Medical students’ attitudes towards increasing early clinical exposure to primary care

Context: The sustainability of the future UK General Practice (GP) workforce is reliant on half of medical graduates choosing a career in primary care (1), but while good quality undergraduate GP placements (particularly those which are early in the curriculum and integrated into ongoing learning) have been linked to subsequent GP career choices (2), exposure has plateaued at 13% of UK undergraduate teaching time(3).Of students in UK medical schools, undergraduates at the University of Nottingham(UON) spend towards the least amount of time in primary care.Research questions: We set out to investigate Nottingham medical students’ attitudes towards a proposed increase in the primary care component of their “early clinical exposure” module from ten half days to fourteen full days during the first two years of the undergraduate course. We sought to assess the potential impact on perceived student learning and experience.Description: We recruited nine students from across the five undergraduate year groups to take part in audio-recorded semi-structured interviews which lasted 30-60 minutes. All participants provided informed consent. Having set out to include 20-30 participants in our sample, recruitment was impaired by students’ busy teaching schedules and overlapping exam seasons within the University. Interviews followed a theme guide and explored topics of exposure time, learning opportunities, and career intentions. We analysed verbatim transcripts using a constant comparative approach, assigning and grouping codes, and merging and revising categories until new data did not alter the resultant themes. We considered data to be saturated once ideas were repetitively expressed and did not prompt revision of themes. A larger sample would have strengthened confidence in our theoretical integrity. Outcomes: Students reported that opportunities encountered in primary care settings allowed them to contextualise their scientific learning and develop core practical and communication skills (Table 1). Their GP placements were multi-disciplinary and holistic, enabling them to build professional relationships with mentors and ultimately feel better-prepared for both their undergraduate clinical phase and future careers. Immersing students into the clinical environment at this early stage of their training provided drive and focus for their academic studies, but some students shared their awareness of a stressful GP workplace with time and administrative pressures, reflecting how this experience discouraged them from choosing GP careers. Participants unanimously supported an expansion to the timetabled early primary care clinical exposure

Medical students’ attitudes towards increasing early clinical exposure to primary care

Context: The sustainability of the future UK General Practice (GP) workforce is reliant on half of medical graduates choosing a career in primary care (1), but while good quality undergraduate GP placements (particularly those which are early in the curriculum and integrated into ongoing learning) have been linked to subsequent GP career choices (2), exposure has plateaued at 13% of UK undergraduate teaching time(3).Of students in UK medical schools, undergraduates at the University of Nottingham(UON) spend towards the least amount of time in primary care. Research questions: We set out to investigate Nottingham medical students’ attitudes towards a proposed increase in the primary care component of their “early clinical exposure” module from ten half days to fourteen full days during the first two years of the undergraduate course. We sought to assess the potential impact on perceived student learning and experience. Description: We recruited nine students from across the five undergraduate year groups to take part in audio-recorded semi-structured interviews which lasted 30-60 minutes. All participants provided informed consent. Having set out to include 20-30 participants in our sample, recruitment was impaired by students’ busy teaching schedules and overlapping exam seasons within the University. Interviews followed a theme guide and explored topics of exposure time, learning opportunities, and career intentions. We analysed verbatim transcripts using a constant comparative approach, assigning and grouping codes, and merging and revising categories until new data did not alter the resultant themes. We considered data to be saturated once ideas were repetitively expressed and did not prompt revision of themes. A larger sample would have strengthened confidence in our theoretical integrity. Outcomes: Students reported that opportunities encountered in primary care settings allowed them to contextualise their scientific learning and develop core practical and communication skills (Table 1). Their GP placements were multi-disciplinary and holistic, enabling them to build professional relationships with mentors and ultimately feel better-prepared for both their undergraduate clinical phase and future careers. Immersing students into the clinical environment at this early stage of their training provided drive and focus for their academic studies, but some students shared their awareness of a stressful GP workplace with time and administrative pressures, reflecting how this experience discouraged them from choosing GP careers. Participants unanimously supported an expansion to the timetabled early primary care clinical exposure

Treatment of chronically depressed patients: A multisite randomized controlled trial testing the effectiveness of \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) for chronic depressions versus usual secondary care

Background \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. Methods/Design The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS). Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score) at post-treatment and follow up. The primary analysis will be by \u27intention to treat\u27 using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. Discussion The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. Trial Registration The Dutch Cochrane Center, NTR1090

New horizons in the role of digital data in the healthcare of older people

There are national and global moves to improve effective digital data design and application in healthcare. This New Horizons commentary describes the role of digital data in healthcare of the ageing population. We outline how health and social care professionals can engage in the proactive design of digital systems that appropriately serve people as they age, carers and the workforce that supports them.// Key Points: //Healthcare improvements have resulted in increased population longevity and hence multimorbidity.// //Shared care records to improve communication and information continuity across care settings hold potential for older people.// Data structure and coding are key considerations.// A workforce with expertise in caring for older people with relevant knowledge and skills in digital healthcare is important./

Ecomorph or Endangered Coral? DNA and Microstructure Reveal Hawaiian Species Complexes: Montipora dilatata/flabellata/turgescens & M. patula/verrilli

