Recruitment of medical graduates from Prague to foundation programme jobs in a UK hospital: results of a 6-year project.

Introduction: International medical graduates (IMGs) are required to fill foundation-level posts in the NHS. Recruiting for these posts is difficult and time consuming. In 2016, we created a link between the Great Western Hospital, Swindon and Charles University, Prague to recruit to these posts. Here, we describe in detail the recruitment process, level of support and outcomes after 6 years, including the success rate of completion of foundation training and their career progression. Methods: Formal structured interviews occurred in Prague or online. Support included tailored educational/clinical supervision and additional simulation sessions. Data collected included exception reports and sick leave records. In 2022, a survey established satisfaction levels with the project and subsequent career progression. Results: All 51 doctors (100%) recruited as IMGs completed foundation training. Exception reporting and sick leave were below the Trust average. Of those doctors, 39 (76%) replied to the survey. All reported that the appointments helped them progress in their careers and 23 (45%) have subsequently been appointed successfully to a national Specialty Training Scheme. Conclusions: This project improved recruitment of non-deanery foundation doctors, prevented rota gaps and provided adequate staffing of junior doctors in our hospital. Concerns around employment of IMGs can be offset by providing a supportive and developmental environment.

Clinical Skills Day: A Novel Approach to Enhancing Procedural Skills Teaching for Foundation Year One Doctors.

Background Completion of the Foundation Year One (FY1) doctor training is a requirement for full General Medical Council registration in the United Kingdom. Training during this year is mapped to a curriculum with one of the key elements being safe procedural skills. The objective of this project was to improve the teaching of procedural skills through the means of a Clinical Skills Day (CSD) and to quantify any improvement. Materials and methods A one-group pretest-posttest design was conducted on 32 doctors who completed a confidence inventory before and after four core procedural stations: suturing, urethral catheterisation (both male and female), lumbar puncture, and bimanual and speculum examinations. The intervention of simulated procedural skills occurred under the supervision of senior clinicians, with FY1 doctors receiving teaching and practising the four skills. The primary outcome was the impact of a CSD on trainees' confidence in performing certain skills. Pre- and post-CSD trainees' confidence levels were collected via an online-focused questionnaire and descriptive statistics, paired t-test, and one-way analysis of variance (ANOVA) with post-hoc Bonferroni comparisons were undertaken for statistical analysis. Results The difference in the mean scores of confidence post-intervention was significant in all four procedural stations with or without supervision (p <0.0001). Conclusions The use of CSDs impacted positively on the FY1 doctors' confidence in performing certain skills. Wider implementation of this promising approach for Foundation Doctors is recommended.

The Citizen Psychologist Curriculum-Preparing psychologists for public service: The 2018 American Psychological Association Presidential Initiative.

This article describes a curriculum developed as part of the American Psychological Association President Jessica Henderson Daniel's, 2018 Presidential Initiative-The Citizen Psychologist. The curriculum is designed to prepare the next generation of Citizen Psychologists to provide the broadest sense of service as leaders in their communities and in public service psychology. The curriculum prepares the learner to bring psychological knowledge, science, and expertise to bear on existing challenges to improve community well-being locally, nationally, and globally. This includes addressing the services needs of various vulnerable populations such as veterans, prisoners, the seriously mentally ill, those with substance abuse problems, children, and older adults. Competency-based curricula are presented in a series of modules, each dedicated to a level of education and training from high school through lifelong learning. Each module presents learning outcomes, activities, and resources designed to develop level-specific competencies. Steps for implementation and recommendations at the local and national level are provided. Implications of incorporating the Citizen Psychologist curriculum in education and training programs are discussed including encouraging students to explore volunteer and career opportunities in public service psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mania presenting as a VZV encephalitis in the context of HIV.

Acute encephalitis can be life-threatening, especially in the immunocompromised population. Viruses are the main infectious agents, with varicella zoster virus (VZV) a common cause. Neuropsychiatric symptoms are well documented, but it is rare for mania to be the only symptom on presentation. Here, we report a case of hypomania in a 31-year-old white British heterosexual man who following investigation was found to be HIV positive and subsequently diagnosed with VZV encephalitis. To date, we are unaware of any similarly reported cases. It is important to raise awareness of atypical HIV presentations to improve clinical outcomes for patients.

Earth Observation-Based Ecosystem Services Indicators for National and Subnational Reporting of the Sustainable Development Goals.

