Understanding the value of a doctorate for allied health professionals in practice in the UK: a survey.

BACKGROUND: The need to transform the United Kingdom's (UK) delivery of health and care services to better meet population needs and expectations is well-established, as is the critical importance of research and innovation to drive those transformations. Allied health professionals (AHPs) represent a significant proportion of the healthcare workforce. Developing and expanding their skills and capabilities is fundamental to delivering new ways of working. However, career opportunities combining research and practice remain limited. This study explored the perceived utility and value of a doctorate to post-doctoral AHPs and how they experience bringing their research-related capabilities into practice environments. METHODS: With a broadly interpretivist design, a qualitatively oriented cross-sectional survey, with closed and open questions, was developed to enable frequency reporting while focusing on the significance and meaning participants attributed to the topic. Participants were recruited via professional networks and communities of practice. Descriptive statistics were used to analyse closed question responses, while combined framework and thematic analysis was applied to open question responses. RESULTS: Responses were received from 71 post-doctoral AHPs located across all four UK nations. Findings are discussed under four primary themes of utilisation of the doctorate; value of the doctorate; impact on career, and impact on self and support. Reference is also made at appropriate points to descriptive statistics summarising closed question responses. CONCLUSION: The findings clearly articulate variability of experiences amongst post-doctoral AHPs. Some were able to influence team and organisational research cultures, support the development of others and drive service improvement. The challenges, barriers and obstacles encountered by others reflect those that have been acknowledged for many years. Acknowledging them is important, but the conversation must move forward and generate positive action to ensure greater consistency in harnessing the benefits and value-added these practitioners bring. If system-wide transformation is the aim, it is inefficient to leave navigating challenges to individual creativity and tenacity or forward-thinking leaders and organisations. There is an urgent need for system-wide responses to more effectively, consistently and equitably enable career pathways combining research and practice for what is a substantial proportion of the UK healthcare workforce.

Comparing the Safety and Effectiveness of Microfocused Ultrasound: Standard vs Targeted Tissue Protocol in Lifting and Tightening the Lower Face and Upper Neck.

BACKGROUND: Micro-focused ultrasound with visualization (MFU-V) delivers energy to specific soft tissue layers beneath the epidermis with the ability to lift and tighten the lower face and neck.  Objective: To determine the efficacy of microfocused ultrasound with visualization (MFU-V) using a standard treatment line protocol versus a customized treatment line protocol based on the patient's unique anatomy targeting the superficial muscular aponeurotic system and fibrous septae for lifting and tightening of the lower face and neck. METHODS: This was a single-center, prospective, randomized, investigator-blinded clinical trial. 51 subjects were randomized to receive a single treatment of MFU-V targeting the lower face and neck using either a standard or custom treatment protocol.   Results: Subjects in both standard and custom treatment groups noted a greater than one-point improvement in jawline laxity. Three-dimensional photography measurements also demonstrated lifting of the lower face and neck in both treatment groups. CONCLUSION: Custom and standard treatment MFU-V protocols produce a safe and effective treatment for tightening and lifting the lower face and neck. Custom treatment protocols aid in maximizing results for patients with variations in the anatomy of the lower face and neck.  J Drugs Dermatol. 2024;23(4):7647.     doi:10.36849/JDD.7647.

Engaging Undergraduate Nursing Students in Collaborative Research.

BACKGROUND: Nurses are expected to base practice on evidence from research, which requires an understanding of the research process. However, baccalaureate nursing students may find research courses uninteresting or feel unprepared to conduct research. Participation in experiential research projects may affect their research attitudes, knowledge, and skills. METHOD: Nursing investigators engaged nursing students in an experiential, active learning research project centered on the effects of pet interaction involving university students. Faculty mentored and partnered with nursing students, immersing them in all research processes. RESULTS: Students confirmed that participation in the project enhanced their understanding of research, improved their clinical and communication skills, and fostered professional growth. Students presented results in a scientific poster at the University's research event. CONCLUSION: Collaborative faculty-student research projects enhance students' interest in and appreciation of evidence-based research, and support professional development, confidence in assuming research roles, and feelings of connection with faculty, each other, and the university. [J Nurs Educ. 2024;63(X):XXX-XXX.].

The Changing Landscape of Treatment for Cystic Fibrosis Related Diabetes.

Objective: Patients with Cystic Fibrosis related diabetes [CFRD] are treated with insulin and high calorie diets to maintain body mass. The combined CFTR modulator elexacaftor/tezacaftor/ivacaftor [ETI] decreases pulmonary exacerbations and improves nutritional status. We reviewed the effects of ETI on BMI, HbA1c and diabetes regimen in patients with CFRD over a period of three years. Methods: Data of previously CFTR-modulator-naïve patients with CFRD and pancreatic insufficiency on ETI therapy were retrieved from an electronic health record database. Patients were followed for a mean duration of 2.7 ± 0.8 years after ETI initiation. Data pertaining to weight, BMI, HbA1c and diabetes regimen were collected at 6 months, 12 months, 2 years and at 3 years post-ETI initiation. Patients were then dichotomized based on their baseline BMI into a low BMI group and an "at target" BMI group. The effects of ETI on changes in weight, BMI, A1c and diabetes regimen were compared in both groups over a period of three years. Results: Twenty-seven patients with CFRD (15 men/12 women), age 30.6 ± 11.5 (SD) years, BMI 22.4 ± 4.0 kg/m2, were included. Fifteen patients had low BMI (<22 kg/m2 for women, <23 kg/m2 for men) and 12 patients had at target BMI (≥22 kg/m2for women, ≥BMI 23 kg/m2 for men). Patients with low BMI had an increase in their BMI from 19.5 ± 1.7 to 21.4 ± 2.2 kg/m2 at one year (p = 0.002), and 21.8 ± 1.8 kg/m2 at three years (p = 0.004) after ETI initiation. Four patients (out of 15) in the low BMI group had achieved normal BMI by the end of study follow up. There was no change in weight in the at target BMI group. HbA1c and basal insulin requirements did not change in either group. Five patients started non-insulin therapies. Conclusion: BMI increased after ETI therapy in CFRD patients with low BMI, but not in those with at target BMI. The use of non-insulin therapies is increasing in CFRD and should be evaluated in future studies.

Sizing Up General Practice Environments for Big-Bodied Patients: An Environmental Assessment of Three Facilities in Aotearoa New Zealand.

OBJECTIVES: This research describes the physical environments of and equipment in Aotearoa New Zealand (NZ) general practices in relation to available standards for big-bodied people (BBP) seeking healthcare. BACKGROUND: The prevalence of BBP both in NZ and globally has increased over the last 30 years and is expected to increase further. As the first and most utilized point of contact for patients in NZ and many countries, it is essential that general practices provide suitable environments to cater for and meet the needs of big-bodied patients seeking healthcare. METHODS: An exploratory study utilizing an environmental investigation was undertaken in three diverse general practices. Data collection consisted of direct observation and physical measurements of practice layout and equipment. Findings were compared to the existing guidelines or standards for the healthcare of BBP. RESULTS: The analysis identified most environmental facets and equipment in all three general practices did not meet published guidelines for the care of BBP. CONCLUSIONS: In the global context of increasing and sustained prevalence of BBP, this exploratory study highlights it is crucial that general practices and similar community-based facilities review their physical environments and equipment and consider modifications to improve accessibility, inclusivity, and comfort for BBP.

Development of the nursing associate professional identity: A longitudinal qualitative study.

AIM: The aim of this study was to understand the factors that contribute to the development of the nursing associate professional identity. DESIGN: A 3-year longitudinal qualitative study of trainee nursing associates. METHODS: Trainee nursing associates in England were interviewed remotely annually in February 2020, March 2021 and March 2022. They also provided diary entries. Data were anonymised, transcribed and analysed thematically. RESULTS: Nursing associate professional identity was developed through: increased knowledge, skills and responsibility; and self-perceptions of identity alongside responses to the role by colleagues. Tensions arose when the scope of practice expected by organisations differed from that expected by the nursing associates. Frustrations occurred when nursing associates were perceived as substitutes for Registered Nurses in the context of nursing workforce shortages. CONCLUSION: Nursing associates in this study clearly valued their new knowledge, skills and responsibility, enabling them to provide enhanced patient care. Increased clarity of role boundaries is necessary in enhancing the professional identity of nursing associates and reducing inter-professional tensions arising from role ambiguity within health and social care organisations. IMPLICATIONS FOR THE PROFESSION: National guidance and employers should provide clarity on the boundaries of the nursing associate role which will strengthen their professional identity and mitigate role ambiguity within health and social care organisations. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research has been used to guide reporting. PATIENT OF PUBLIC CONTRIBUTION: A patient and public involvement group was consulted during the initial study design stage. IMPACT: This study aimed to understand the factors which contribute to the development of a nursing associate professional identity. Nursing associate professional identity is developed through increased knowledge, skills and responsibility, and the perceptions of identity by participants themselves and their colleagues. The findings should inform the implementation of initiatives to clarify nursing associate role boundaries and the development of similar roles internationally.

The mental health and well-being implications of a mesothelioma diagnosis: A mixed methods study.

PURPOSE: Mesothelioma is an incurable, asbestos-related cancer with a poor prognosis. There is scant evidence about the mental health and well-being impacts on patients and carers living with the illness. This study aimed to investigate mesothelioma's impact on mental health and well-being and the scale of mental health conditions in patients and informal carers. METHODS: A mixed-methods design was used: a cross-sectional survey of mesothelioma patients and informal carers plus semi-structured interviews with patients and carers. The survey used validated scales collecting data on mental health aspects of mesothelioma: the EQ5D to assess health-related quality-of-life; the Hospital Anxiety and Depression scale; the PCL-5 to assess Posttraumatic Stress; and the Posttraumatic Growth Inventory. The datasets were integrated during analysis. RESULTS: 96 useable survey responses were received. A clinical level of depression was reported by 29 participants (30.21%), of anxiety by 48 (50%), of posttraumatic distress disorder by 32 (33.33%), and of posttraumatic growth by 34 (35.42%). Carers had worse scores than patients. Three main themes were developed from interviews with 10 patients and 11 carers: 'Prognosis', 'Support from services', and 'Social connections and communication'. CONCLUSIONS: Healthcare professionals delivering a mesothelioma diagnosis require regular training in communication skills plus updating in current treatment options, so they provide an appropriate mix of realism and hope. Better signposting to mental health support is needed for patients and carers. Our introduction of posttraumatic growth into the mesothelioma literature is novel. We recommend specialist nurses are trained to recognise, understand, and foster posttraumatic growth.

Effect of a Community Health Worker-Led Intervention Among Low-Income and Minoritized Patients With Cancer: A Randomized Clinical Trial.

PURPOSE: To determine whether a community health worker (CHW)-led intervention could improve health-related quality of life (HRQoL; primary outcome) more than usual care among low-income and racial and ethnic minoritized populations newly diagnosed with cancer. METHODS: This randomized clinical trial was conducted from November 1, 2018, until August 31, 2021, in outpatient cancer clinics in Atlantic City, NJ, and Chicago, IL. Hourly low-wage worker members of an employer union health fund age 18 years or older with newly diagnosed solid tumor and hematologic malignancies were randomly assigned 1:1 to usual care (control group) or usual care augmented with a trained CHW for 12 months (intervention group). The CHW assisted participants with advance care planning (ACP), proactively screened symptoms, and referred participants to community-based resources for identified health-related social needs. Usual care comprised nurse case management and benefits redesign (waived copayments and free transportation for any cancer care received at preferred oncology clinics in each city). The primary outcome was HRQoL. Secondary outcomes included patient activation, satisfaction with decision, ACP documentation, health care use, total health care costs, and overall survival. RESULTS: A total of 160 participants were enrolled. Intervention group participants had a greater increase in mean HRQoL scores at 4-month and 12-month follow-up as compared with baseline than control group participants (expected mean difference, 11.25 [95% CI, 7.28 to 15.22]; 11.29 [95% CI, 6.96 to 15.62], respectively). CONCLUSION: In this randomized trial, a CHW-led intervention significantly improved HRQoL for low-income and racial and ethnic minoritized patients with cancer more than usual care alone.