M. dilatata, M. flabellata, and M. patula and 80 other scleractinian corals were petitioned to be listed under the US Endangered Species Act (ESA), which would have major conservation implications. One of the difficulties with this evaluation is that reproductive boundaries between morphologically defined coral species are often permeable, and morphology can be wildly variable. We examined genetic and morphological variation in Hawaiian Montipora with a suite of molecular markers (mitochondrial: COI, CR, Cyt-B, 16S, ATP6; nuclear: ATPsβ, ITS) and microscopic skeletal measurements. Mitochondrial markers and the ITS region revealed four distinct clades: I) M. patula/M. verrilli, II) M. cf. incrassata, III) M. capitata, IV) M. dilatata/M. flabellata/M. cf. turgescens. These clades are likely to occur outside of Hawai'i according to mitochondrial control region haplotypes from previous studies. The ATPsβ intron data showed a pattern often interpreted as resulting from hybridization and introgression; however, incomplete lineage sorting may be more likely since the multicopy nuclear ITS region was consistent with the mitochondrial data. Furthermore, principal components analysis (PCA) of skeletal microstructure was concordant with the mitochondrial clades, while nominal taxa overlapped. The size and shape of verrucae or papillae contributed most to identifying groups, while colony-level morphology was highly variable. It is not yet clear if these species complexes represent population-level variation or incipient speciation (CA<1MYA), two alternatives that have very different conservation implications. This study highlights the difficulty in understanding the scale of genetic and morphological variation that corresponds to species as opposed to population-level variation, information that is essential for conservation and for understanding coral biodiversity

Estimating connectivity in marine populations : an empirical evaluation of assignment tests and parentage analysis under different gene flow scenarios

Author Posting. © Blackwell Publishing, 2009. This is the author's version of the work. It is posted here by permission of Blackwell Publishing for personal use, not for redistribution. The definitive version was published in Molecular Ecology 18 (2009): 1765-1776, doi:10.1111/j.1365-294X.2009.04109.x.The application of spatially explicit models of population dynamics to fisheries management and the design marine reserves network systems has been limited due to a lack of empirical estimates of larval dispersal. Here we compared assignment tests and parentage analysis for examining larval retention and connectivity under two different gene flow scenarios using panda clownfish (Amphiprion polymnus) in Papua New Guinea. A metapopulation of panda clownfish in Bootless Bay with little or no genetic differentiation among 5 spatially discrete locations separated by 2-6km provided the high gene flow scenario. The low gene flow scenario compared the Bootless Bay metapopulation with a genetically distinct population (Fst = 0.1) located at Schumann Island, New Britain, 1,500km to the north-east. We used assignment tests and parentage analysis based on microsatellite DNA data to identify natal origins of 177 juveniles in Bootless Bay and 73 juveniles at Schumann Island. At low rates of gene flow, assignment tests correctly classified juveniles to their source population. On the other hand, parentage analysis led to an overestimate of self-recruitment within the two populations due to the significant deviation from panmixia when both populations were pooled. At high gene flow (within Bootless Bay), assignment tests underestimated self-recruitment and connectivity among subpopulations, and grossly overestimated self-recruitment within the overall metapopulation. However, the assignment tests did identify immigrants from distant (genetically distinct) populations. Parentage analysis clearly provided the most accurate estimates of connectivity in situations of high gene flow.We thank ARC Centre of Excellence, the National Science Foundation (OCE 0424688), the Coral Reef Initiatives for the Pacific (CRISP), the TOTAL Foundation, Populations Fractionées et Insulaires (PPF EPHE) and GEF/World bank’s CRTR program (Connectivity working group) for financial support

New horizons in the role of digital data in the healthcare of older people

There are national and global moves to improve effective digital data design and application in healthcare. This New Horizons commentary describes the role of digital data in healthcare of the ageing population. We outline how health and social care professionals can engage in the proactive design of digital systems that appropriately serve people as they age, carers and the workforce that supports them

Treatment of chronically depressed patients: A multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depressions versus usual secondary care

AbstractBackground'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands.Methods/DesignThe purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS). Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score) at post-treatment and follow up. The primary analysis will be by 'intention to treat' using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective.DiscussionThe study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US

Contrasting Patterns of Coral Bleaching Susceptibility in 2010 Suggest an Adaptive Response to Thermal Stress

Background: \ud Coral bleaching events vary in severity, however, to date, the hierarchy of susceptibility to bleaching among coral taxa has been consistent over a broad geographic range and among bleaching episodes. Here we examine the extent of spatial and temporal variation in thermal tolerance among scleractinian coral taxa and between locations during the 2010 thermally induced, large-scale bleaching event in South East Asia.\ud \ud Methodology/Principal Findings: \ud Surveys to estimate the bleaching and mortality indices of coral genera were carried out at three locations with contrasting thermal and bleaching histories. Despite the magnitude of thermal stress being similar among locations in 2010, there was a remarkable contrast in the patterns of bleaching susceptibility. Comparisons of bleaching susceptibility within coral taxa and among locations revealed no significant differences between locations with similar thermal histories, but significant differences between locations with contrasting thermal histories (Friedman = 34.97; p,0.001). Bleaching was much less severe at locations that bleached during 1998, that had greater historical temperature variability and lower rates of warming. Remarkably, Acropora and Pocillopora, taxa that are typically highly susceptible, although among the most susceptible in Pulau Weh (Sumatra, Indonesia) where respectively, 94% and 87% of colonies died, were among the least susceptible in Singapore, where only 5% and 12% of colonies died.\ud \ud Conclusions/Significance: \ud The pattern of susceptibility among coral genera documented here is unprecedented. A parsimonious explanation for these results is that coral populations that bleached during the last major warming event in 1998 have adapted and/or acclimatised to thermal stress. These data also lend support to the hypothesis that corals in regions subject to more variable temperature regimes are more resistant to thermal stress than those in less variable environments