Coping with General Practice: An exploratory study of the working lives of General Practitioners in 2017

Problem Whilst it is recognised that health policy is changing the shape and direction of primary care, an expert generalist role is still required in the system to help meet the breadth of clinical challenges posed. At the same time, the NHS is finding it difficult to recruit and retain sufficient General Practitioners (GPs) who wish to do patient facing work This was a study of GPs working in England in 2017. It aimed to explore both nature of the demands of their role as well as the support mechanisms available and how these GP s managed the demands of their work. Approach As the researcher is a GP, participants were recruited using a Snowball/ Respondent driven sampling strategy. Data was gathered using a series of semi-structured telephone interviews which were transcribed. Semistructured interviews were chosen to allow the respondents to provide depth of information about attitudes and experiences as well as to permit expression of feelings and opinions.A critical realist approach informed the approach to this study. Framework analysis was used for data management and analysis. A matrix of five overarching themes was identified. Findings Interviews with 12 Drs were completed. This sample included salaried Drs and partners practising across England. Five worked full-time and the others part-time. Their primary medical qualifications had been gained (between 1970 and 2012) in the UK, India, Europe and South Africa, mirroring the range seen in GMC workforce data. The five major themes identified were: Health Policy impacts, Changes in the external environment, Dealing with Complexity, Uncertainty in a changing system, Impact on the individual doctor's stress and coping mechanisms (including moderating and mediating factors). Consequences This group of doctors was acutely aware of the service re-organisation taking place around them. For the majority, promised increased resources had not materialised and workload was rising inexorably.The interview findings are discussed in the context of stress and coping. The final theme operates in a similar fashion to that described in the Job Demands-Resources model (Schaufeli and Bakker).An overarching consideration is ‘eudaemonic’ well-being, several were experiencing anhedonia and feeling of being ‘chronically sub-burnout’. There appeared to be significant deficits in core dimensions of well-being as well as a sense of ‘moral distress’. Jameton warns that failure to recognise this or acknowledge these experiences had devastating effects on both the individual and the services they provide. The findings of this study will be used to inform a questionnaire study of stress and coping in a larger sample of GPs in England, considering whether particular characteristics of the doctor or their working environment are related to burnout. These finding may inform workplace changes aimed at ameliorating the current workforce crisi

Identification of larval sea basses (Centropristis spp.) using ribosomal DNA-specific molecular assays

This paper is not subject to U.S. copyright. The definitive version was published in Fishery Bulletin 106 (2008): 183-193.The identification of sea bass (Centropristis) larvae to species is difficult because of similar morphological characters, spawning times, and overlapping species ranges. Black sea bass (Centropristis striata) is an important fishery species and is currently considered to be overfished south of Cape Hatteras, North Carolina. We describe methods for identifying three species of sea bass larvae using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays based on species-specific amplification of rDNA internal transcribed spacer reg ions. The assays were tested against DNA of ten other cooccurring reef fish species to ensure the assay’s specificity. Centropristis larvae were collected on three cruises during cross-shelf transects and were used to validate the assays. Seventysix Centropristis larvae were assayed and 69 (91%) were identified successfully. DNA was not amplified from 5% of the larvae and identification was inconclusive for 3% of the larvae. These assays can be used to identify sea bass eggs and larvae and will help to assess spawning locations, spawning times, and larval dispersal.Collection of larvae at sea was supported by funding from the National Science Foundation through OCE 9876565 to C. Jones, S. Thorrold, A. Valle-Levinson, and J. Hare. Additional funding for this project was provided by Office of National Marine Sanctuaries and by Grays Reef National Marine Sanctuary

Nurses Alumni Association Bulletin, Fall 1991

Annual Meeting Calendar Annual Luncheon - Meeting Notice Meeting Notice Dates Officers and Committee Chairmen President\u27s Message Treasurer\u27s Report Proposed Budget- 1991 News About Our Graduates History of the School of Nursing The Future of Nursing School Health - 20 Years Ago - Today Happy Birthday Resume of Minutes of Alumni Association Meetings Alumni Office News Committee Reports By-Laws Bulletin Nominating Relief Fund Satellite Scholarship Social Finance Nursing Education at Jefferson - A Century of Excellence The Decade Fund Fiftieth Anniversary In Memoriam, Names of Deceased Graduates Luncheon Photos My Dear Son Weather Lore Class News Scholarship Application Non-Graduate Scholarship Fund Application Relief Fund Application Centennial Tile Order Form Membership Application Pins, Transcripts, Class Address Lists, Change of Address Form Ma

