Would changing the selection process for GP trainees stem the workforce crisis? A cohort study using multiple-imputation and simulation

BACKGROUND: There is currently a shortage of qualified GPs in the UK and not all of the training posts available each year are filled. Changing the way in which GP trainees are selected could help increase the training post fill rate and the number of new entrants to the GP Register. The aim of this study was to model the impact of changing the selection process for GP training on the number of trainees obtaining GP Registration, either with or without extensions. METHOD: This was a cohort study using UK applications for GP training in 2011-14. Application data were linked using GMC numbers to training outcome data where available, and imputed using multiple imputation where missing. The number of trainees appointed and GP Registrations within three and five years' full-time-equivalent were estimated for four different selection processes. RESULTS: The cut scores used in the actual 2015 selection process makes it impossible to fill all training posts. Random selection is the worst option, but the difference between this and other processes modelled falls as more trainees are selected. There are large marginal effects on outcomes: those with the highest selection scores are more likely to obtain GP Registration than those with the lowest scores. CONCLUSIONS: Changing the selection process alone would have a small impact on the number of GP Registrations; reducing/removing cut scores would have a much larger impact. This would also increase the number of trainees requiring extensions and being released from training which would have adverse consequences for the profession

Working with the cracks in the rigging in researching early childhood professional development

This paper seeks to explore the development of the relationship between a group of early childhood academics from the same university and practitioners from a particular early years setting in the North of England into an innovative professional development and research project. The paper uses Foucauldian notions of heterotopia to theorise an approach to professional development and research concerned with examining the discourses and practices associated with provision for two-year-old children. In place of a transmission model of professional development and scientific preoccupations with research purity, we explore what is offered by an alternative approach that offered a broader engagement with ideas, feelings and the body and the layering of research complexity. We consider what emerges when the practitioners take the learning from the project back into their own settings and conclude by considering the possibilities and complexities of academics and practitioners working together to research and represent what emerged from the project

Morphological and moisture availability controls of the leaf area-to-sapwood area ratio: Analysis of measurements on Australian trees

© 2015 Published by John Wiley & Sons Ltd. The leaf area-to-sapwood area ratio (LA:SA) is a key plant trait that links photosynthesis to transpiration. The pipe model theory states that the sapwood cross-sectional area of a stem or branch at any point should scale isometrically with the area of leaves distal to that point. Optimization theory further suggests that LA:SA should decrease toward drier climates. Although acclimation of LA:SA to climate has been reported within species, much less is known about the scaling of this trait with climate among species. We compiled LA:SA measurements from 184 species of Australian evergreen angiosperm trees. The pipe model was broadly confirmed, based on measurements on branches and trunks of trees from one to 27 years old. Despite considerable scatter in LA:SA among species, quantile regression showed strong (0.2 < R1 < 0.65) positive relationships between two climatic moisture indices and the lowermost (5%) and uppermost (5-15%) quantiles of log LA:SA, suggesting that moisture availability constrains the envelope of minimum and maximum values of LA:SA typical for any given climate. Interspecific differences in plant hydraulic conductivity are probably responsible for the large scatter of values in the mid-quantile range and may be an important determinant of tree morphology. We compiled LA:SA measurements from 183 species of Australian evergreen angiosperm trees. The pipe model was broadly confirmed. LA:SA quantile regression showed positive relationships between two climatic moisture indices and the lowermost and uppermost quantiles

University and early childhood setting collaboration in practice and research innovation

This paper focuses on the long-standing relationship between early childhood academics in a university and early years’ practitioners in a combined nursery school and children's centre in Manchester, United Kingdom. The paper explores its development into a unique collaboration, centred on a belief in the importance of research– informed practice and practice–informed research in improving practice and outcomes for children and families. In the UK, the closest parallel is with work carried out by the Pen Green Centre, Corby and St Thomas’ Children’s Centre and the Centre for Research in Early Childhood, Birmingham. The paper uses Holland et al's concept of 'figured worlds' (1998) and Foucauldian notions of power to explore the meeting of academic, practitioner and political worlds. The research is longitudinal and includes both qualitative (exploring lived experience) and quantitative (measurement of impact) aspects as we explore the transformation of life chances in a particular community. A key feature is the attention given to the diverse agendas of children, parents, community collaborators, experienced early years practitioners, students of early childhood, early childhood academics, local authority quality officers and university leaders. The paper highlights the tensions and successes inherent in attending to the competing needs and demands of children, families, local government, funding agencies and the academy.We explore the ways in which the different positional identities come to affect the relative power held by the different stakeholders and what we have learnt about the processes of joint working required for success in negotiating a path between competing concerns

Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. Methods: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002–2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. Results: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Conclusion: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK

Relation of substance use disorders to mortality, accident and emergency department attendances, and hospital admissions: A 13-year population-based cohort study in Hong Kong

BACKGROUND: The impact of substance use disorders (SUD) in an Asian population has not been fully explored. We aimed to assess the risk of mortality, accident and emergency (A&E) department attendances, and hospital admissions associated with SUD in a population-based cohort study. METHOD: Patients diagnosed with SUD in public A&E departments from 2004 to 2016 (N = 8,423) were identified in the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority and 1:1 matched to patients without SUD by propensity score (N = 6,074 in each group). Relative risks of mortality, A&E attendances and hospital admissions were assessed using Cox regression and Hurdle negative binomial regression. RESULTS: Patients with SUD had higher mortality (hazard ratio=1.43; 95% confidence interval [CI]=1.26-1.62) and more often died from poisoning or toxicity and injuries. The odds ratio (OR) for A&E attendances and all-cause hospital admissions associated with SUD were 2.80 (95% CI=2.58-3.04) and 3.54 (95% CI=3.26-3.83), respectively. The impact of SUD on the above outcomes was greatest among school-aged individuals (≤ 21 years) and decreased with age. The relative risk of mental disorder-related hospital admissions was much higher than that for infections, respiratory diseases, and cardiovascular diseases. In patients with SUD, ketamine and amphetamine use were associated with increased A&E attendances than opioid use. CONCLUSIONS: SUD was associated with increased mortality, A&E attendances and hospital admissions, especially in school-aged individuals. Our findings suggest prioritising early treatment and preventive interventions for school-aged individuals and focusing on the management of comorbid mental disorders and the use of ketamine and amphetamine

Investigating Dementia via a multicompartmental poroelastic model of parenchymal tissue

In this paper, a workflow within the VPH-DARE@IT Clinical Research Platform is presented. This is used to model the biomechanical behaviour of perfused brain tissue. This workflow features a 3D multicompartmental poroelastic framework, patient-specific brain anatomy representations and continuous waveforms of internal carotid and vertebral arteries, which are used as a means of personalizing the boundary conditions that feed the arterial compartment of the in-house poroelastic solver. Results are shown comparing CSF/ISF clearance and accumulation in two males of similar age, both are non-smokers, however one is more active and is diagnosed with MCI and experiences less sleep

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a Multicenter, Multinational, 14-Day Inception Cohort Study

PURPOSE: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). METHODS: All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. RESULTS: Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. CONCLUSIONS: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients