Continuing professional development for Physician Associates in primary care.

The Physician Associate role is relatively new to the United Kingdom and is currently undergoing a period of significant expansion. This includes an aim of 1000 PAs working in primary care by 2020. The profession has specific continuing professional development requirements which need to be addressed. These requirements can be met through the deployment of some well established pedagogical strategies which are already in use for junior doctors and allied health professionals.

Comparison of the scope of practice of physician associates with that of healthcare professions with prescribing responsibility from point of registration.

Physician associates (PAs) have been practising in the UK since the mid-2000s and are due to be regulated by the General Medical Council (GMC) after summer 2024. Presently, PAs are not able to prescribe prescription-only medication (POM), but this is anticipated to change following GMC regulation. This research compared the scope of practice (SoP) of PAs with other healthcare professionals who have some level of prescribing authority from the point of registration, to establish the need for PAs to prescribe POM and to explore which of the prescribing authority options would fit the PA role. The comparison demonstrates that PA SoP would suggest the need to prescribe POM, and that any prescribing authority should not be limited to a set clinical speciality or patient population. Additional research is needed to explore PA clinical practice further and identify the range of POM for which PAs need prescribing authority.

Is our bTB policy one of the worst attempts to control a major notifiable disease ever seen?

A group of experienced vets argue that the lack of control of endemically TB-infected communities of badgers has resulted in a bovine TB dilemma that is worse now than it was 50 years ago.

'It's oxymoronic for vets to be activist vegans'.

Neil Howie argues that livestock farming is essential to meet the global demand for food and that vets should be focusing on improving the food-animal cycle rather than abolishing it.

Do peripheral blood cultures taken in the emergency department influence clinical management?

BACKGROUND: Blood cultures are routinely used to investigate suspected sepsis in the emergency department despite several studies showing their limited influence on patient management. OBJECTIVES: To quantify the use and clinical relevance of blood cultures obtained in the emergency department. METHODS: A retrospective study of blood cultures taken in the emergency department between 1 January 2003 and 31 December 2004. Microbiology results and patients' records were reviewed to determine the influence of positive cultures on subsequent patient management. RESULTS: 2213 blood cultures were taken in the emergency department over the study period. 132 (6%) yielded a positive result. Three positive cultures had incomplete information. Of the remaining 129 positive cultures, 30 (1.4% of all cultures) were "true positives" and 4 (0.18%) influenced subsequent patient management. CONCLUSIONS: Blood cultures taken in our emergency department (Southern General Hospital, Glasgow, UK) rarely yield bacterial growth, and over 2 years only four cultures seemed to directly influence patient management. Better guidelines are required for targeted use of blood cultures in the emergency department.

Do peripheral blood cultures taken in the emergency department influence clinical management?

BACKGROUND: Blood cultures are routinely used to investigate suspected sepsis in the emergency department despite several studies demonstrating their limited influence on patient management. OBJECTIVES: To quantify the use and clinical relevance of blood cultures obtained in the emergency department. METHODS: A retrospective study of blood cultures taken in the emergency department between 1 January 2003 and 31 December 2004. Microbiology results and patient records were reviewed to determine the influence of positive cultures on subsequent patient management. RESULTS: 2213 blood cultures were taken in the emergency department over the study period. 132 (6%) yielded a positive result. Three positive cultures cases had incomplete information. Of the remaining 129 positive cultures, 30 (1.4% of all cultures) were "true positives" and 4 (0.18%) influenced subsequent patient management. CONCLUSIONS: Blood cultures taken in our emergency department rarely yield bacterial growth and over 2 years, only four seemed to directly influence patient management. Better guidelines are required for targeted use of blood cultures in the emergency department.

Can opportunistic case-finding of paraproteins be clinically justified?

The addition of serum protein electrophoresis by laboratory staff upon finding an increased total protein or globulin appears to be practised widely in the UK. The criteria for assessing which samples are subject to electrophoresis vary considerably. They consist of initial objective laboratory data subsequently modified, somewhat subjectively, by other laboratory data and clinical details, but have often been chosen pragmatically. The aim of the practice is to identify patients with occult B-cell malignancies that warrant treatment. While it has been lent legitimacy in many cases by involving clinical haematologists in discussions, the views of other stakeholders, including other physicians and patients, have often not been considered, thus raising a number of ethical questions that need to be addressed. The practice is reviewed against both current knowledge of B-cell malignancies and monoclonal gammopathy of undetermined significance and criteria for screening, of which this forms a particular example. The arguments for and against addition of electrophoresis are finely balanced, partly because of the very limited outcome data available. We conclude that those currently following this practice should continue to do so, there is a need to establish outcome data as widely as possible according to standard criteria and there should be involvement of physicians, patients and national bodies in discussions about the practice so that the practical and ethical issues can be addressed.

Mycoplasma bovis and otitis in dairy calves in the United Kingdom.

Signs of severe otitis media in 20% of dairy calves on one farm were associated with Mycoplasma bovis infection, based on isolation from the external ear canal and nares. Affected calves seroconverted to M. bovis and no other significant bacteria were isolated. Infection was considered likely to have originated from cows in the milking herd based on evidence of seroconversion and detection of infection in a milk sample. M. bovis infection should be considered when investigating otitis problems in calves.