18,045 research outputs found

    Perceived barriers and opportunities to improve working conditions and staff retention in Emergency Departments:a qualitative study

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    Background:Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs).Methods:A qualitative approach was taken, using focus groups with ED staff (doctors, nurses, advanced care practitioners) of all grades, seniority and professional backgrounds from across the UK. Snowball recruitment was undertaken using social media and Royal College of Emergency Medicine communication channels. Focus groups were conducted online and organised by profession. A semi structured topic guide was used to explore difficulties in the work environment, impact of these difficulties, barriers and priorities for change. Data were analysed using a directive content analysis to identify common themes.Results:Of the 116 clinical staff who completed the eligibility and consent forms, 46 met criteria and consented, of those, 33 participants took part. Participants were predominantly White British (85%), female (73%) and doctors (61%). Four key themes were generated: ‘culture of blame and negativity’, ‘Untenable working environments’, ‘compromised leadership’ and ‘striving for support’. Data pertaining to barriers and opportunities for change were identified as sub-themes. In particular, strong leadership emerged as a key driver of change across all aspects of working practices.Conclusion:This study identified four key themes related to workplace concerns and their associated barriers and opportunities for change. Culture, working environment and need for support echoed current narratives across healthcare settings. Leadership emerged more prominently than in prior studies as both a barrier and opportunity for wellbeing and retention in the EM workplace. Further work is needed to develop leadership skills early on in clinical training, provide protected time and opportunity to refine leadership skills and a clear pathway to address higher levels of management

    IDHwt glioblastomas can be stratified by their transcriptional response to standard treatment, with implications for targeted therapy

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    Background: Glioblastoma (GBM) brain tumors lacking IDH1 mutations (IDHwt) have the worst prognosis of all brain neoplasms. Patients receive surgery and chemoradiotherapy but tumors almost always fatally recur.Results: Using RNA sequencing data from 107 pairs of pre- and post-standard treatment locally recurrent IDHwt GBM tumors, we identify two responder subtypes based on longitudinal changes in gene expression. In two thirds of patients, a specific subset of genes is upregulated from primary to recurrence (Up responders), and in one third, the same genes are downregulated (Down responders), specifically in neoplastic cells. Characterization of the responder subtypes indicates subtype-specific adaptive treatment resistance mechanisms that are associated with distinct changes in the tumor microenvironment. In Up responders, recurrent tumors are enriched in quiescent proneural GBM stem cells and differentiated neoplastic cells, with increased interaction with the surrounding normal brain and neurotransmitter signaling, whereas Down responders commonly undergo mesenchymal transition. ChIP-sequencing data from longitudinal GBM tumors suggests that the observed transcriptional reprogramming could be driven by Polycomb-based chromatin remodeling rather than DNA methylation.Conclusions: We show that the responder subtype is cancer-cell intrinsic, recapitulated in in vitro GBM cell models, and influenced by the presence of the tumor microenvironment. Stratifying GBM tumors by responder subtype may lead to more effective treatment.</p

    Psychologically Informed Practice and Policy (PIPP) Project:Key Recommendations for Retention and Workforce Wellbeing in Emergency Care

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    The PIPP project is a UKRI funded collaborative study between University of Bath and the Royal College of Emergency Medicine. The PiPP Project investigated current workplace concerns, barrier to change and opportunities for development and growth. This document details specific evidence-based recommendations relating to four key areas identified within the PIPP project as prioritised targets in emergency care workforce development: ‘an environment to thrive in’, ‘cultivating a better culture’, ‘a tailored pathway of care’ and ‘enhanced leadership’. The recommendations are based on new empirical data and supported by existing guidelines and research

    Whole slide image understanding in pathology : what is the salient scale of analysis?

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    Background: In recent years, there has been increasing research in the applications of Artificial Intelligence in the medical industry. Digital pathology has seen great success in introducing the use of technology in the digitisation and analysis of pathology slides to ease the burden of work on pathologists. Digitised pathology slides, otherwise known as whole slide images, can be analysed by pathologists with the same methods used to analyse traditional glass slides. Methods: The digitisation of pathology slides has also led to the possibility of using these whole slide images to train machine learning models to detect tumours. Patch-based methods are common in the analysis of whole slide images as these images are too large to be processed using normal machine learning methods. However, there is little work exploring the effect that the size of the patches has on the analysis. A patch-based whole slide image analysis method was implemented and then used to evaluate and compare the accuracy of the analysis using patches of different sizes. In addition, two different patch sampling methods are used to test if the optimal patch size is the same for both methods, as well as a downsampling method where whole slide images of low resolution images are used to train an analysis model. Results: It was discovered that the most successful method uses a patch size of 256 × 256 pixels with the informed sampling method, using the location of tumour regions to sample a balanced dataset. Conclusion: Future work on batch-based analysis of whole slide images in pathology should take into account our findings when designing new models.Peer reviewe

    A shock to the (health) system: Experiences of adults with rare disorders during the first COVID-19 wave

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    BackgroundBefore COVID-19, people with rare diseases (RD) experienced numerous disparities in quality of life and healthcare access and quality, yet little is known about the experiences of this underserved group during the pandemic.ResultsDuring the first wave of the COVID-19 pandemic in the United States, spring and summer of 2020, 759 participants representing 231 unique RDs responded to open-ended questions about the impact of the pandemic on life with a RD, healthcare access, and coping. Qualitative conventional content analysis was used to analyze responses. Identified themes represented positive and negative dimensions of change, including a shock to the (health) system, coping with uncertainty, and the value of social support while isolated.ConclusionsLimitations in healthcare access and quality were the most frequently described as impacts of COVID-19. Other major negative impacts included exacerbation of symptoms, psychological distress, and a lack of usual social support and reliable information. However, participants also noted silver linings, especially in healthcare. For some, expanded telehealth enhanced their ability to access medical and mental health providers and RD specialists. Finally, many participants hoped that, by highlighting social and health inequities faced by people with RDs and other minorities, the pandemic would prompt greater understanding and policies that could improve the quality of life of the RD community

    Evidence-informed recommendations on managing breast screening atypia : perspectives from an expert panel consensus meeting reviewing results from the sloane atypia project

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    Evidence-based clinical guidelines are essential to maximise patient benefit and to reduce clinical uncertainty and inconsistency in clinical practice. Gaps in the evidence base can be addressed by data acquired in routine practice. At present, there is no international consensus on management of women diagnosed with atypical lesions in breast screening programmes. Here we describe how routine NHS breast screening data collected by the Sloane atypia project was used to inform a management pathway that maximises early detection of cancer and minimises over investigation of lesions with uncertain malignant potential. A half-day consensus meeting with 11 clinical experts, 1 representative from Independent Cancer Patients’ Voice, 6 representatives from NHS England (NHSE) including from Commissioning, and 2 researchers was held to facilitate discussions of findings from an analysis of the Sloane atypia project. Key considerations of the expert group in terms of the management of women with screen detected atypia were: a) frequency and purpose of follow-up; b) communication to patients; c) generalisability of study results; d) workforce challenges. The group concurred that the new evidence does not support annual surveillance mammography for women with atypia, irrespective of type of lesion, or woman’s age. Continued data collection is paramount to monitor and audit the change in recommendations
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