Understanding risk perception in travellers

Information is widely available about travel risks and prevention. Yet, every year a proportion of travellers are affected by illnesses or injuries sustained during their trip, many of which are preventable. In this article we will consider how people perceive risk; how people make decisions about engaging in preventative behaviour; and the role of the pre-travel consultation in promoting healthy behaviour in travellers. The article defines factors that affect travellers’ choices about taking preventative measures and describes strategies to enhance the effectiveness of the pre-travel consultation

Does the structure of the medical consultation align with an educational model of clinical communication? A study of physicians’ consultations from a postgraduate examination

OBJECTIVE: This study examined whether the structure of consultations in which physicians were tasked with sharing information corresponded to the chronological stages proposed by an established educational model of clinical communication. METHOD: Seventy six simulated consultations from a postgraduate examination for general medical hospital physicians were transcribed verbatim and converted into diagrams showing consultation structure. All doctor-patient/relative talk was allocated into six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing, using the ‘communication process skills’ from the Calgary-Cambridge Guide to the Medical Interview. RESULTS: The majority of consultations included four or five of the expected phases, with most talk (41-92%) in Explanation and Planning. There was no discernible consistency of structure across the consultations or in consultations from the same scenario. Consultations varied in the presence, sequential order, size, location and reappearance of phases. CONCLUSIONS: The structure of consultations in this standardised setting bore little resemblance to the chronological order of phases predicted by an educational model. PRACTICE IMPLICATIONS: Educational guidance and interventions to support patients in preparing for consultations need to take account of doctors’ behaviour in practice. Assumptions about the organisation of medical consultations should be queried in the absence of an evidence base

A national qualitative investigation of the impact of service change on doctors' training during Covid-19

BACKGROUND: The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated. METHODS: Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding. RESULTS: Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic. CONCLUSIONS: The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking

Comparison of human mammary epithelial cells immortalized by simian virus 40 T-Antigen or by the telomerase catalytic subunit

We directly compared two methods of immortalizing human mammary epithelial cells (HMECs). Cells were transfected with an expression plasmid either for hTERT, the catalytic subunit of telomerase, or for the simian virus 40 (SV40) early region genes. Under standard culture conditions, HMECs were not immortalized by hTERT unless they had spontaneously ceased expression of the p16(INK4a) tumor suppressor gene. Untransfected HMECs had low levels of telomerase expression, and immortalization by both methods was associated with an increase in telomerase activity and prevention of telomere shortening. SV40-induced immortalization was accompanied by aberrant differentiation, loss of DNA damage response, karyotypic instability and, in some cases, tumorigenicity. hTERT-immortalized cells had fewer karyotypic changes, but had intact DNA damage responses, and features of normal differentiation. Although SV40-immortalized cells are useful for studies of carcinogenesis, hTERT-immortalized cells retain more properties of normal cells.NHMR

What do patients want from their psychiatrist? A cross- sectional questionnaire based exploratory study from Karachi

<p>Abstract</p> <p>Background</p> <p>The aspects of consultation that are important for psychiatric patients have always remained a less acknowledged area. The aim of this study was to identify these aspects.</p> <p>Methods</p> <p>A Cross-sectional, questionnaire based study was carried out in a psychiatry outpatient clinic of two tertiary care hospitals in a developing country. The patients were asked to fill out the questionnaire containing a total of 11 close-ended questions plus 1 open-ended question. They graded them as not important, important, very important or do not know. Non-psychotic patients aged 18 and above, visiting the clinic were recruited into the study before they went in for their first consultation.</p> <p>Results</p> <p>The response rate of patients was 84%. More than 90% wanted the doctor to tell them the cause of their illness, talk to them about their condition, provide symptomatic relief, let them know that how long their illness would last and make the final decision about their treatment plan. Less than 20% wanted to be part of a support network. A significant 82% wanted talking therapy as part of their treatment plan.</p> <p>Conclusion</p> <p>The three issues, most important for patients were: the doctor should listen to them, make the final decision about treatment and provide symptomatic relief. Only 20% wanted to be a part of patients' support group.</p

Treatment fidelity in the Camden Weight Loss (CAMWEL) intervention assessed from recordings of advisor-participant consultations

BACKGROUND: Variations in the delivery of content and process can alter the effectiveness of complex interventions. This study examined the fidelity of a weight loss intervention (Camden Weight Loss) from recorded consultations by assessing advisors’ delivery of content, use of motivational interviewing approach and therapeutic alliance. METHODS: A process evaluation was conducted of advisor-participant consultations in a 12-month randomised controlled trial of an intervention for adult volunteers with a body mass index categorised as overweight or obese. A convenience sample of 22 consultations (12% of 191 participants) recorded at the intervention mid-point were available for analysis. Consultations were independently rated by two observers independent of intervention or study delivery, using: a fidelity scale, the Motivational Interviewing Treatment Integrity Scale and the Primary Care Therapy Process Rating Scale. Raters were blind to participants’ responses to the intervention and weight outcomes. Half the participants (N = 11) achieved significant weight loss (≥ 5% of baseline weight). RESULTS: A mean of 41% of prescribed content was delivered, with a range covered per session of 8–98%, falling below the 100% content expected per session. Tasks included most frequently were: taking weight and waist measurements (98%), scheduling next appointment (86%), review of general progress (85%) and reviewing weight change (84%). Individual items most frequently addressed were ‘giving encouragement’ and ‘showing appreciation of participant’s efforts’ (95 and 88% respectively). Consultation length (mean 19 min, range 9–30) was shorter than the 30-min allocation. Quantity of content correlated with consultation length (p < 0.01). Advisors’ use of motivational interviewing was rated at ‘beginner proficiency’ for Global Clinician Rating, Reflection to Question Ratio and Percent Open Questions. Therapeutic alliance scores were moderate. Affective aspects were rated highly (e.g. supportive encouragement, involvement and warmth). CONCLUSION: Intervention fidelity varied in both content and process, emphasising the importance of ongoing fidelity checks in a complex intervention. Advisors focused on certain practical aspects of the intervention and providing an encouraging interpersonal climate. This concurs with other research findings, which have revealed the value participants in a weight loss intervention place on an empathic advisor-participant relationship

Does the inclusion of 'professional development' teaching improve medical students' communication skills?

Background: This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations.Methods: Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported.Results: Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination.Conclusions: Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients