Patient-controlled variable dosing of levodopa for Parkinson's disease.

Medication for idiopathic Parkinson's disease (PD) is for symptomatic relief, and typically, patients are advised to take their medication at agreed regular times. Here, we present a lady with moderate PD and superimposed anxiety for whom this management strategy did not work well as it increased her anxiety significantly around dosing times. She was switched to an PRN regime and although taking the same total dose of levodopa with similar symptom control was overall much happier. Although there are sound reasons behind regular dosing of levodopa (its short duration of action and relationship of clinical response to plasma concentration), a holistic co-created management plan against classical advice but taking into account the psychological burden of disease and medication may in many cases be more appropriate.

Physician trainee research collaboratives: a mixed methods exploration of UK experience.

BACKGROUND: Physician trainee research collaboratives (TRCs) help trainees develop research skills and establish peer networks. We aimed to identify the structure, activity and views of physician TRCs in the UK. METHODS: Representatives from physician TRCs in the UK were invited to complete an online survey and participate in a focus group. RESULTS: Representatives from 23 physician TRCs completed the survey. There was wide variation in collaborative structure, senior input and funding resources. Seventy-four per cent of physician TRCs had published peer-reviewed articles, with 70% reporting ongoing projects at the time of the survey. The survey and focus group identified improved patient care, research and leadership skills as benefits of collaborative work; while institutional and consultant support, limited time for research, funding opportunities and restrictions on group authorship were cited as challenges to collaborative success. CONCLUSION: Physician TRC activity continues to grow and demonstrates a dynamic approach to research for all trainees.

Exception reporting in 2018: how often is it happening?

BACKGROUND: Exception reporting is the main process in England to resolve issues related to junior doctor working hours. Concerns have been raised regarding variable report submission, but no significant exploration has occurred. This study assesses frequency of exception reporting and correlates it with frequency of working beyond rostered hours and overall satisfaction. METHODS: National training survey (NTS) scores for 'Overall Satisfaction' and frequency of working beyond rostered hours was obtained for 26 randomly identified trusts throughout England and correlated with exception reporting frequency from guardian of safe working (guardian) quarterly reports covering April 2018. RESULTS: Guardian reports were obtained for 24 trusts. NTS data suggest trainees worked beyond their rostered hours 12.1 times per quarter (interquartile range (IQR) 10.0-12.9) whereas guardian reports show they exception reported 0.15 times per quarter (IQR 0.084-0.25). Trainees exception report 1.2% of the time they work beyond rostered hours (IQR 0.8-2.4%).Frequency of exception reporting correlates poorly with the frequency with which trainees work beyond rostered hours (coefficient -0.22) and with a marker of overall satisfaction (coefficient -0.21). CONCLUSION: The current exception reporting process significantly under-reports trainee working hours although there is regional variation.

The role of the future physician: building on shifting sands.

The role of the future physician in the NHS is of interest to current doctors, patients, policymakers and the wider public. Amid the COVID-19 pandemic, it has never been more clear that the healthcare needs of the population, and the technical and scientific advances with which to solve them, are rapidly evolving and the medical workforce must adapt to these changes to deliver personalised healthcare. This article considers the current challenges that need to be addressed to deliver a future physician-led healthcare service that works for its patients. Key themes are expanded upon, including the changing healthcare workforce, digital and technological innovation, service delivery, complex conditions and changing patient demographics. The impact and challenges of the ongoing COVID-19 pandemic on these factors are highlighted. Avenues for development are suggested, both in postgraduate medical training and the health service as a whole. These changes will be required to deliver the physicians of the future, imbued with the skills and attributes they will need to provide a high standard of care in the mid-21st century.

Rostering in a pandemic: Sustainability is key.

In preparation for the peak of the first wave of COVID-19, many healthcare organisations implemented emergency rotas to ensure they were adequately staffed. These rotas - while addressing the acute issues - are in many cases not sustainable. As we move past the peak and services start resuming, many organisations need to reassess their rotas. There are considerable wellbeing benefits to optimal rostering. In this article we discuss how best to achieve this and suggest a number of key principles, including the following: involvement of staff affected by the rota; taking into account individual circumstances; building in flexibility and adequate time for rest; and designing rotas for different grades of staff together to create stable teams.

The tryptophan 620 allele of the lymphoid tyrosine phosphatase (PTPN22) gene predisposes to autoimmune Addison's disease.

OBJECTIVE: Previous studies of the association between autoimmune Addison's disease (AAD) and a nonsynonymous single nucleotide polymorphism (SNP) in the PTPN22 gene (C1858T, pR620W; SNP ID no. rs2476601) have shown conflicting results. We aimed to examine this association using additional cohorts of AAD subjects from the UK and Poland. DESIGN: DNA samples were obtained from UK and Polish AAD subjects (n = 251 and 87, respectively) and ethnically matched healthy controls (n = 429 and 236, respectively). Genotyping for the C1858T PTPN22 marker was performed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assay. Meta-analysis of the results, together with those from three other populations, was performed using RevMan v5.0 software. RESULTS: In 251 UK AAD subjects the frequency of the PTPN22 1858T allele was 12.2% compared to 7.8% in healthy UK controls; P = 0.008. Similarly, in 87 Polish AAD subjects the PTPN22 1858T allele was found in 19.5% of alleles compared to 11.7% in healthy Polish subjects; P = 0.010. A meta-analysis, combining these result with published data for three other populations, involving 797 AAD subjects and 2032 controls in total, showed that the 1858T allele was associated with AAD susceptibility with a pooled odds ratio (OR) of 1.44 [95% confidence interval (CI) 1.21-1.72; P = 5.6 x 10(-5)], under a fixed-effects model. CONCLUSION: This study confirms the association between the PTPN22 1858T allele and AAD in an expanded UK cohort and in the previously unstudied Polish population. This meta-analysis allows for the first time a reliable estimate of the strength of effect of this autoimmune disease susceptibility allele across different European Caucasian populations.

Factors influencing overall satisfaction of Core Medical Trainees in the Yorkshire and the Humber region, UK.

BACKGROUND: This study explores the importance of various factors upon the overall satisfaction of Core Medical Trainees (CMTs) in the Yorkshire and Humber Deanery to aid targeting of improvement efforts. METHODS: Responses for all CMTs in Yorkshire and the Humber to all questions and domains from the UK National Training Survey 2017 were correlated with a marker of overall trainee satisfaction. Questions with high and low degrees of correlation were identified, as well as recurrent themes. RESULTS: Clinical supervision appears to be closely related to overall trainee satisfaction, frequently correlating well, whereas educational supervision does not. Almost all themes with high correlation were regarding day-to-day experience, whereas those correlating poorly were regarding infrastructure issues. CONCLUSIONS: Assuming similar costs, to improve overall trainee experience the most limited resources are probably best targeted at those factors influencing day-to-day experience, such as freeing consultant time for clinical supervision rather than developing one-off trainee experiences.