Doctors with dyslexia: a world of stigma, stonewalling and silence, still?

Introduction: Dyslexia is a common learning difficulty, affecting 10% of the UK and worldwide populations. It is also becoming increasingly recognised within medical education. There is little research into the experiences of doctors with dyslexia. This paper forms part five of a programme of research from the authors into the experiences of UK medical students and junior doctors with dyslexia. Our research question is: “what are the lived experiences of medical students and junior doctors with dyslexia?” Methods: This is an Interpretive Phenomenological (qualitative) study. Dyslexic doctors were recruited from a single UK Foundation School. Participants were interviewed, in-depth, by telephone. Interviews were audio-recorded and transcribed verbatim. These underwent a thematic Template Analysis, which was verified in an iterative manner by both researchers. Results: Eight participants were interviewed. Core themes emerging for junior doctors’ experiences were: Their “disease”; perception from others; stonewalling; emotional responses; disclosure; influence on career pathway; and working life as the real word. Conclusions: Our results highlight a world of stigma, stonewalling, bullying and a reluctance to disclose. These results may suggest a need for education and public information about dyslexia, to begin to tackle this prejudice. Making adjustments to time in undergraduate exams may also not be enough. One of the most startling findings was the fear of being identified as “dyslexic”. Keywords: Dyslexia, Interpretive Phenomenology, Specific Learning Difficulties, Junior Doctors, Lived Experience

Text Mining Narrative Survey Responses to Develop Engagement Scale Items

A sixteen-item employee engagement scale was supplemented with items developed from literature review, from related scales, and from text mining narrative responses to an open-ended question about improving employee performance. The text mining procedure is described and may be useful to other scale developers. Some items derived from text mining performed as well as those developed using traditional methods. Possible modifications and extensions of the method are suggested

Cancer survival in Australia 1992–1997 : geographic categories and socioeconomic status

Cancer Survival in Australia 1992-1997 is the first national analysis of how cancer survival varies by socioeconomic status and geographic region. It presents an analysis of five-year relative survival proportions by geographic category and socioeconomic status for persons diagnosed with cancer during the years 1992-1997.This analysis is presented by age and sex for all cancers (Excluding non-melanocytic skin cancers) combined and for the following National Health Priority Area cancers - colorectal cancer, cancer of the lung, melanoma, cancer of the breast (females only), cancer of the cervix, cancer of the prostate, and non-Hodgkin\u27s lymphoma.This report is the third in a series of three reports on relative survival after being diagnosed with cancer. It is an important reference for all those interested in the health of Australians

Reassessing Concurrent Tribal–State–Federal Criminal Jurisdiction in Kansas

This is the published version

Cancer in Australia 1998

Cancer in Australia 1998 presents comprehensive national data on cancer incidence and mortality. The report provides 1998 data for cancers by site, age and sex, and summary data for each State and Territory. Incidence and mortality trends since the early 1980s, age patterns for selected cancers, comparisons with New Zealand cancer data and an analysis of cancers of unknown primary site are features of this report. The information in this report is supported by more detailed information for all cancer sites on the AIHW\u27s web site www.aihw.gov.au. Cancer in Australia 1998 is an important reference from the Cancer Series for all those interested in the health of Australians

Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines.

INTRODUCTION: Pancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency. METHODS AND ANALYSIS: A review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting. RESULTS: Recommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines

Clinical and cost effectiveness of endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstruction: a systematic review

