Quality Management in Medical Foundation Training: Lessons for Pharmacy

BACKGROUND: This work forms part of a review of pharmacy education and training being undertaken by the pharmacy regulator in the U.K. AIM: To gather and review information and experiences from medical Foundation training and to consider relevance and applicability to quality management in the Pharmacy Pre-registration Scheme. METHODS: Document analysis and semi-structured interviews with key stakeholders at regional and national levels. RESULTS: Nine interviews were conducted. The medical model is based upon three levels: quality assurance undertaken by the regulators, quality management undertaken at a regional level by Deaneries, and quality control undertaken by the local education provider. The medical regulators define the standards that foundation training programmes are expected to meet and have developed a process based on inspection visits to the deaneries to verify that standards are being met. Deaneries have some flexibility in designing their quality management systems. CONCLUSION: The review of medical Foundation training identified some tools of quality management. Triangulation of data from several methods in the medical Foundation programme includes site visits, self-assessment and trainee and trainer feedback. These principles are worthy of debate and consideration for future quality management of the Pharmacy Pre registration Scheme

Quality Management in Pharmacy Pre-registration Training: Recommendations for the Future

BACKGROUND: This work forms part of a review of pharmacy education and training undertaken by the pharmacy regulator in the U.K.. It is the last in a series of three papers describing a review of quality management systems for pharmacy pre-registration training in the U.K.. AIMS: To synthesise the data collected in the first two stages of the study and with key pharmacy stakeholders identify specific quality management strategies for implementation in the pharmacy pre-registration year. METHODS: Interim analysis of data collected from questionnaires and interviews to produce a preliminary set of recommendations which were presented for discussion at a stakeholder meeting. RESULTS: The stakeholders agreed to the recommendations with a number of provisos. There was support amongst stakeholders for a national quality management system in pharmacy that applies to all sectors. CONCLUSION: This paper makes some general recommendations for the Pharmacy Pre-registration Scheme. What is now needed is clarification of the infrastructure within which the quality management systems are to be implemented. This will then allow a quality management system to be built defining the roles and responsibilities of each level of organisation within the infrastructure

Quality Management in Pharmacy Pre-registration Training: Current Practice

BACKGROUND: The Royal Pharmaceutical Society conducted a review of pharmacy education policy in its ‘Making pharmacy education fit for the future’ project. The future quality management of pharmacy pre-registration training was included within the scope of the review. AIM: To identify and review practice examples of quality management in current pharmacy pre-registration training programmes, in England, Scotland and Wales. METHODS: Mixed methods including documentary analysis, a survey of pharmacy pre-registration stakeholders, and individual interviews. RESULTS: The questionnaire was sent to 27 organisations in total; responses were received from all 27. Twelve respondents (9 secondary care, 2 community pharmacy, 1 industry) reported having developed standards in addition to the RPSGB standards that their training programmes were required to meet. Quality management tools used by pharmacy pre-registration training providers included site visits and tutor and trainee questionnaires. CONCLUSION: This paper describes some the tools of quality management that have been adopted and developed by providers of pharmacy pre-registration training. It has identified pockets of good practice, but there is a clear need for a national quality management system in pharmacy pre-registration training

Circulating testosterone and prostate-specific antigen in nipple aspirate fluid and tissue are associated with breast cancer.

Preliminary evidence has associated testosterone and prostate-specific antigen (PSA) with breast cancer. Our objective was to determine whether a) testosterone levels in nipple aspirate fluid (NAF), serum, or breast tissue are associated with breast cancer; b) testosterone levels in serum are associated with levels in NAF; c) PSA in NAF, serum, or breast tissue is associated with breast cancer; and d) serum PSA is associated with NAF PSA levels. We obtained 342 NAF specimens from 171 women by means of a modified breast pump. Additionally, we collected 201 blood samples from 99 women and 51 tissue samples from 41 subjects who underwent surgical resection for suspected disease. Women currently using birth control pills or hormone replacement therapy were excluded from the study. Controlling for age and menopausal status, serum testosterone was significantly increased in women with breast cancer (p = 0.002). NAF and serum testosterone levels were not associated. Neither NAF nor tissue testosterone was associated with breast cancer. Controlling for menopausal status and age, NAF PSA was significantly decreased in women with breast cancer (p \u3c 0.001). We did not find serum PSA to be associated with breast cancer, although we found an indication that, in postmenopausal women, its levels were lower in women with cancer. Serum PSA was associated with NAF PSA in postmenopausal women (p \u3c 0.001). PSA levels in cancerous tissue were significantly lower than in benign breast specimens from subjects without cancer (p = 0.011), whereas levels of PSA in histologically benign specimens from subjects with cancer were intermediate. Our results suggest that serum testosterone is increased and NAF PSA is decreased in women with breast cancer, with PSA expression being higher in normal than in cancerous breast tissues. NAF and serum PSA levels in postmenopausal women are correlated, suggesting that as laboratory assessment of PSA becomes more sensitive, serum PSA may become useful in identifying women with breast cancer

