A Cross-sectional Questionnaire Study to Gather the Teaching Preferences and Expectations of UK Undergraduate Medical Students For Culinary Medicine Learning

Aim: To determine undergraduate medical students’ teaching preferences and expectations for Culinary Medicine (CM) learning with a view to informing development of a CM course at a UK medical school. Setting: A single, urban UK medical school. Participants :180 undergraduate medical students. Study design: A cross-sectional questionnaire study collecting quantitative and qualitative (free-text) data. Methods and outcome measures: An online questionnaire consisting of 16 questions of various styles (Likert-type, multiple choice and free-text). Quantitative analysis of multiple choice and Likert-type scale questions was conducted. Qualitative thematic analysis was used to analyse the free-text responses and identify themes. Results: Three core themes related to students’ understanding of CM were identified: (1) ‘CM Learning’: students’ perceived relevance of CM knowledge, perceived relevance of CM to healthcare and their expectations for teaching; (2) ‘The Relationship between Food and Health’: links between diet, social factors and health; and (3) ‘Evidence-based Medicine’: students’ perceptions about scientific principles underlying CM. Quantitative analysis revealed that, although 83% of students felt that learning CM is important for their future clinical practice, 56% felt unable to take a dietary history. 73% of students were dissatisfied with the quality, and 78% were dissatisfied with the quantity, of existing medical school teaching understood to be relevant to CM. Topics that students would like to be taught on a CM course included weight management and portion control. Students felt that problem-based style learning would be the most appropriate method for delivering CM teaching. Conclusions: This study revealed that medical students felt their dietary counsulting skills could be improved with further clinically relevant teaching in the undergraduate medical curriculum. Students’ preferences for CM learning have been taken into consideration in the development of a CM course for fifth-year undergraduate students at a UK medical school, which is delivered during their General Practice placement

Milestones: a mixed methods study of an educational intervention to improve care of the dying

Background: Approximately 460 000 people die annually in England. Three-quarters of these deaths are expected. Health Education England is prioritising upskilling of clinical staff in response to reports of poor care quality in the last days of life in acute hospitals, where almost half of all deaths occur. This study explores the impact of an end-of-life care (EoLC) educational intervention, Milestones, in acute hospital trusts in Greater London. Methods: This is a mixed methods study. Learners completed a questionnaire pre- (n=452), immediately post- (n=488) and 3 to 8 months post- (n=37) intervention. The questionnaire measured learner confidence in EoLC covering the National Health Service adopted ‘Priorities for the Care of the Dying Person’. Paired t-tests were used to determine statistically significant difference in learner confidence pre- and post-intervention. A convenience sample of learners (n=7) and educators (n=5) were recruited to qualitative semi-structured interviews that sought to understand if, how and why Milestones worked. Data were analysed using a thematic approach. Results: A statistically significant increase in learner confidence across all five priorities of care’ was sustained up to 8 months (p<0.001). Interviewees wanted to discuss wider challenges in EoLC related to the organisations and cultural contexts in which they worked. Concerns included balancing hope when decision-making, learning as a multidisciplinary team and emotional impact. Conclusion: The findings suggest that Milestones is a flexible, beneficial resource for teaching EoLC that facilitates enhanced learner engagement. Understanding generated about wider concerns can inform future educational material development, organisational process and research study design

The domestic and gendered context for retirement

Against a global backdrop of population and workforce ageing, successive UK governments have encouraged people to work longer and delay retirement. Debates focus mainly on factors affecting individuals’ decisions on when and how to retire. We argue that a fuller understanding of retirement can be achieved by recognizing the ways in which individuals’ expectations and behaviours reflect a complicated, dynamic set of interactions between domestic environments and gender roles, often established over a long time period, and more temporally proximate factors. Using a qualitative data set, we explore how the timing, nature and meaning of retirement and retirement planning are played out in specific domestic contexts. We conclude that future research and policies surrounding retirement need to: focus on the household, not the individual; consider retirement as an often messy and disrupted process and not a discrete event; and understand that retirement may mean very different things for women and for men

Prediction of RCF Damage on Underground Metro Lines

London Underground (LUL) is one of the largest metro networks in the world and carried nearly 1.5 billion passengers in 2015. This increasing passenger demand leads to higher axle loads and shorter headways in the railway operations. However, this has a detrimental impact on the damage generated at the wheel-rail interface. In spite of the advances in rolling stock and track engineering, new developments in material manufacturing methods and rail inspection technology, cracking in rails still remains a major concern for infrastructure managers in terms of safety and maintenance costs. In this study, field data from two metro lines on the LUL network was analysed to identify the distribution and severity of the different damage types. Detailed vehicle dynamics route simulations were conducted for the lines and the calculated wheel-rail forces were investigated to assess the applicability current models for the prediction of rail damage on metro lines. These models include the Whole Life Rail Model (WLRM), previously developed for Great Britain (GB) main line tracks, and Shakedown theory. The influence of key factors such as curve radius, different friction conditions, track irregularities and wheel-rail profiles on the wheel-rail contact interface have been evaluated and compared with outputs from simulations on mainline routes. The study found that the contact patch energy (Tγ) and the interaction between wear and RCF in rails were highly influenced by the characteristics of metro tracks. It was also shown that both the Tγ and Shakedown methods can provide successful prediction of damage susceptibility of rails. However, in order to increase the accuracy of damage predictions and to ascertain the severity of different damage types, the duty conditions which are observed by the rail and the changes in contact conditions resulting from the successive vehicle passes should be considered in the modelling

Is preparation for end of life associated with pre-death grief in caregivers of people with dementia?

