Shared decision making between registrars and patients : web based decision aids

BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources

The one minute mentor : a pilot study assessing medical students’ and residents’ professional behaviours through recordings of clinical preceptors’ immediate feedback

Introduction: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. Goal: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors’ brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. Methods: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached their clinical supervisors to give approximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar’s clinical encounters. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner’s performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. Results: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach α around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. Discussion: This method of assessing learners’ professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to students and evaluators. Initial data shows good reliability but to be valid, training of clinical supervisors is necessary to help them provide useful comments based on defined behaviours and attributes of students. In addition, the validity of the scoring method remains to be confirmed

Can rural practice nurses, physician assistants and nurse practitioners fulfil patient expectations regarding "Well Woman Checks"?

Many GPs are of the opinion that a "Well Woman Check" is a 'ticket of entry' for the patient and an opportunity for other preventive health and screening measures. As screening tests, breast and pelvic examination in asymptomatic women during a "Well Woman Check" are not supported by evidence despite widespread practice. Consequently, debate exists regarding the ability of practice nurses (PNs), physician assistants (PAs) and nurse practitioners (NPs) to perform "Well Woman Checks" and cervical smears, particularly if they include breast and pelvic examination. Female patients express a variety of opinions regarding their expectations of, and value attached to "Well Woman Checks"

Small and Very Small Meat and Poultry Processor Stakeholder Regional Meetings with Food Safety Inspection Service Leadership

Between October 2016 and October 2017, four regional meetings were held around the United States between small and very small meat processors, high-ranking USDA Food Safety Inspection Service (FSIS) officials, and other local meat sector stakeholders and support organizations. The purpose of the meetings was for FSIS officials to tour small plants, hear directly from small processors about their needs and challenges, and discuss ways that these can be addressed by the Agency. The meetings were organized by the National Sustainable Agriculture Coalition, with input from a working group of small plant operators and others, including the Niche Meat Processor Assistance Network. NSAC and FSIS agreed to assess the value of the meetings after the first four and use evaluation results to plan next steps. NMPAN surveyed participants in December 2017. Results of that survey are reported here

Genetic Contribution of Emmer Wheat (Triticum dicoccon Schrank) to Heat Tolerance of Bread Wheat

Rising global temperatures cause substantial yield losses in many wheat growing environments. Emmer wheat (Triticum dicoccon Schrank), one of the first wheat species domesticated, carries significant variation for tolerance to abiotic stresses. This study identified new genetic variability for high-temperature tolerance in hexaploid progeny derived from crosses with emmer wheat. Eight hexaploid and 11 tetraploid parents were recombined in 43 backcross combinations using the hexaploid as the recurrent parent. A total of 537 emmer-based hexaploid lines were developed by producing approximately 10 doubled haploids on hexaploid like BC1F1 progeny and subsequent selection for hexaploid morphology. These materials and 17 commercial cultivars and hexaploid recurrent parents were evaluated under two times of sowing in the field, in 2014–2016. The materials were genotyped using a 90K SNP platform and these data were used to estimate the contribution of emmer wheat to the progeny. Significant phenotypic and genetic variation for key agronomical traits including grain yield, TKW and screenings was observed. Many of the emmer derived lines showed improved performance under heat stress (delayed sowing) compared with parents and commercial cultivars. Emmer derived lines were the highest yielding material in both sowing dates. The emmer wheat parent contributed between 1 and 44% of the genome of the derived lines. Emmer derived lines with superior kernel weight and yield generally had a greater genetic contribution from the emmer parent compared to those with lower trait values. The study showed that new genetic variation for key traits such as yield, kernel weight and screenings can be introduced to hexaploid wheat from emmer wheat. These genetic resources should be explored more systematically to stabilize grain yield and quality in a changing climate

Case Study No. 6: Straus Family Creamery and Dairy

Developed by the UCSC Center for Agroecology & Sustainable Food Systems, this series of case studies focuses on the social and environmental efforts of innovative U.S. food system businesses across different geographies, scales, legal structures, and points along the food supply chain.While these represent only a handful of the thousands of socially and environmentally responsible food businesses across the nation, they have many features that others can learn from in developing sustainable businesses that incorporate the triple bottom line of people, planet, and profits

Case Study No. 4: Organically Grown Company

Developed by the UCSC Center for Agroecology & Sustainable Food Systems, this series of case studies focuses on the social and environmental efforts of innovative U.S. food system businesses across different geographies, scales, legal structures, and points along the food supply chain.While these represent only a handful of the thousands of socially and environmentally responsible food businesses across the nation, they have many features that others can learn from in developing sustainable businesses that incorporate the triple bottom line of people, planet, and profits

Case Study No. 5: The Farmers Diner

Developed by the UCSC Center for Agroecology & Sustainable Food Systems, this series of case studies focuses on the social and environmental efforts of innovative U.S. food system businesses across different geographies, scales, legal structures, and points along the food supply chain.While these represent only a handful of the thousands of socially and environmentally responsible food businesses across the nation, they have many features that others can learn from in developing sustainable businesses that incorporate the triple bottom line of people, planet, and profits

Case Study No. 3: Destiny Organics

Developed by the UCSC Center for Agroecology & Sustainable Food Systems, this series of case studies focuses on the social and environmental efforts of innovative U.S. food system businesses across different geographies, scales, legal structures, and points along the food supply chain.While these represent only a handful of the thousands of socially and environmentally responsible food businesses across the nation, they have many features that others can learn from in developing sustainable businesses that incorporate the triple bottom line of people, planet, and profits

Case Study No. 4: Organically Grown Company

Developed by the UCSC Center for Agroecology & Sustainable Food Systems, this series of case studies focuses on the social and environmental efforts of innovative U.S. food system businesses across different geographies, scales, legal structures, and points along the food supply chain.While these represent only a handful of the thousands of socially and environmentally responsible food businesses across the nation, they have many features that others can learn from in developing sustainable businesses that incorporate the triple bottom line of people, planet, and profits