Decision-making that impacts sustainability occurs at national and subnational levels, highlighting the need for multi-scale Earth observations (EO) and geospatial data for assessing the United Nations' Sustainable Development Goals (SDGs). EnviroAtlas, developed by the United States Environmental Protection Agency and partners, provides a collection of web-based, interactive maps of environmental and socio-economic data relevant to the SDGs. EnviroAtlas maps ecosystem services indicators at national, regional, and local extents that can contribute to targets set forth in numerous goals, such as SDG 6 for clean water, SDG 11 for sustainable cities and communities, and SDG 15 for life on land. Examples of EnviroAtlas indicators that provide a way to view spatial inequalities, help fill gaps in environmental indicators, and integrate socio-economic and environmental data for the SDGs are explored herein. Remotely sensed EO data are essential for producing these indicators and informing planning and decision-making for the SDGs at subnational scales. The National Land Cover Dataset is the basis for many EnviroAtlas maps at the national extent, while National Agriculture Imagery Program and Light Detection and Ranging (LiDAR) data are used to classify Meter-scale Urban Land Cover in select US metro areas. These 30 meter and 1 meter land cover products are combined with demographic and other geospatial data (remotely sensed and otherwise) to produce integrated indicators that can aid in target setting of the SDGs. Though EnviroAtlas was created for the conterminous US, the methods for indicator creation are transferable, and the open-source code for the EnviroAtlas resource may serve as an example for other nations. Achieving the SDGs means assessing targets and decision-making outcomes at local, regional, and national levels using consistent and accurate data. Geospatial resources like EnviroAtlas that provide open access to indicators based on EO data and allow for assessment at multiple extents and resolutions are critical to broadly addressing national to subnational SDG goals and targets.

Electrochemical Aptamer Scaffold Biosensors for Detection of Botulism and Ricin Proteins.

Electrochemical DNA (E-DNA) biosensors enable the detection and quantification of a variety of molecular targets, including oligonucleotides, small molecules, heavy metals, antibodies, and proteins. Here we describe the design, electrode preparation and sensor attachment, and voltammetry conditions needed to generate and perform measurements using E-DNA biosensors against two protein targets, the biological toxins ricin and botulinum neurotoxin. This method can be applied to generate E-DNA biosensors for the detection of many other protein targets, with potential advantages over other systems including sensitive detection limits typically in the nanomolar range, real-time monitoring, and reusable biosensors.

Cuidados de enfermagem nas complicações no pós-operatório de cirurgia de revascularização do miocárdio / Cuidados de enfermería en las complicaciones en el post-operatorio de cirugía de revascularización del miocardio / Nursing care in postoperative complications of myocardial revascularization surgery

Objetivo descrever as complicações e os cuidados de enfermagem ofertados aos pacientes no pós-operatório da cirurgia de revascularização do miocárdio. Método estudo descritivo retrospectivo, com abordagem quantitativa, realizado mediante análise de 80 prontuários de indivíduos submetidos à cirurgia de revascularização do miocárdio entre janeiro e dezembro de 2014. Resultados dentre as complicações encontradas no pós-operatório, destacaram-se as complicações pulmonares (82,5%) e as cardíacas (30%). Notou-se que a monitoração do equilíbrio de líquido e dos sinais vitais, seguido pelo reconhecimento na alteração da pressão sanguínea foram os cuidados de enfermagem mais ofertados. Conclusões a monitoração dos sinais vitais, o reconhecimento da alteração da pressão sanguínea, a monitoração do equilíbrio de líquidos e dos padrões respiratórios para bradipneia, taquipneia e hiperventilação foram os cuidados de enfermagem mais ofertados aos pacientes no período pós-operatório da cirurgia de revascularização do miocárdio.

Objetivo describir las complicaciones y los cuidados de enfermería ofertados a los pacientes en el post-operatorio de la cirugía de revascularización del miocardio. Método estudio descriptivo retrospectivo, con enfoque cuantitativo, realizado mediante análisis de 80 prontuarios de individuos sometidos a la cirurgia de revascularización del miocardio entre enero y diciembre de 2014. Resultados dentro de las complicaciones encontradas en el post-operatorio, se destacaron las complicaciones pulmonares (82,5%) y las cardíacas (30%). Se notó que el monitoreo del equilibrio de líquido y de los signos vitales, seguido por el reconocimiento en la alteración de la presión sanguínea fueron los cuidados de enfermería más ofertados. Conclusiones el monitoreo de los signos vitales, el reconocimiento de la alteración de la presión sanguínea, el monitoreo del equilibrio de líquidos y de los padrones respiratorios para bradipnea, taquipnea y hiperventilación fueron los cuidados de enfermería más ofertados a los pacientes en el período post-operatorio de la cirugía de revascularización del miocardio.

Objective to describe the complications and the nursing care offered to patients in the postoperative period of myocardial revascularization surgery (MRS). Method a retrospective descriptive study with quantitative approach was carried out through the analysis of 80 medical charts of individuals submitted to MRS between January and December 2014. Results pulmonary (82.5%) and cardiac (30%) were the most frequent complications found in the postoperative period. It was observed that monitoring fluid balance and vital signs, followed by detection of altered blood pressure were the most frequently provided nursing care measures. Conclusions monitoring of vital signs, recognition of changes in blood pressure, monitoring of fluid balance and of respiratory patterns for bradypnea, tachypnea, and hyperventilation were the most frequently offered nursing care measures to patients in the postoperative period of myocardial revascularization surgery (MRS).

Interdisciplinary debate in the teaching-learning process on bioethics: academic health experiences / Calendario reproduDebate interdisciplinario en el proceso de aprendizaje en la bioética: experiencias de los alumnos de las carreras del área de la salud / Debate interdisciplinar no processo ensino aprendizagem em bioética: experiências de acadêmicos da área da saúde

Objective.The study aimed to understand the health of student experiences to participate in interdisciplinary discussions in bioethics and know the contributions of interdisciplinary methodological resource for the teaching-learning process at graduation. Methods. Descriptive study of qualitative approach in a public higher education institution of Divinópolis, Minas Gerais, Brazil. Results. Three categories of analysis were identified: ''active methodologies in the training of a professional critic,'' ''interdisciplinary debate as facilitator reflection of bioethics'' and ''feelings and attitudes caused by the interdisciplinary debate.'' Discussion. There was a lack of approach of bioethical contents in the health curriculum, and the adoption of active methodologies provides a better reflection in bioethics, but that requires changing paradigms of teachers and educational institutions.

Objetivo.Comprender las experiencias de los alumnos, participantes en los debates interdisciplinarios en bioética, de las carreras del área de la salud y conocer las aportaciones de este recurso metodológico para el proceso de enseñanza-aprendizaje en el pregrado. Métodos. Estudio descriptivo de enfoque cualitativo de tipo análisis de contenido realizado en una institución de educación superior pública de Divinópolis, Minas Gerais, Brasil. Participaron 15 estudiantes (12 de enfermería y tres de medicina). Resultados. Se identificaron tres categorías de análisis: ''metodologías activas en la formación de un profesional crítico'', ''debate interdisciplinario como facilitador de la reflexión de la bioética'', y ''sentimientos y actitudes provocadas por el debate interdisciplinario''. Se evidenció que existe una falta de enfoque de los contenidos bioéticos en el plan de estudios de la salud. Conclusión. La adopción de la metodología activa del debate interdisciplinario posibilitó una mejor reflexión de la bioética, contribuyendo a la formación del futuro profesional.

Objetivo.O estudo buscou compreender as experiências de acadêmicos de saúde ao participarem de debates interdisciplinares em bioética e conhecer as contribuições do recurso metodológico mesa interdisciplinar para o processo ensino-aprendizagem na graduação. Métodos. Estudo descritivo, de abordagem qualitativa, em uma instituição de ensino superior pública de Divinópolis, Minas Gerais, Brasil. Participaram 15 estudantes (12 de enfermagem e três de medicina). Resultados. Identificaram-se três categorias de análise: ''metodologias ativas na formação de um profissional crítico'', ''debate interdisciplinar como facilitador da reflexão da bioética'' e ''sentimentos e atitudes provocadas pelo debate interdisciplinar''. Discussão A adoção da metodologia ativa do debate interdisciplinar possibilitou uma melhor reflexão da bioética, contribuindo à formação do futuro profissional.

