Optimising planned medical education strategies to develop learners' person-centredness: a realist review

Context: Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. Methods: A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms ‘medical education’ and ‘person-centred’ and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. Results: Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context–intervention–mechanism–outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. Conclusion: Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness

Role of Nutrition in Alcoholic Liver Disease: Summary of the Symposium at the ESBRA 2017 Congress.

The symposium, "Role of Nutrition in Alcoholic Liver Disease", was held at the European Society for Biomedical Research on Alcoholism Congress on 9 October 2017 in Crete, Greece. The goal of the symposium was to highlight recent advances and developments in the field of alcohol and nutrition. The symposium was focused on experimental and clinical aspects in relation to the role of different types of dietary nutrients and malnutrition in the pathogenesis of alcoholic liver disease (ALD). The following is a summary of key research presented at this session. The speakers discussed the role of dietary fats and carbohydrates in the development and progression of alcohol-induced multi-organ pathology in animal models of ALD, analyzed novel nutrition-related therapeutics (specifically, betaine and zinc) in the treatment of ALD, and addressed clinical relevance of malnutrition and nutrition support in ALD. This summary of the symposium will benefit junior and senior faculty currently investigating alcohol-induced organ pathology as well as undergraduate, graduate, and post-graduate students and fellows

Embedded researchers as part of a whole systems approach to physical activity: Reflections and recommendations

Whole systems approaches are increasingly being advocated as a way of responding to complex public health priorities such as obesity and physical inactivity. Due to the complex and adaptive nature of such systems, researchers are increasingly being embedded within host organisations (i.e., those which facilitate the whole systems approach) to work with key stakeholders to illuminate and understand mechanisms of change and develop a culture of continuous improvement. While previous literature has reported on the benefits and challenges of embedded researchers in health care, little is known about the experiences and learnings of those situated within these complex whole systems approaches. In this paper, we present our reflections of being embedded researchers within four distinct whole systems approaches and outline recommendations and considerations for commissioners working with or seeking support from an embedded researcher

Last months of life of people with intellectual disabilities: A UK population-based study of death and dying in intellectual disability community services.

BACKGROUND: Population-based data are presented on the nature of dying in intellectual disability services. METHODS: A retrospective survey was conducted over 18 months with a sample of UK-based intellectual disability service providers that supported over 12,000. Core data were obtained for 222 deaths within this population. For 158 (71%) deaths, respondents returned a supplemented and modified version of VOICES-SF. RESULTS: The observed death was 12.2 deaths per 1,000 people supported per year, but just over a third deaths had been deaths anticipated by care staff. Mortality patterns, place of usual care and availability of external support exerted considerable influence over outcomes at the end of life. CONCLUSION: Death is not a common event in intellectual disability services. A major disadvantage experienced by people with intellectual disabilities was that their deaths were relatively unanticipated. People with intellectual disabilities living in supported living settings, even when their dying was anticipated, experienced poorer outcomes

Monolithically Integratable Colliding Pulse Modelocked Laser Source for O-CDMA Photonic Chip Development

We demonstrate modelocking of a colliding-pulse mode-locked laser formed by 3-μm-deep etched-mirrors on an InP platform for integration with passive waveguide components. Timing jitter of 243 fs and pulse width of 10 ps were measured

The NICE COVID‐19 rapid guideline on haematopoietic stem cell transplantation: development, implementation and impact

A new coronavirus SARS‐CoV‐2 emerged at the start of 2020 with rapid worldwide spread. It is the causative agent of Coronavirus Disease 2019 (COVID‐19). The resulting pandemic has been challenging for centres undertaking autologous and allogeneic haematopoietic stem cell transplants (HSCT). One of the main risks in HSCT is infection susceptibility, including viral infections, which are often more severe and life‐threatening.1 In response to the COVID‐19 pandemic, the National Institute for Health and Care Excellence (NICE) published the first version of the COVID‐19 rapid guideline for HSCT (NG164) on 1 April 20202; this was updated on 29 July 2020 in response to the changing context of the pandemic. The British Society of Blood and Marrow Transplantation and Cellular Therapy (BSBMTCT) and the European Society for Blood and Marrow Transplantation (EBMT) also developed detailed guidance to support transplant centres.3-5 This paper describes the development and update processes for NICE NG164, detailing the rationale behind the recommendations, implementation and the impact of COVID‐19 on HSCT activity in the UK compared with 2019, based on registrations in the BSBMTCT registry. The full NICE guidance can be obtained from: https://www.nice.org.uk/guidance/ng164

Predictors of care-giver stress in families of preschool-aged children with developmental disabilities

Background This study examined the predictors, mediators and moderators of parent stress in families of preschool-aged children with developmental disability. Method One hundred and five mothers of preschool-aged children with developmental disability completed assessment measures addressing the key variables. Results Analyses demonstrated that the difficulty parents experienced in completing specific caregiving tasks, behaviour problems during these caregiving tasks, and level of child disability, respectively, were significant predictors of level of parent stress. In addition, parents’ cognitive appraisal of care-giving responsibilities had a mediating effect on the relationship between the child’s level of disability and parent stress. Mothers’ level of social support had a moderating effect on the relationship between key independent variables and level of parent stress. Conclusions Difficulty of care-giving tasks, difficult child behaviour during care-giving tasks, and level of child disability are the primary factors which contribute to parent stress. Implications of these findings for future research and clinical practice are outlined

National Evaluation of the Preventing and Tackling Mental Ill Health through Green Social Prescribing Project: Interim Report - September 2021 to September 2022

This is the final version. This report, and the accompanying briefing, summary and appendices documents, are published by Defra (Defra Project Code BE0191) and are available from the Department’s Science and Research Projects Database at https://randd.defra.gov.ukDepartment for Environment, Food and Rural Affair