Trainee nursing associates in England: A multisite qualitative study of higher education institution perspectives.

AIM: To explore the experiences of university employees on the development and implementation of the nursing associate programme. BACKGROUND: As part of wider policy initiatives to address workforce shortages, provide progression for healthcare assistants and offer alternative routes into nursing, England recently introduced the nursing associate level of practice. Little research has yet considered university perspectives on this new programme. METHODS: An exploratory qualitative study reported following COREQ criteria. Twenty-seven university staff working with trainee nursing associates in five universities across England were recruited. Data, collected via semi-structured interviews from June to September 2021, were analysed through a combined framework and thematic analysis. RESULTS: Three themes developed: 'Centrality of partnerships' considered partnerships between employers and universities and changing power dynamics. 'Adapting for support' included responding to new requirements and changing pedagogical approaches. 'Negotiating identity' highlighted the university's role in advocacy and helping trainees develop a student identity. CONCLUSIONS: Nursing associate training in England has changed the dynamics between universities and healthcare employers, shifting learners' identity more to 'employee' rather than 'student'. Universities have adapted to support trainees in meeting academic and professional standards whilst also meeting employer expectations. While challenges remain, the ability of nurse educators to make adjustments, alongside their commitment to quality educational delivery, is helping establish this new training programme and thereby meet government policy initiatives. IMPLICATIONS FOR NURSING POLICY: The international movement of apprenticeship models in universities has the potential to change the status of the learner in nursing educational contexts. National policies that encourage this model should ensure that the implications and challenges this change of status brings to learners, employers and education institutions are fully considered prior to their implementation.

New Zealand hospice staff perspectives on 'Xcellent Gowns' for big bodied palliative care patients: a qualitative study.

Introduction A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care. Aim This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective. Methods Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM . Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement. Results The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants' interview transcripts. Discussion The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing.

Cell state transition analysis identifies interventions that improve control of Mycobacterium tuberculosis infection by susceptible macrophages.

Understanding cell state transitions and purposefully controlling them to improve therapies is a longstanding challenge in biological research and medicine. Here, we identify a transcriptional signature that distinguishes activated macrophages from the tuberculosis (TB) susceptible and resistant mice. We then apply the cSTAR (cell state transition assessment and regulation) approach to data from screening-by-RNA sequencing to identify chemical perturbations that shift the transcriptional state of tumor necrosis factor (TNF)-activated TB-susceptible macrophages toward that of TB-resistant cells, i.e., prevents their aberrant activation without suppressing beneficial TNF responses. Last, we demonstrate that the compounds identified with this approach enhance the resistance of the TB-susceptible mouse macrophages to virulent Mycobacterium tuberculosis.

Ribosome-binding antibiotics increase bacterial longevity and growth efficiency.