Processo Ensino-Aprendizagem em Bioética: um Debate Interdisciplinar / The Learning Process in Bioethics: an Interdisciplinary Debate

RESUMO Introdução Mediante as transformações políticas, científicas e epidemiológicas, surgem novas demandas de cuidados e a necessidade de formar profissionais críticos frente aos problemas bioéticos. Objetivo Identificar as experiências de profissionais participantes de uma mesa interdisciplinar voltada ao processo ensino-aprendizagem em bioética. Métodos Estudo descritivo, de abordagem qualitativa, por meio da análise de conteúdo de Bardin, na modalidade análise temática. Resultados e discussão Foram entrevistados 11 profissionais de saúde e humanas, participantes dos debates promovidos numa universidade pública federal de Divinópolis (MG), Brasil. Dos relatos emergiram duas categorias de análise: “o debate interdisciplinar como ferramenta para o processo ensino-aprendizagem” e “perplexidade mediante a complexidade dos temas bioéticos”. Os profissionais ressaltaram a relevância dos debates, por possibilitarem a interlocução entre teoria e prática, e por vislumbrarem diferentes contextos e opiniões. Destacaram a necessidade de espaços de reflexão e discussão frente à complexidade dos temas. Considerações finais O debate em mesas interdisciplinares favorece o processo ensino-aprendizagem, oferecendo subsídios para o posicionamento dos profissionais e para uma tomada de decisão consciente frente aos problemas bioéticos da atualidade.

ABSTRACT Introduction By means of the political, scientific and epidemiological changes, there have emerged new demands for care and the need to train professionals to play critical roles related to bioethical issues. Objective To identify the experiences of professionals who participated in an interdisciplinary panel discussion about the learning process in bioethics. Methods A descriptive study of a qualitative approach, using Bardin’s content analysis, thematic analysis mode. Results and discussion We interviewed 11 health and humanities professionals, participants in the debates held at a federal public university in Divinópolis, Minas Gerais, Brazil. Two categories of analysis emerged from the reports: “the interdisciplinary debate as a tool for the learning process” and “perpexity in view of complex bioethical issues”. The professionals highlighted the relevance of the debate, as it supported a dialogue between theory and practice and the consideration of different backgrounds and opinions. They highlighted the need for spaces for reflection and discussion, considering the complexity of the issues. Conclusion The debate through interdisciplinary tables favors the teaching-learning process, offering support for the placement of professionals and conscientious decision-making regarding contemporary bioethical issues.

Interdisciplinary debate in the teaching-learning process on bioethics: academic health experiences.

OBJECTIVE: The study aimed to understand the health of student experiences to participate in interdisciplinary discussions in bioethics and know the contributions of interdisciplinary methodological resource for the teaching-learning process at graduation. METHODS: Descriptive study of qualitative approach in a public higher education institution of Divinópolis, Minas Gerais, Brazil. RESULTS: Three categories of analysis were identified: ''active methodologies in the training of a professional critic,'' ''interdisciplinary debate as facilitator reflection of bioethics'' and ''feelings and attitudes caused by the interdisciplinary debate.'' Discussion. There was a lack of approach of bioethical contents in the health curriculum, and the adoption of active methodologies provides a better reflection in bioethics, but that requires changing paradigms of teachers and educational institutions.

Electrochemical aptamer scaffold biosensors for detection of botulism and ricin toxins.

Protein toxins present considerable health risks, but detection often requires laborious analysis. Here, we developed electrochemical aptamer biosensors for ricin and botulinum neurotoxins, which display robust and specific signal at nanomolar concentrations and function in dilute serum. These biosensors may aid future efforts for the rapid diagnosis of toxins.

"SHOUT" to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital.

Acute kidney injury (AKI) affects up to 20% of all patients admitted to hospital, and is associated with a higher risk of adverse clinical outcomes, increased healthcare costs, as well as long term risks of chronic kidney disease and end stage renal failure. The aim of this project was to improve the quality of care for patients with AKI admitted to the acute medical unit (AMU) at the Great Western Hospital (GWH). We assessed awareness and self reported confidence among physicians in our Trust, in addition to basic aspects of care relevant to AKI on our AMU. A multifaceted quality improvement strategy was developed, which included measures to improve awareness such as a Trust wide AKI awareness day, and reconfiguring the admission proforma on our AMU in order to enhance risk assessment, staging, and early response to AKI. Ancillary measures such as the dissemination of flashcards for lanyards containing core information were also used. Follow up assessments showed that foundation year one (FY1) doctors' self reported confidence in managing AKI increased from 2.8 to 4.2, as measured on a five point Likert scale (P=0.0003). AKI risk assessment increased from 13% to 57% (P=0.07) following a change in the admission proforma. Documentation of the diagnosis of AKI increased from 66% to 95% (P=0.038) among flagged patients. Documentation of urine dip results increased from 33% to 73% (P=0.01), in addition to a rise in appropriate referral for specialist input, although this was not statistically significant. Our results suggest that using the twin approaches of improving awareness, and small changes to systemic factors such as modification of the admission proforma, can lead to significant enhancements in the quality of care of patients with AKI.