OBJECTIVES: Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers. DESIGN: Cross-sectional. SETTING: Caregivers of people with dementia living at home or in a care home. PARTICIPANTS: In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%). MEASUREMENTS: Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales ("personal sacrifice burden"; "heartfelt sadness"; "worry and felt isolation"). RESULTS: Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower "heartfelt sadness." CONCLUSION: We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers' social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979)

How do factors of sociodemographic, health literacy and dementia experience influence carers' knowledge of dementia?

BACKGROUND: Dementia is a life limiting disease following a progressive trajectory. As carers often become key decision makers, their knowledge of dementia will have health implications for the person living with dementia as well as carer’s psychological wellbeing. AIM: To explore how sociodemographic factors, health literacy and dementia experience influence family carers knowledge about dementia. METHOD: In this cross-sectional, mixed methods study, we interviewed 150 family carers and assessed their dementia knowledge using the Dementia Knowledge Assessment Scale (DKAS). Linear regression analyses were used to examine whether health literacy, previous experiences of dementia, support group attendance and sociodemographic characteristics predicted knowledge. Sixteen carers also completed qualitative interviews which explored unmet information needs. Transcripts and field notes were thematically analysed. RESULTS: Most participants were partners (47%) or adult children (48%) and cared for someone with severe (32%) or moderate (43%) dementia. Mean DKAS scores were 34.8/50 (SD = 7.0, range = 17–48) reflecting 8/25 incorrect answers. Backwards elimination regression found greater dementia knowledge was associated with greater health literacy for appraising information (coef 3.48, 95% CI (1.38, 5.58); p = 0.001) and more years of education (coef 0.39, 95% CI (0.12, 0.65); p = 0.004). Although not significant, knowledge was slightly lower in those who attended a support group, and a trend was found between ability to understand health information and knowledge. Only 39% accurately identified dementia as life shortening, indicating notable gaps in knowledge. Four qualitative themes were identified; arm yourself with information, ability to steer through information, other experience of dementia can be helpful and the importance of relationships with health care professionals. CONCLUSIONS: In an information age, vast amounts of information are available, but this can bring difficulties. Carers with more years of education and higher health literacy knew more about dementia. Professionals should consider how carers with lower health literacy can be supported through provision of timely, relevant information

Exploring how family carers of a person with dementia manage pre-death grief: A mixed methods study

Objectives Many family carers of a person with dementia experience pre-death grief. We aimed to identify strategies that help carers manage pre-death grief. We hypothesised that emotion and problem focussed styles would be associated with lower, and dysfunctional coping with higher grief intensity. Methods Mixed methods observational study using structured and semi-structured interviews with 150 family carers of people with dementia living at home or in a care home. Most participants were female (77%), caring for a parent (48%) or partner/spouse (47%) with mild (25%), moderate (43%) or severe (32%) dementia. They completed the Marwit-Meuser Caregiver Grief Inventory Short Form and the Brief Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. We asked carers to identify strategies used for managing grief. We recorded field notes for 150 interviews and audio-recorded additional interviews with a sub-sample of 16 participants. Results Correlations indicated that emotion-oriented coping was associated with lower grief (R = −0.341), and dysfunctional coping with higher grief (R = 0.435), with a small association with problem-focused strategies (R = −0.109), partly supporting our hypothesis. Our qualitative themes broadly match the three Brief-COPE styles. Unhelpful strategies of denial and avoidance align with dysfunctional coping strategies. Psychological strategies (including acceptance and humour) and seeking support were consistent with emotion-focused strategies, but we did not identify a theme relating to problem-focused strategies. Conclusion Most carers identified multiple strategies for processing grief. Carers could readily identify supports and services that they found helpful for managing pre-death grief, yet current services appear under-resourced to meet growing demand. (ClinicalTrials.gov ID: NCT03332979)

CoMPASs: IOn programme (Care Of Memory Problems in Advanced Stages of dementia: Improving Our Knowledge): protocol for a mixed methods study

Approximately 700 000 people in the UK have dementia, rising to 1.2 million by 2050; one-third of people aged over 65 will die with dementia. Good end-of-life care is often neglected, and detailed UK-based research on symptom burden and needs is lacking. Our project examines these issues from multiple perspectives using a rigorous and innovative design, collecting data which will inform the development of pragmatic interventions to improve care