Medical students' experience of personal loss: incidence and implications.

BACKGROUND: Medical students are generally young people, often away from home for the first time and undertaking a course in which they are learning to care for people at all stages of life, including those approaching death. Existing research indicates that their experiences of personal bereavement may have significant implications for their pastoral welfare and medical learning. No previous studies have tracked medical student experience of bereavement longitudinally and no recent data are available from the UK. AIMS: The study aims to identify medical students' experience of personal bereavement: the prevalence prior to and during the course and their relationship with those who died. METHOD: Paper and online questionnaire including questions about recent personal loss. SETTING / PARTICIPANTS: Four cohorts of core science and clinical medical students at the University of Cambridge, 1021 participants in total. RESULTS: Mean response rate was 65.2% for core science students and 72.8% for clinical students. On entry to the core science course, 23.1% of all students had experienced a loss at some point. Between 13.0% and 22.5% experienced bereavement during years 1 - 5 of the course: some (1.3% - 6.3%) experienced multiple or repeated losses. Close deaths reported were most commonly those of grandparents followed by friends. CONCLUSIONS: Medical students commonly experience close personal bereavement, both before and during their course. Educators need to be aware of the range of personal and educational implications of bereavement for medical students, and ensure that appropriate help is available. Further research could explore incidence of loss at other medical schools and investigate the impact and depth of experience of loss.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Quantifying the health and economic benefits of active commuting in Scotland

Background: Despite the substantial evidence base for the health and economic benefits of walking and cycling, there remains a lack of published findings on the levels and benefits of active commuting at a national level. This study aimed to quantify the proportion of active commuters who met a daily equivalent of weekly physical activity recommendations through their commuting journeys, and the economic value of health benefits associated with active commuting in Scotland. Methods: A repeat cross-sectional analysis of the 2001 and 2011 waves of the Scottish Census was conducted. We analysed data from approximately 250,000 respondents aged 16–74 at each time-point who selected walking or cycling for their usual journey to work. A count was taken of walkers and cyclists whose daily commuting time was at least 30 min. The Health Economic Assessment Tool was used to estimate the number of deaths averted by active commuting, and the associated economic value of walking and cycling annually and over a 10-year period. Results: Active modes of commuting accounted for a modal share of 13.5% (n = 244,009) in 2001, and 14.5% (n = 286,145) in 2011. In 2001, 46.5% of all active commuters met a daily target of 30 min of moderate intensity activity rising to 50.2% in 2011. In Scotland, the annual health economic benefit of commuting to work by walking was estimated to be approximately EUR 700.2 million, and EUR 79.8 million for cycling to work. Conclusion: This study provides clear evidence of the substantial health and economic benefits that active commuting makes at a population level. These findings support the case for further investment to increase levels of walking and cycling

Longitudinal qualitative evaluation of pharmacist integration into the urgent care setting

Purpose: To describe the most effective model for managing, educating, and training pharmacist advanced clinical practitioners (ACPs) in the urgent care center (UCC) setting, role evolution and how to measure their effectiveness. Participants and methods: Ethical approval was obtained to perform a qualitative longitudinal cohort study in three sites, with three pharmacists in each trained as ACPs from 2016 to 2017. ACP role, location, management, mentorship, and supervision were locally determined. ACPs attended focus groups (FGs) at 1 and 3 months (sites 1–3), 6 and 12 months (site 1 only), and the UCC staff were interviewed once with a topic guide regarding training, integration, role, and impact. Verbatim transcriptions were analyzed thematically. Results: Eight ACP FGs and 24 stakeholder interviews produced major themes of communication, management, education and training, role, and outcomes. Effective education, training, and integration required communication of role to address concerns regarding salary differentials, supportive management structure, and multi-professional learning. ACPs reported that the model of workplace training, experiential learning, and university-based education was appropriate. Training was better located in the minor injuries and general practitioner areas. Recommended measures of effectiveness included patient satisfaction and workload transfer. Conclusion: The education and training model was appropriate. Communication and management require careful consideration to ensure effective integration and role development. Pharmacists were better located initially in the minor illness rather than major trauma areas. Quality of patient experience resulting from the new role was important in addition to reassurance that the role represented a positive contribution to workload

Pragmatic evaluation of a coproduced physical activity referral scheme:a UK quasi-experimental study

Contains fulltext : 226129.pdf (publisher's version ) (Open Access

BMI and HbA1c are metabolic markers for pancreatic cancer: matched case-control study using a UK primary care database