Antibiotics, by definition, reduce bacterial growth rates in optimal culture conditions; however, the real-world environments bacteria inhabit see rapid growth punctuated by periods of low nutrient availability. How antibiotics mediate population decline during these periods is poorly understood. Bacteria cannot optimize for all environmental conditions because a growth-longevity tradeoff predicts faster growth results in faster population decline, and since bacteriostatic antibiotics slow growth, they should also mediate longevity. We quantify how antibiotics, their targets, and resistance mechanisms influence longevity using populations of Escherichia coli and, as the tradeoff predicts, populations are maintained for longer if they encounter ribosome-binding antibiotics doxycycline and erythromycin, a finding that is not observed using antibiotics with alternative cellular targets. This tradeoff also predicts resistance mechanisms that increase growth rates during antibiotic treatment could be detrimental during nutrient stresses, and indeed, we find resistance by ribosomal protection removes benefits to longevity provided by doxycycline. We therefore liken ribosomal protection to a "Trojan horse" because it provides protection from an antibiotic but, during nutrient stresses, it promotes the demise of the bacteria. Seeking mechanisms to support these observations, we show doxycycline promotes efficient metabolism and reduces the concentration of reactive oxygen species. Seeking generality, we sought another mechanism that affects longevity and we found the number of doxycycline targets, namely, the ribosomal RNA operons, mediates growth and longevity even without antibiotics. We conclude that slow growth, as observed during antibiotic treatment, can help bacteria overcome later periods of nutrient stress.

Who Is Holding the Syringe? A Survey of Truth in Advertising Among Medical Spas.

BACKGROUND: The degree of supervision and level of expertise required for performing cosmetic procedures differs significantly from state to state. Medical spas providing cosmetic procedures have seen exponential growth since 2020. OBJECTIVE: To provide a representative sample of the medical spa industry in the Unites States regarding the expertise among providers performing cosmetic procedures and the degree of oversight at medical spas offering these procedures. MATERIALS AND METHOD: Descriptive study based on a standardized telephone interview performed by a secret shopper in Chicago and surrounding suburbs. Data were then extracted and analyzed. RESULTS: Of 127 medical spas reviewed, a supervising physician was not on-site at 81.1% of the facilities. Patients were informed of this at 64.6% of the surveyed medical spas. CONCLUSION: There is considerable variation in the oversight and in the training among those performing cosmetic procedures at surveyed medical spas. As cosmetic procedures become increasingly popular among the public, further regulation of medical spas is warranted to protect patient safety.

Euglycemic diabetic ketoacidosis: The paradox of delayed correction of acidosis.

OBJECTIVE: The effectiveness of standard treatment for diabetic ketoacidosis (DKA) in "euglycemic DKA" (EuDKA, blood glucose (BG) ≤ 250 mg/dL) was evaluated with respect to the time to correction of BG ≤ 200 mg/dL, anion gap (AG)≤12 mmol/L, and serum bicarbonate [HCO3] ≥18 mmol/L. METHODS: Data were retrieved from an electronic health record (EPIC) for "diabetic ketoacidosis." Patients were categorized by initial BG as EuDKA, middle range DKA (MrDKA, >250 < 600 mg/dL) and hyperosmolar DKA (HyperDKA ≥600 mg/dL). RESULTS: There were 56 patients (27men, 29women; age 45.8 ± 15.6 (SD) years. The initial 8-h insulin infusion rate (0.05 ± 0.02, 0.09 ± 0.03, 0.14 ± 0.05units/kg/h, p < 0.001) and the time to correction of BG (3.4 ± 1.9, 6.1 ± 2.9 and 9.6 ± 3.9 h, p < 0.001), differed for EuDKA, MrDKA and HyperDKA. There were no differences in the time to correction of AG or [HCO3]. The earlier time to correction of BG in EuDKA resulted in paradoxical longer lag times for correction of [HCO3] (p = 0.003) and AG (p = 0.048). Changes in BG, AG and [HCO3] correlated with insulin infusion rates of 0.08-0.1units/kg/h whereas in EuDKA the insulin infusion rate was 0.05 ± 0.02 units/kg/h. CONCLUSION: In EuDKA, correlation analyses suggest that higher glucose and insulin infusion rates than what would be projected for the level of blood glucose are required to reverse ketoacidosis. Prospective trials are required to optimize the levels of glucose and insulin infusions in EuDKA.

Clinical Physics Boot Camp for Radiation Oncology Residents: A Pilot Study.

