistas in Astronomy, special issue on Artificial Neural Networks in Astronom

Zonal asymmetries in middle atmospheric ozone and water vapour derived from Odin satellite data 2001–2010

Stationary wave patterns in middle atmospheric ozone (O<sub>3</sub>) and water vapour (H<sub>2</sub>O) are an important factor in the atmospheric circulation, but there is a strong gap in diagnosing and understanding their configuration and origin. Based on Odin satellite data from 2001 to 2010 we investigate the stationary wave patterns in O<sub>3</sub> and H<sub>2</sub>O as indicated by the seasonal long-term means of the zonally asymmetric components O<sub>3</sub>* = O<sub>3</sub>-[O<sub>3</sub>] and H<sub>2</sub>O* = H<sub>2</sub>O-[H<sub>2</sub>O] ([O<sub>3</sub>], [H<sub>2</sub>O]: zonal means). At mid- and polar latitudes we find a pronounced wave one pattern in both constituents. In the Northern Hemisphere, the wave patterns increase during autumn, maintain their strength during winter and decay during spring, with maximum amplitudes of about 10–20 % of the zonal mean values. During winter, the wave one in O<sub>3</sub>* shows a maximum over the North Pacific/Aleutians and a minimum over the North Atlantic/Northern Europe and a double-peak structure with enhanced amplitude in the lower and in the upper stratosphere. The wave one in H<sub>2</sub>O* extends from the lower stratosphere to the upper mesosphere with a westward shift in phase with increasing height including a jump in phase at upper stratosphere altitudes. In the Southern Hemisphere, similar wave patterns occur mainly during southern spring. By comparing the observed wave patterns in O<sub>3</sub>* and H<sub>2</sub>O* with a linear solution of a steady-state transport equation for a zonally asymmetric tracer component we find that these wave patterns are primarily due to zonally asymmetric transport by geostrophically balanced winds, which are derived from observed temperature profiles. In addition temperature-dependent photochemistry contributes substantially to the spatial structure of the wave pattern in O<sub>3</sub>* . Further influences, e.g., zonal asymmetries in eddy mixing processes, are discussed

Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use

BACKGROUND: The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. AIM: To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. DESIGN: A systematic literature review and analysis of psychometric properties. DATA SOURCES: PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. RESULTS: From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. CONCLUSION: There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field

Time to improve informed consent for dialysis: an international perspective

The literature reveals that current nephrology practice in obtaining informed consent for dialysis falls short of ethical and legal requirements. Meeting these requirements represents a significant challenge, especially because the benefits and risks of dialysis have shifted significantly with the growing number of older, comorbid patients. The importance of informed consent for dialysis is heightened by several concerns, including: (1) the proportion of predialysis patients and patients on dialysis who lack capacity in decision making and (2) whether older, comorbid, and frail patients understand their poor prognosis and the full implications to their independence and functional status of being on dialysis. This article outlines the ethical and legal requirements for a valid informed consent to dialysis: (1) the patient was competent, (2) the consent was made voluntarily, and (3) the patient was given sufficient information in an understandable manner to make the decision. It then considers the application of these requirements to practice across different countries. In the process of informed consent, the law requires a discussion by the physician of the material risks associated with dialysis and alternative options. We argue that, legally and ethically, this discussion should include both the anticipated trajectory of the illness and the effect on the life of the patient with particular regard to the outcomes most important to the individual. In addition, a discussion should occur about the option of a conservative, nondialysis pathway. These requirements ensure that the ethical principle of respect for patient autonomy is honored in the context of dialysis. Nephrologists need to be open to, comfortable with, and skillful in communicating this information. From these clear, open, ethically, and legally valid consent discussions, a significant dividend will hopefully flow for patients, families, and nephrologists alike