BACKGROUND: Early evidence suggests that using radiofrequency ablation as an adjunct to standard care (i.e. endoscopic retrograde cholangiopancreatography with stenting) may improve outcomes in patients with malignant biliary obstruction. OBJECTIVES: To assess the clinical effectiveness, cost-effectiveness and potential risks of endoscopic bipolar radiofrequency ablation for malignant biliary obstruction, and the value of future research. DATA SOURCES: Seven bibliographic databases, three websites and seven trials registers were searched from 2008 until 21 January 2021. REVIEW METHODS: The study inclusion criteria were as follows: patients with biliary obstruction caused by any form of unresectable malignancy; the intervention was reported as an endoscopic biliary radiofrequency ablation to ablate malignant tissue that obstructs the bile or pancreatic ducts, either to fit a stent (primary radiofrequency ablation) or to clear an obstructed stent (secondary radiofrequency ablation); the primary outcomes were survival, quality of life or procedure-related adverse events; and the study design was a controlled study, an observational study or a case report. Risk of bias was assessed using Cochrane tools. The primary analysis was meta-analysis of the hazard ratio of mortality. Subgroup analyses were planned according to the type of probe, the type of stent (i.e. metal or plastic) and cancer type. A de novo Markov model was developed to model cost and quality-of-life outcomes associated with radiofrequency ablation in patients with primary advanced bile duct cancer. Insufficient data were available for pancreatic cancer and secondary bile duct cancer. An NHS and Personal Social Services perspective was adopted for the analysis. A probabilistic analysis was conducted to estimate the incremental cost-effectiveness ratio for radiofrequency ablation and the probability that radiofrequency ablation was cost-effective at different thresholds. The population expected value of perfect information was estimated in total and for the effectiveness parameters. RESULTS: Sixty-eight studies (1742 patients) were included in the systematic review. Four studies (336 participants) were combined in a meta-analysis, which showed that the pooled hazard ratio for mortality following primary radiofrequency ablation compared with a stent-only control was 0.34 (95% confidence interval 0.21 to 0.55). Little evidence relating to the impact on quality of life was found. There was no evidence to suggest an increased risk of cholangitis or pancreatitis, but radiofrequency ablation may be associated with an increase in cholecystitis. The results of the cost-effectiveness analysis were that the costs of radiofrequency ablation was £2659 and radiofrequency ablation produced 0.18 quality-adjusted life-years, which was more than no radiofrequency ablation on average. With an incremental cost-effectiveness ratio of £14,392 per quality-adjusted life-year, radiofrequency ablation was likely to be cost-effective at a threshold of £20,000 per quality-adjusted life-year across most scenario analyses, with moderate uncertainty. The source of the vast majority of decision uncertainty lay in the effect of radiofrequency ablation on stent patency. LIMITATIONS: Only 6 of 18 comparative studies contributed to the survival meta-analysis, and few data were found concerning secondary radiofrequency ablation. The economic model and cost-effectiveness meta-analysis required simplification because of data limitations. Inconsistencies in standard reporting and study design were noted. CONCLUSIONS: Primary radiofrequency ablation increases survival and is likely to be cost-effective. The evidence for the impact of secondary radiofrequency ablation on survival and of quality of life is limited. There was a lack of robust clinical effectiveness data and, therefore, more information is needed for this indication. FUTURE WORK:  Future work investigating radiofrequency ablation must collect quality-of-life data. Highquality randomised controlled trials in secondary radiofrequency ablation are needed, with appropriate outcomes recorded. STUDY REGISTRATION: This study is registered as PROSPERO CRD42020170233. FUNDING:  This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 7. See the NIHR Journals Library website for further project information

Twelve tips for teaching medical students with dyslexia

Dyslexia is a common learning difficulty. As a result of SS' own experiences as a medical student with dyslexia, we have been researching and teaching on this topic for the past two years. Here, we present twelve tips for teaching medical students with dyslexia. These are gathered from our personal experiences and research, discussions with other educators, and wider literature on the topic. This article aims to shed some light on dyslexia, and also to make practical suggestions. Teaching students with dyslexia should not be a daunting experience. Small changes to existing methods, at minor effort, can make a difference - for example, adding pastel colors to slide backgrounds or avoiding Serif fonts. These tips can help educators gain more insight into dyslexia and incorporate small, beneficial adaptations into their teaching

Cancer in Australia 1999

Cancer in Australia 1999 presents comprehensive national data on cancer incidence and mortality and summary data on screening, survival, inpatient hospital and general practice episodes, risk factors, and the cancer workforce. The report provides 1999 data for cancer by site, age and sex, and summary data for each State and Territory. Incidence and mortality trends since the early 1980s and age patterns for selected cancers are features of this report. Cancer in Australia 1999 is an important reference from the Cancer Series for all those interested in the health of Australians