The physics curriculum is a source of anxiety both for medical students considering radiation oncology (RO) as a possible career and for current residents facing the physics boards. To improve the orientation process for residents and medical students, we created a physics boot camp using clinically relevant patient vignettes to teach physics fundamentals. The initial boot camp was a week-long program of 1.5 to 2 hours daily, with each day consisting of a didactic session and hands-on laboratory. Boot camp topics covered included physics fundamentals, electron treatments, photon treatments, brachytherapy, and urgent clinical setups. Learners completed pre- and postsurveys, where each rated their knowledge and comfort level with RO workflow on a 5-point scale. Learners also completed daily knowledge-based assessments testing the information presented before and after these daily sessions. A total of 10 participants were included in the initial boot camp: 8 residents and 2 medical students. A repeat, single-day, multi-institutional boot camp a year later included 5 of the original resident participants. Participant scores were paired for analysis using student t tests. For the initial boot camp, all participants reported significantly increased confidence in the physics aspects of the RO workflow (mean 3.24 vs 4.18; P = .0023). However, when comparing those self-assessment scores from participants with more than a year of physics background to those earlier in their training, only the early training participants' scores remained significant (advanced learners: mean 4.0 vs 4.38, P = .129; early learners: mean 2.66 vs 4.02, P = .0025). All participants had improved scores on their knowledge-based assessments (mean 74% vs 89%; P = .0001), which remained statistically significant for both early learners (mean 68% vs 87%; P = .0005) and advanced learners (mean 84% vs 93%; P = .0447). For repeat participants, preboot camp knowledge showed continued improvement (mean 61% vs 79%; P = .049) at 1 year. A formal physics boot camp orientation improves both resident comfort level and knowledge base with clinical physics, with participants early in their training deriving the greatest benefit.

Realist synthesis of factors affecting retention of staff in UK adult mental health services.

OBJECTIVES: The shortage of healthcare staff is a global problem. UK mental health services have, on average, a higher turnover of staff than the NHS. Factors affecting retention of this staff group need to be explored in more depth to understand what is working for whom, for what reasons and in what circumstances. This review aims to conduct a realist synthesis to explore evidence from published studies, together with stakeholder involvement to develop programme theories that hypothesise how and why retention occurs in the mental health workforce and identify additional evidence to explore and test these theories thereby highlighting any persistent gaps in understanding. This paper develops programme theories that hypothesise why retention occurs and in what context and tests these theories thereby highlighting any persistent gaps in understanding. METHODS: Realist synthesis was used to develop programme theories for factors affecting retention of UK mental health staff. This involved: (1) stakeholder consultation and literature scoping to develop initial programme theories; (2) structured searches across six databases to identify 85 included relevant literature relating to the programme theories; and (3) analysis and synthesis to build and refine a final programme theory and logic model. RESULTS: Phase I combined findings from 32 stakeholders and 24 publications to develop six initial programme theories. Phases II and III identified and synthesised evidence from 88 publications into three overarching programme theories stemming from organisational culture: interconnectedness of workload and quality of care, investment in staff support and development and involvement of staff and service users in policies and practice. CONCLUSIONS: Organisational culture was found to have a key underpinning effect on retention of mental health staff. This can be modified but staff need to be well supported and feel involved to derive satisfaction from their roles. Manageable workloads and being able to deliver good quality care were also key.

Versatile microbial communities rapidly assimilate ammonium hydroxide-treated plastic waste.

Waste plastic presently accumulates in landfills or the environment. While natural microbial metabolisms can degrade plastic polymers, biodegradation of plastic is very slow. This study demonstrates that chemical deconstruction of polyethylene terephthalate (PET) with ammonium hydroxide can replace the rate limiting step (depolymerization) and by producing plastic-derived terephthalic acid and terephthalic acid monoamide. The deconstructed PET (DCPET) is neutralized with phosphoric acid prior to bioprocessing, resulting in a product containing biologically accessible nitrogen and phosphorus from the process reactants. Three microbial consortia obtained from compost and sediment degraded DCPET in ultrapure water and scavenged river water without addition of nutrients. No statistically significant difference was observed in growth rate compared to communities grown on DCPET in minimal culture medium. The consortia were dominated by Rhodococcus spp., Hydrogenophaga spp., and many lower abundance genera. All taxa were related to species known to degrade aromatic compounds. Microbial consortia are known to confer flexibility in processing diverse substrates. To highlight this, we also demonstrate that two microbial consortia can grow on similarly deconstructed polyesters, polyamides, and polyurethanes in water instead of medium. Our findings suggest that microbial communities may enable flexible bioprocessing of mixed plastic wastes when coupled with chemical deconstruction.

