The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students

<p>Abstract</p> <p>Background</p> <p>The UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on.</p> <p>The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were:</p> <p>1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor;</p> <p>2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctor</p> <p>Method</p> <p>In the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemar's test. Analysis of the qualitative data was carried out using the constant comparative method.</p> <p>Results</p> <p>Only 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part.</p> <p>Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind.</p> <p>Conclusions</p> <p>Our study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.</p

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated

Examining the potential public health benefit of offering STI testing to men in amateur football clubs: evidence from cross-sectional surveys

Background: In Britain, young people continue to bear the burden of sexually transmitted infections (STIs) so efforts are required, especially among men, to encourage STI testing. The SPORTSMART study trialled an intervention that sought to achieve this by offering chlamydia and gonorrhoea test-kits to men attending amateur football clubs between October and December 2012. With football the highest participation team sport among men in England, this paper examines the potential public health benefit of offering STI testing to men in this setting by assessing their sociodemographic characteristics, sexual behaviours, and healthcare behaviour and comparing them to men in the general population. Methods: Data were collected from 192 (male) members of 6 football clubs in London, United Kingdom, aged 18–44 years via a 20-item pen-and-paper self-completion questionnaire administered 2 weeks after the intervention. These were compared to data collected from 409 men of a similar age who were resident in London when interviewed during 2010–2012 for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a national probability survey that used computer-assisted-personal-interviewing with computer-assisted-self-interview. Age standardisation and multivariable regression were used to account for sociodemographic differences between the surveys. Results: Relative to men in the general population, SPORTSMART men were younger (32.8 % vs. 21.7 % aged under 25 y), and more likely to report (all past year) at least 2 sexual partners (adjusted odds ratio, AOR: 3.25, 95 % CI: 2.15–4.92), concurrent partners (AOR: 2.05, 95 % CI: 1.39–3.02), and non-use of condoms (AOR: 2.17, 95 % CI: 1.39–3.41). No difference was observed in STI/HIV risk perception (AOR for reporting “not at all at risk” of STIs: 1.25, 95 % CI: 0.76–2.04; of HIV: AOR: 1.54, 95 % CI: 0.93–2.55), nor in reporting STI testing in the past year (AOR: 0.83, 95 % CI: 0.44–1.54), which was reported by only one in six men. Conclusions: Relative to young men in the general population, football club members who completed the SPORTSMART survey reported greater sexual risk behaviour but similar STI/HIV risk perception and STI testing history. Offering STI testing in amateur football clubs may therefore widen access to STI testing and health promotion messages for men at higher STI risk, which, given the minority currently testing and the popularity of football in England, should yield both individual and public health benefit

Circadian preference and physical and cognitive performance in adolescence:A scoping review

Adolescence is a crucial period of development which coincides with changes in circadian rhythmicity. This may augment the impact of circadian preference on performance in this group. We aimed to scope the literature available on chronotypes and their effect on physical and mental aspects of performance in adolescents. Methods: Studies were identified by systematically searching bibliographical databases and grey literature. Results: The Morningness-Eveningness Questionnaire was the most frequently reported tool for circadian preference assessment. Academic achievement was the most prevailing outcome, with evidence suggesting that morning type adolescents tend to outperform evening types, yet the results vary depending on multiple factors. Performance in tests of intelligence and executive functions was generally better at optimal times of the day (synchrony effect). Physical performance was examined in 8 studies, with very heterogeneous outcomes. Conclusions: Although the associations between circadian preference and performance in adolescents are evident in some areas, there are many factors that may be involved in the relationship and require further investigation. This review highlights the assessment of physical performance in relation to chronotypes, the multidimensional assessment of circadian preference, and the need for longitudinal studies as priorities for further research

The SPORTSMART study: a pilot randomised controlled trial of sexually transmitted infection screening interventions targeting men in football club settings

Background: Uptake of chlamydia screening by men in England has been substantially lower than by women. Non-traditional settings such as sports clubs offer opportunities to widen access. Involving people who are not medically trained to promote screening could optimise acceptability. Methods: We developed two interventions to explore the acceptability and feasibility of urine-based sexually transmitted infection (STI) screening interventions targeting men in football clubs. We tested these interventions in a pilot cluster randomised control trial. Six clubs were randomly allocated, two to each of three trial arms: team captain-led and poster STI screening promotion; sexual health adviser-led and poster STI screening promotion; and poster-only STI screening promotion (control/comparator). Primary outcome was test uptake. Results: Across the three arms, 153 men participated in the trial and 90 accepted the offer of screening (59%, 95% CI 35% to 79%). Acceptance rates were broadly comparable across the arms: captain-led: 28/56 (50%); health professional-led: 31/46 (67%); and control: 31/51 (61%). However, rates varied appreciably by club, precluding formal comparison of arms. No infections were identified. Process evaluation confirmed that interventions were delivered in a standardised way but the control arm was unintentionally ‘enhanced’ by some team captains actively publicising screening events. Conclusions: Compared with other UK-based community screening models, uptake was high but gaining access to clubs was not always easy. Use of sexual health advisers and team captains to promote screening did not appear to confer additional benefit over a poster-promoted approach. Although the interventions show potential, the broader implications of this strategy for UK male STI screening policy require further investigation