Ways to teach modelling—a 50 year study

This article describes a sequence of design research projects, some exploratory others more formal, on the teaching of modelling and the analysis of modelling skills. The initial motivation was the author’s observation that the teaching of applied mathematics in UK high schools and universities involved no active modelling by students, but was entirely focused on their learning standards models of a restricted range of phenomena, largely from Newtonian mechanics. This did not develop the numeracy/mathematical literacy that was so clearly important for future citizens. Early explorations started with modelling workshops with high school teachers and mathematics undergraduates, observed and analysed—in some case using video. The theoretical basis of this work has been essentially heuristic, though the Shell Centre studies included, for example, a detailed analysis of formulation processes that has not, as so often, been directly replicated. Recent work has focused on developing a formative assessment approach to teaching modelling that has proved both successful and popular. Finally, the system-level challenges in trying to establish modelling as an integral part of mathematics curricula are briefly discussed

On Weak Keys and Forgery Attacks Against Polynomial-Based MAC Schemes

Abstract. Universal hash functions are commonly used primitives for fast and secure message authentication in the form of Message Authentication Codes (MACs) or Authenticated Encryption with Associated Data (AEAD) schemes. These schemes are widely used and standardised, the most well known being McGrew and Viega’s Galois/Counter Mode (GCM). In this paper we identify some properties of hash functions based on polynomial evaluation that arise from the underlying algebraic structure. As a result we are able to describe a general forgery attack, of which Saarinen’s cycling attack from FSE 2012 is a special case. Our attack removes the requirement for long messages and applies regardless of the field in which the hash function is evaluated. Furthermore we provide a common description of all published attacks against GCM, by showing that the existing attacks are the result of these algebraic properties of the polynomial-based hash function. We also greatly expand the number of known weak GCM keys and show that almost every subset of the keyspace is a weak key class. Finally, we demonstrate that these algebraic properties and corresponding attacks are highly relevant to GCM/2 +, a variant of GCM designed to increase the efficiency in software

Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy

© Springer-Verlag GmbH Germany, part of Springer Nature 2018Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.Peer reviewedFinal Accepted Versio

Expression of a prostate-associated protein, human glandular kallikrein (hK2), in breast tumours and in normal breast secretions

The recent demonstration of human glandular kallikrein (hK2) expression in a breast carcinoma cell line has suggested that this putatively prostate-restricted, steroid hormone-regulated protease may also be expressed in breast epithelium in vivo and secreted into the mammary duct system. Given that the only substrate yet identified for hK2 activity is the precursor of prostate-specific antigen (PSA), the expression of which in breast carcinomas may be associated with favourable prognosis, our purpose was to examine the expression pattern of both hK2 and PSA in breast tumour tissues. Cytosolic extracts of 336 primary breast carcinomas prepared for routine oestrogen receptor (ER) and progesterone receptor (PR) analysis, as well as 31 nipple aspirates from six women with non-diseased mammary glands, were assayed for hK2 and PSA using immunofluorometric assays developed by the authors. In the tumour extracts, measurable hK2 and PSA concentrations were detected in 53% and 73% of cases respectively, and were positively correlated to each other (r = 0.59, P = 0.0001). Higher concentrations of PSA and hK2 were found in tumours expressing steroid hormone receptors (P = 0.0001 for PSA and P = 0.0001 for hK2, by Wilcoxon tests for both ER and PR), and both PSA (r = 0.25, P = 0.0001) and hK2 (r = 0.22, P = 0.0001) correlated directly with PR levels. A negative correlation between patient age and PSA (r = –0.12, P = 0.03) was also found. Both proteins were present in nipple aspirate fluid at relatively high concentrations which were positively correlated (r = 0.53, P = 0.002). The molecular weights of the immunoreactive species quantified by the hK2 and PSA assays were established by high-performance liquid chromatography (HPLC) and were consistent with the known molecular weights of hK2 and PSA. Together these data provide the first evidence, to our knowledge, that both malignant breast tissue and normal breast secretion contain measurable quantities of hK2, and that the degree of hK2 expression or secretion is directly proportional to the expression of PSA and steroid hormone receptors. hK2 expression may therefore be a marker of steroid hormone action in breast tissue. © 2000 Cancer Research Campaig

Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle

Summary The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign aims to support implementation of Fracture Liaison Services (FLS) throughout the world. Introduction FLS have been shown to close the ubiquitous secondary fracture prevention care gap, ensuring that fragility fracture sufferers receive appropriate assessment and intervention to reduce future fracture risk. Methods Capture the Fracture has developed internationally endorsed standards for best practice, will facilitate change at the national level to drive adoption of FLS and increase awareness of the challenges and opportunities presented by secondary fracture prevention to key stakeholders. The Best Practice Framework (BPF) sets an international benchmark for FLS, which defines essential and aspirational elements of service delivery. Results The BPF has been reviewed by leading experts from many countries and subject to beta-testing to ensure that it is internationally relevant and fit-for-purpose. The BPF will also serve as a measurement tool for IOF to award ‘Capture the Fracture Best Practice Recognition’ to celebrate successful FLS worldwide and drive service development in areas of unmet need. The Capture the Fracture website will provide a suite of resources related to FLS and secondary fracture prevention, which will be updated as new materials become available. A mentoring programme will enable those in the early stages of development of FLS to learn from colleagues elsewhere that have achieved Best Practice Recognition. A grant programme is in development to aid clinical systems which require financial assistance to establish FLS in their localities. Conclusion Nearly half a billion people will reach retirement age during the next 20 years. IOF has developed Capture the Fracture because this is the single most important thing that can be done to directly improve patient care, of both women and men, and reduce the spiralling fracture-related care costs worldwide.</p