Training and development experiences of nursing associate trainees based in primary care across England: a qualitative study.

BACKGROUND: The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care. AIM: To explore the experiences and career development opportunities for trainee nursing associates based in primary care. METHODS: This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically. FINDINGS: Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a 'valuable opportunity for career progression'. Trainees were frustrated by the 'emphasis on secondary care' in both academic content and placement portfolio requirements. They also experienced 'inconsistency in support' from their managers and assessors and noted a number of 'constraints to their learning opportunities', including the opportunity to progress to become registered nurses. CONCLUSION: This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.

Collagenase Clostridium Histolyticum-aaes Injections for Volumetric Change of Cellulite Dimples and Gluteal Contouring.

BACKGROUND: Collagenase clostridium histolyticum-aaes (CCH) is approved for the treatment of moderate-to-severe cellulite. OBJECTIVE: This is a retrospective image review of subjects previously enrolled in Cohort 2 of the EN3835-305 trial to determine the effects of CCH on volumetric changes of cellulite dimples and overall gluteal contouring. METHODS: In this retrospective analysis, photographs from Day 90 and Day 180 were superimposed on baseline images and the volumetric change of each treated cellulite dimple was quantified. Side-by-side photographs of the buttocks were also evaluated for change in gluteal contour using the Physician Global Aesthetic Improvement Scale (PGAIS). RESULTS: Fifty-eight female subjects and 403 cellulite dimples were evaluated. Three-dimensional imaging analysis revealed a significant improvement in total negative dimple volume at both Day 90 and Day 180 of 27% and 26%, respectively ( p < .001 and p = .002, respectively). At Day 90, the overall gluteal contour, as signified by the mean PGAIS among the 3 blinded dermatologists, was rated as +1 (improved) in 27% ( n = 17) of the subjects. At Day 180, the mean PGAIS was +1 (improved) or +2 (very much improved) in 39% ( n = 26) of the subjects. CONCLUSION: CHH is an effective tool for treating cellulite dimples and improving gluteal contour.

A Randomized, Single-Center, Double-Blinded, Split-Body Clinical Trial of Poly- l -Lactic Acid for the Treatment of Cellulite of the Buttocks and Thighs.

BACKGROUND: More than 90% of women report concerns of cellulite on their skin. Poly- l lactic acid (PLLA-SCA) is a biocompatible, semipermanent, synthetic filler that induces neocollagenesis. OBJECTIVE: To investigate the safety and efficacy of PLLA-SCA for the treatment of cellulite of the buttock and thigh regions. METHODS: This was a prospective, single-center, double-blinded, split-body, clinical trial of 20 women with slight to moderate skin laxity of the buttocks and/or thighs contributing to mild-to-moderate cellulite. Each subject's buttocks and thighs were randomized to receive injections with up to 2 vials of PLLA-SCA or the equivalent volume of bacteriostatic water per treatment area. Subjects received at total of 3 treatments 4 weeks apart and were followed for 330 days. RESULTS: Treatment of the buttocks with PLLA-SCA resulted in significant reduction of depression depth, improvement in the morphological appearance of the skin, improvement in the grade of skin laxity, and overall improvement in cellulite appearance. Treated thighs showed reduction in the depth and number of depressions and an improvement in overall cellulite appearance. No significant procedure side effects were found. CONCLUSION: Poly- l lactic acid offers an effective and safe method for treating cellulite of the buttocks and thighs.