Epidemiology of American Football Injuries at Universities in the United Kingdom

Background:College-level American football injury data are routinely collected; however, data relating to American football injuries at universities in the United Kingdom have never been reported.Purpose:To describe the epidemiology of UK university American football injuries.Study Design:Descriptive epidemiology study.Methods:An online survey tool was used to collect the injury data of 410 players from 56 UK university teams who participated in the 2014-2015 British Universities and College Sports American football season. Survey data were collected from January to February 2016 and were analyzed to determine the incidence and patterns of injury.Results:Overall, 710 injuries and 204 concussions were self-reported among the 410 participants, of which 334 (81.5%) were injured and 131 (32.0%) experienced concussion symptoms. The rate of injury per 100 athlete-seasons was greater in defensive players (195.3) than offensive players (155.1). The most common injuries were knee and ankle ligament injuries. Most injuries were classified as severe (time loss of >4 weeks).Conclusion:UK university American football injuries differ markedly from those reported for US colleges. UK university players appear to have less playing experience, greater concussion risks, more severe injuries, and a greater proportion of injuries in defensive players versus offensive players

Nurses\u27 Alumnae Association Bulletin, June 1969

Alumnae President\u27s Message Officers and Chairmen Financial Report Progressive Changes at Jefferson School of Nursing Report Student Activities School of Practical Nursing Report Jefferson Expansion Report Clerk-Typist Report Committee Reports Resume of Alumnae Meetings Class News 1969 CLINIC Correspondence Notice

A Cross-National Investigation into the Marketing Department\u27s Influence Within the Firm: Toward Initial Empirical Generalizations

This study of the influence of the marketing department (MD), as well as its relationship with firm performance, includes seven industrialized countries and aims to generalize the conceptual model presented by Verhoef and Leeflang (2009). This investigation considers the antecedents of perceived MD influence, top management respect for the MD, and MD decision influence, as well as the relationships of these three influence variables with market orientation (MO) and business performance (BP). Meta-analytic procedures reveal initial empirical generalizations: Accountability, MD innovativeness, and the customer connection capabilities of the MD relate consistently to all three studied MD influence measures. The generalization also shows that MD influence contributes to BP indirectly through its positive relationship with MO and directly through its positive direct relationship with BP

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

Background: The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. Objectives: To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. Search methods: In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. Selection criteria: We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. Data collection and analysis: Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. Main results: We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events. Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school. There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions. There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). Authors' conclusions: Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes

Advanced Processing of Food Waste Based Digestate for Mitigating Nitrogen Losses in a Winter Wheat Crop

The anaerobic digestion of food waste converts waste products into ‘green’ energy. Additionally, the secondary product from this process is a nutrient-rich digestate, which could provide a viable alternative to synthetically-produced fertilisers. However, like fertilisers, digestate applied to agricultural land can be susceptible to both ammonia (NH3) and nitrous oxide (N2O) losses, having negative environmental impacts, and reducing the amount of N available for crop uptake. Our main aim was to assess potential methods for mitigating N losses from digestate applied to a winter wheat crop and subsequent impact on yield. Plot trials were conducted at two UK sites, England (North Wyke-NW) and Wales (Henfaes-HF), to assess NH3 and N2O losses, yield and N offtake following a single band-spread digestate application. Treatments examined were digestate (D), acidified-digestate (AD), digestate with the nitrification inhibitor DMPP (D+NI), AD with DMPP (AD+NI), and a zero-N control (C). Determination of N losses was conducted using wind tunnels for NH3, and static manual and automatic chambers for N2O. The N offtake in both grain and straw was also measured. Ammonium nitrate (NH4NO3) fertiliser N response plots (from 75 to 300 kg N ha−1) were included to compare yields with the organic N source. Cumulative NH3-N losses were 27.6 % from D and D+NI plots and 1.5 % for AD and AD+NI of the total N applied, a significant reduction of 95 % with acidification. Cumulative N2O losses varied between 0.13 and 0.35 % of the total N applied and were reduced by 50 % with the use of DMPP. Grain yields for the digestate treatments were 7.52 – 9.21 and 7.23 – 9.23 t DM ha−1 at HF and NW, respectively. Yields were greater from the plots receiving acidified‐digestate relative to the non-acidified treatments but the differences were not significant. The yields (as a function of the N applied with each treatment) obtained for the digestate treatments ranged between 84.2 % (D+NI) and 103.6 % (D) of the yields produced by the same N rate from an inorganic source at HF. Advanced processing of digestate reduced N losses providing an environmentally sound option for N-management