Correlation of same-visit HbA1c test with laboratory-based measurements: A MetroNet study

BACKGROUND: Glycated hemoglobin (HbA1c) results vary by analytical method. Use of same-visit HbA1c testing methodology holds the promise of more efficient patient care, and improved diabetes management. Our objective was to test the feasibility of introducing a same-visit HbA1c methodology into busy family practice centers (FPC) and to calculate the correlation between the same-visit HbA1c test and the laboratory method that the clinical site was currently using for HbA1c testing. METHODS: Consecutive diabetic patients 18 years of age and older having blood samples drawn for routine laboratory analysis of HbA1c were asked to provide a capillary blood sample for same-visit testing with the BIO-RAD Micromat II. We compared the results of the same-visit test to three different laboratory methods (one FPC used two different laboratories). RESULTS: 147 paired samples were available for analysis (73 from one FPC; 74 from the other). The Pearson correlation of Micromat II and ion-exchange HPLC was 0.713 (p < 0.001). The Micromat II mean HbA1c was 6.91%, which was lower than the 7.23% from the ion-exchange HPLC analysis (p < 0.001). The correlation of Micromat II with boronate-affinity HPLC was 0.773 (p < 0.001); Micromat II mean HbA1c 6.44%, boronate-affinity HPLC mean 7.71% (p < 0.001). Correlation coefficient for Micromat II and immuno-turbidimetric analysis was 0.927 (p < 0.001); Micromat II mean HbA1c was 7.15% and mean HbA1c from the immuno-turbidimetric analysis was 7.99% (p = 0.002). Medical staff found the same-visit measurement difficult to perform due to the amount of dedicated time required for the test. CONCLUSION: For each of the laboratory methods, the correlation coefficient was lower than the 0.96 reported by the manufacturer. This might be due to variability introduced by the multiple users of the Micromat II machine. The mean HbA1c results were also consistently lower than those obtained from laboratory analysis. Additionally, the amount of dedicated time required to perform the assay may limit its usefulness in a busy clinical practice. Before introducing a same-visit HbA1c methodology, clinicians should compare the rapid results to their current method of analysis

UK-born Pakistani-origin infants are relatively more adipose than white British infants: findings from 8704 mother-offspring pairs in the Born-in-Bradford prospective birth cohort

Background: Previous studies have shown markedly lower birth weight among infants of South Asian origin compared with those of White European origin. Whether such differences mask greater adiposity in South Asian infants and whether they persist across generations in contemporary UK populations is unclear. Our aim was to compare birth weight, skinfold thickness and cord leptin between Pakistani and White British infants and to investigate the explanatory factors, including parental and grandparental birthplace. Methods: We examined the differences in birth weight and skinfold thickness between 4649 Pakistani and 4055 White British infants born at term in the same UK maternity unit and compared cord leptin in a subgroup of 775 Pakistani and 612 White British infants. Results: Pakistani infants were lighter (adjusted mean difference −234 g 95% CI −258 to −210) and were smaller in both subscapular and triceps skinfold measurements. The differences for subscapular and triceps skinfold thickness (mean z-score difference −0.27 95% CI −0.34 to −0.20 and −0.23 95% CI −0.30 to −0.16, respectively) were smaller than the difference in birth weight (mean z-score difference −0.52 95% CI −0.58 to −0.47) and attenuated to the null with adjustment for birth weight (0.03 95% CI −0.03 to 0.09 and −0.01 95% CI −0.08 to 0.05, respectively). Cord leptin concentration (indicator of fat mass) was similar in Pakistani and White British infants without adjustment for birth weight, but with adjustment became 30% higher (95% CI 17% to 44%) among Pakistani infants compared with White British infants. The magnitudes of difference did not differ by generation. Conclusions: Despite being markedly lighter, Pakistani infants had similar skinfold thicknesses and greater total fat mass, as indicated by cord leptin, for a given birth weight than White British infants. Any efforts to reduce ethnic inequalities in birth weight need to consider differences in adiposity and the possibility that increasing birth weight in South Asian infants might inadvertently worsen health by increasing relative adiposity

Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>We describe early dissemination patterns for first-line bevacizumab given for metastatic colorectal cancer treatment.</p> <p>Methods</p> <p>We analyzed patient surveys and medical records for a population-based cohort with metastatic colorectal cancer treated in multiple regions and health systems in the United States (US). Eligible patients were diagnosed with metastatic colorectal cancer and initiated first-line chemotherapy after US Food & Drug Administration (FDA) bevacizumab approval in February 2004. First-line bevacizumab therapy was defined as receiving bevacizumab within 8 weeks of starting chemotherapy for metastatic colorectal cancer. We evaluated factors associated with first-line bevacizumab treatment using logistic regression.</p> <p>Results</p> <p>Among 355 patients, 31% received first-line bevacizumab in the two years after FDA approval, including 26% of men, 41% of women, and 16% of those ≥ 75 years. Use rose sharply within 6 months after FDA approval, then plateaued. 20% of patients received bevacizumab in combination with irinotecan; 53% received it with oxaliplatin. Men were less likely than women to receive bevacizumab (adjusted OR 0.55; 95% CI 0.32-0.93; p = 0.026). Patients ≥ 75 years were less likely to receive bevacizumab than patients < 55 years (adjusted OR 0.13; 95% CI 0.04-0.46; p = 0.001).</p> <p>Conclusions</p> <p>One-third of eligible metastatic colorectal cancer patients received first-line bevacizumab shortly after FDA approval. Most patients did not receive bevacizumab as part of the regimen used in the pivotal study leading to FDA approval.</p

Application of multi-criteria decision analysis techniques and decision support framework for informing plant select agent designation and decision making

The United States Department of Agriculture (USDA) Division of Agricultural Select Agents and Toxins (DASAT) established a list of biological agents (Select Agents List) that threaten crops of economic importance to the United States and regulates the procedures governing containment, incident response, and the security of entities working with them. Every 2 years the USDA DASAT reviews their select agent list, utilizing assessments by subject matter experts (SMEs) to rank the agents. We explored the applicability of multi-criteria decision analysis (MCDA) techniques and a decision support framework (DSF) to support the USDA DASAT biennial review process. The evaluation includes both current and non-select agents to provide a robust assessment. We initially conducted a literature review of 16 pathogens against 9 criteria for assessing plant health and bioterrorism risk and documented the findings to support this analysis. Technical review of published data and associated scoring recommendations by pathogen-specific SMEs was found to be critical for ensuring accuracy. Scoring criteria were adopted to ensure consistency. The MCDA supported the expectation that select agents would rank high on the relative risk scale when considering the agricultural consequences of a bioterrorism attack; however, application of analytical thresholds as a basis for designating select agents led to some exceptions to current designations. A second analytical approach used agent-specific data to designate key criteria in a DSF logic tree format to identify pathogens of low concern that can be ruled out for further consideration as select agents. Both the MCDA and DSF approaches arrived at similar conclusions, suggesting the value of employing the two analytical approaches to add robustness for decision making

A Glycosaminoglycan Extract from Portunus pelagicus Inhibits BACE1, the beta Secretase Implicated in Alzheimer's Disease

Therapeutic options for Alzheimer’s disease, the most common form of dementia, are currently restricted to palliative treatments. The glycosaminoglycan heparin, widely used as a clinical anticoagulant, has previously been shown to inhibit the Alzheimer’s disease-relevant β-secretase 1 (BACE1). Despite this, the deployment of pharmaceutical heparin for the treatment of Alzheimer’s disease is largely precluded by its potent anticoagulant activity. Furthermore, ongoing concerns regarding the use of mammalian-sourced heparins, primarily due to prion diseases and religious beliefs hinder the deployment of alternative heparin-based therapeutics. A marine-derived, heparan sulphate-containing glycosaminoglycan extract, isolated from the crab Portunus pelagicus, was identified to inhibit human BACE1 with comparable bioactivity to that of mammalian heparin (IC50 = 1.85 μg mL−1 (R2 = 0.94) and 2.43 μg mL−1 (R2 = 0.93), respectively), while possessing highly attenuated anticoagulant activities. The results from several structural techniques suggest that the interactions between BACE1 and the extract from P. pelagicus are complex and distinct from those of heparin