Missed opportunities: Module design to meet the learning and access needs of practitioners - A work based learning pilot in the rehabilitation setting

It is with great pleasure that this report is presented as a result of an exciting project that truly exemplified partnership working. For a Higher Education Institution to come together with an NHS organisation to negotiate and tailor an education initiative in direct response to the needs of both the organisation and its staff is a very positive direction of travel. The project has been possible through the enthusiasm and commitment of its partners, their contribution of resources including time and funding, and the support of others who have played a part in enabling it to happen. The willingness of the students taking part in the pilot module should be recognised as much of what we have learnt from the process and the evaluation of it, will more directly benefit future students rather than the participating students themselves. As with any pilot, there are risks and where challenges have not been foreseen they have been addressed along the way, flexibly and promptly. Whilst a relatively small project, it has generated much interest from others interested in work based learning approaches and potential students from across the health care professions wanting to take part in future courses. On behalf of the Project Team, I hope you find the report useful and encourage you to make contact if you require further information, wish to explore work based learning opportunities (uni-discipline or multi-professional) here at the University or would like to discuss research or evaluation

Evaluation (and related activities) of a NHS supported local delivery model for non-credit bearing Multi-professional Support for Learning and Assessment in Practice in Greater Manchester

Background: HEE North West (HEE NW) is currently piloting for 12 months a partnership of Trusts within Greater Manchester to deliver non-credit bearing Multi-Professional Support of Learning and Assessment in Practice (MSLAP) programme in NHS, private, voluntary and independent settings under an agreement with the University of Bolton (UoB). Health Education England North West (HEE NW) have commissioned an evaluation of the model by the University of Salford School of Nursing, Midwifery, Social Work & Social Sciences (NMSWSS) to compare this model to different national HEE mentorship training delivery models and policies

Evaluation of a primary care triumvirate leadership development programme

This paper evaluates a primary care triumvirate leadership programme from the perspectives of key stakeholders (General Practitioners, General Practice Nurses, Practice Managers, programme and practice colleagues); and to provide evidencedinformed recommendations for future primary care triumvirate healthcare leadership development. Kirkpatrick's Four/Five Levels of Evaluation Model was used as the evaluation approach. Data was collected by the use of face to face and telephone focus group interviews. Thematic analysis was used to generate themes relating to the four levels of Kirkpatrick's model. Findings show how adopting a primary care triumvirate leadership approach offers a promising platform for operationalising the contemporary collective and distributed approaches to leadership development. Future programmes could benefit further by adopting a multi-dimensional leadership development model. This would expose the primary care triumvirate leader to the evidence based Six 'E's' approach to leadership development (evaluate, examine, exposure, education, environment, experience)

Economic Outcomes of Patients Receiving Antiretroviral Therapy for HIV/AIDS in South Africa Are Sustained through Three Years on Treatment

BACKGROUND. Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation. METHODOLOGY/PRINCIPAL FINDINGS. A cohort of 855 adult pre-ART patients and patients on ART for <6 months was enrolled and interviewed an average of 4.4 times each during routine clinic visits for up to three years after treatment initiation using an instrument designed for the study. The probability of pain in the previous week fell from 74% before ART initiation to 32% after three years on ART, fatigue from 66% to 12%, nausea from 28% to 4%, and skin problems from 55% to 10%. The probability of not feeling well physically yesterday fell from 46% to 23%. Before starting ART, 39% of subjects reported not being able to perform their normal activities sometime during the previous week; after three years, this proportion fell to 10%. Employment rose from 27% to 42% of the cohort. Improvement in all outcomes was sustained over 3 years and for some outcomes increased in the second and third year. CONCLUSIONS/SIGNIFICANCE. Improvements in adult ART patients' symptom prevalence, general health, ability to perform normal activities, and employment status were large and were sustained through the first three years on treatment. These results suggest that some of the positive economic and social externalities anticipated as a result of large-scale treatment provision, such as increases in workforce participation and productivity and the ability of patients to carry on normal lives, may indeed be accruing.South Africa Mission of the U.S. Agency for International Development (GHSA-00-00020-00, 674-A-00-09-00018-00, 674-A-00-02-00018); National Institute of Allergies and Infectious Diseases (PEPFAR 13, K01AI083097); APDA Advanced Center for Parkinson Research at UAB (NIH F30NS065661, NIH R01CA122930); National Institutes of Health Blueprint Core for Neuroscience Research (NS057098

Early and Late Direct Costs in a Southern African Antiretroviral Treatment Programme: A Retrospective Cohort Analysis

Gary Maartens and colleagues describe the direct heath care costs and identify the drivers of cost over time in an HIV managed care program in Southern Africa

Prophylactic Mastectomy in BRCA1/2 Mutation Carriers and Women at Risk of Hereditary Breast Cancer: Long-Term Experiences at the Rotterdam Family Cancer Clinic

Background BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. Methods From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). Results No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). Conclusions The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues

The pathology of familial breast cancer: The pre-BRCA1/BRCA2 era - historical perspectives

A proportion of breast carcinomas develop as a result of a genetic predispostion to the disease. Prior to cloning of the BRCA1 and BRCA2 genes a limited number of studies were carried out to identify specific histopathological characteristics of hereditary breast cancer. These studies are the subject of this review. The main finding was the association of the (atypical) medullary type of breast cancer with a family history; the most important caveat being that medullary breast cancer is found more frequently in young patients. In view of the frequent bilateral occurrence of lobular cancer, this histologic type is also likely to be associated with a predisposing genetic defect. Future investigations will have to test this hypothesis. In addition to mutations in the BRCA1 and BRCA2 genes, there are as yet unidentified genetic defects predisposing to breast cancer development, and histopathology may well help in identifying these genes in the future

Quantifying the Performance of Individual Players in a Team Activity

Teamwork is a fundamental aspect of many human activities, from business to art and from sports to science. Recent research suggest that team work is of crucial importance to cutting-edge scientific research, but little is known about how teamwork leads to greater creativity. Indeed, for many team activities, it is not even clear how to assign credit to individual team members. Remarkably, at least in the context of sports, there is usually a broad consensus on who are the top performers and on what qualifies as an outstanding performance.In order to determine how individual features can be quantified, and as a test bed for other team-based human activities, we analyze the performance of players in the European Cup 2008 soccer tournament. We develop a network approach that provides a powerful quantification of the contributions of individual players and of overall team performance.We hypothesize that generalizations of our approach could be useful in other contexts where quantification of the contributions of individual team members is important