Background Weight loss, hyperglycaemia and diabetes are known features of pancreatic cancer. We quantified the timing and the amount of changes in body mass index (BMI) and glycated haemoglobin (HbA1c), and their association with pancreatic cancer from five years before diagnosis. Methods A matched case-control study was undertaken within 590 primary care practices in England, United Kingdom. 8,777 patients diagnosed with pancreatic cancer (cases) between 1st January 2007 and 31st August 2020 were matched to 34,979 controls by age, gender and diabetes. Longitudinal trends in BMI and HbA1c were visualised. Odds ratios adjusted for demographic and lifestyle factors (aOR) and 95% confidence intervals (CI) were calculated with conditional logistic regression. Subgroup analyses were undertaken according to the diabetes status. Results Changes in BMI and HbA1c observed for cases on longitudinal plots started one and two years (respectively) before diagnosis. In the year before diagnosis, a 1 kg/m2 decrease in BMI between cases and controls was associated with aOR for pancreatic cancer of 1.05 (95% CI 1.05 to 1.06), and a 1 mmol/mol increase in HbA1c was associated with aOR of 1.06 (1.06 to 1.07). ORs remained statistically significant (p < 0.001) for 2 years before pancreatic cancer diagnosis for BMI and 3 years for HbA1c. Subgroup analysis revealed that the decrease in BMI was associated with a higher pancreatic cancer risk for people with diabetes than for people without (aORs 1.08, 1.06 to 1.09 versus 1.04, 1.03 to 1.05), but the increase in HbA1c was associated with a higher risk for people without diabetes than for people with diabetes (aORs 1.09, 1.07 to 1.11 versus 1.04, 1.03 to 1.04). Conclusions The statistically significant changes in weight and glycaemic control started three years before pancreatic cancer diagnosis but varied according to the diabetes status. The information from this study could be used to detect pancreatic cancer earlier than is currently achieved. However, regular BMI and HbA1c measurements are required to facilitate future research and implementation in clinical practice

Processes and Procedures for Data Publication: A Case Study in the Geosciences

The Peer REview for Publication and Accreditation of Research Data in the Earth sciences (PREPARDE) project is a JISC and NERC funded project which aims to investigate the policies and procedures required for the formal publication of research data, ranging from ingestion into a data repository, through to formal publication in a data journal. It also addresses key issues arising in the data publication paradigm, including, but not limited to, issues related to how one peer reviews a dataset, what criteria are needed for a repository to be considered objectively trustworthy, and how datasets and journal publications can be effectively cross-linked for the benefit of the wider research community. PREPARDE brings together a wide range of experts in the research, academic publishing and data management fields both within the Earth Sciences and in the broader life sciences with the aim of producing general guidelines applicable to a wide range of scientific disciplines and data publication types. This paper provides details of the work done in the first half of the project; the project itself will be completed in June 2013

Preliminary effects and acceptability of a co-produced physical activity referral intervention

Objectives: To explore the preliminary effects and acceptability of a co-produced physical activity referral intervention. Study Design: Longitudinal design with data collected at baseline and post a 12-week physical activity referral intervention. Setting. Community leisure centre. Methods: 32 adults with controlled lifestyle-related health conditions took part in a physical activity referral intervention (co-produced by a multidisciplinary stakeholder group) comprising 12 weeks’ subsidised fitness centre access plus four behaviour change consultations. A complete case analysis (t-tests and magnitude-based inferences) was conducted to assess baseline-to-12-week change in physical activity, cardiometabolic, and psychological measures. Semi-structured interviews were conducted (n=12) to explore experiences of the intervention. Results: Mean improvements were observed in cardiorespiratory fitness-2 (3.6 ml.kg.-1min-1 (95% confidence interval 1.9 to 5.4) P<0.001) and moderate-to-vigorous physical activity (12.6 min.day (95% CI 4.3 to 29.6) P=0.013). Participants were positive about the support from exercise referral practitioners, but experienced some challenges in a busy and under staffed gym environment. Conclusions: A co-produced physical activity referral intervention elicited short-term improvements in physical activity and cardiometabolic health. Further refinements may be required, via ongoing feedback between stakeholders, researchers and service users, to achieve the intended holistic physical activity focus of the intervention, prior to a definitive trial

A direct physical interaction between Nanog and Sox2 regulates embryonic stem cell self-renewal

Embryonic stem (ES) cell self-renewal efficiency is determined by the Nanog protein level. However, the protein partners of Nanog that function to direct self-renewal are unclear. Here, we identify a Nanog interactome of over 130 proteins including transcription factors, chromatin modifying complexes, phosphorylation and ubiquitination enzymes, basal transcriptional machinery members, and RNA processing factors. Sox2 was identified as a robust interacting partner of Nanog. The purified Nanog–Sox2 complex identified a DNA recognition sequence present in multiple overlapping Nanog/Sox2 ChIP-Seq data sets. The Nanog tryptophan repeat region is necessary and sufficient for interaction with Sox2, with tryptophan residues required. In Sox2, tyrosine to alanine mutations within a triple-repeat motif (S X T/S Y) abrogates the Nanog–Sox2 interaction, alters expression of genes associated with the Nanog-Sox2 cognate sequence, and reduces the ability of Sox2 to rescue ES cell differentiation induced by endogenous Sox2 deletion. Substitution of the tyrosines with phenylalanine rescues both the Sox2–Nanog interaction and efficient self-renewal. These results suggest that aromatic stacking of Nanog tryptophans and Sox2 tyrosines mediates an interaction central to ES cell self-renewal