Linking ecosystem services and human health: the Eco-Health Relationship Browser.

OBJECTIVES: Ecosystems provide multiple services, many of which are linked to positive health outcomes. Review objectives were to identify the set of literature related to this research topic, and to design an interactive, web-based tool highlighting the weight of evidence, thus making the information more accessible. METHODS: A systematic review was conducted to create the Eco-Health Relationship Browser ( http://www.epa.gov/research/healthscience/browser/introduction.html ). The search was conducted in four stages utilizing Google Scholar, PubMed and Science Direct, targeted journals, and targeted keywords; search results were limited to peer-reviewed journal articles published in English from 1 January 1990 to 31 December 2012. RESULTS: The review identified 344 relevant articles; a subset of 169 articles was included in the Browser. Articles retrieved during the search focused on the buffering and health-promotional aspects of ecosystem services. Landscape and Urban Planning, Urban Forestry and Urban Greening, and Health and Place yielded the most articles relevant to this search. CONCLUSIONS: Results from the systematic review were used to populate the Browser, which organizes the diverse literature and allows users to visualize the numerous connections between ecosystem services and human health.

Getting the measure of syphilis: qPCR to better understand early infection.

OBJECTIVES: Until recently, PCR had been used to detect but not quantify Treponema pallidum. To understand infection kinetics of this uncultivable organism, a real-time PCR assay was developed to quantify 47 kDa membrane lipoprotein gene DNA (tpp47). METHODS: Assay specificity was determined against DNA from humans, skin organisms and sexually transmitted pathogens. tpp47 DNA (Nichols strain) was used to construct a standard curve for T pallidum quantification. Blood and ulcer samples were obtained from 99 patients being investigated or screened for syphilis and tpp47 was quantified. RESULTS: The assay was specific, not cross-reactive with other organisms tested and sensitive, with a detection limit of a single copy of tpp47 DNA. For ulcer samples, the assay was 100% sensitive and 97.14% specific. Sensitivity fell to 34.1% for blood samples but specificity remained high (100%). tpp47 DNA was more commonly detected, and at a higher copy number, in blood of patients with secondary infection (sensitivity 57.89%) compared with primary infection. Quantity of tpp47 DNA was higher in primary infection ulcers, especially in HIV-1-positive patients, than in ulcers persisting into secondary disease. CONCLUSIONS: Quantifying T pallidum provides insight into syphilis infection kinetics: Ulcers of primary disease in HIV-1-positive patients are perhaps more infectious and the presence and load of T pallidum bacteraemia is variable, with a peak in the secondary stage. Quantitative PCR has the potential to map T pallidum infection and to highlight the impact of HIV on syphilis.

Septic illness and Kaposi's sarcoma.

Kaposi's sarcoma (KS) usually presents with typical skin lesions. We report two cases that presented with illnesses suggesting major sepsis, but were found to have disseminated KS at postmortem with little in the way of cutaneous involvement.

Individual and cultural-diversity competency: focus on the therapist.

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was held in Arizona in November 2002. One of the workshops, Individual and Cultural Differences (ICD), focused on racism, homophobia, and ageism. The consensus was that self-awareness and knowledge about the three "isms" are critical components in the education and training of psychologists. This article, authored by four of the workshop attendees, is a review of the current research and theoretical literature. Implications that address both content and context in graduate programs and training sites are presented. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Helping adolescents cope with stress during stressful times.

Increasing levels of stress in the daily lives of adolescents is an important health concern. Adolescents experience a variety of stressful situations and use a wide range of coping strategies to help effectively manage stress. Recent research on adolescent coping with stressful situations is reviewed. Findings support an association between coping and adolescent health problems, chronic physical illness, and mental health. More research is needed to investigate the long-term benefits of coping with stress on adolescent health and well-being. Specific recommendations for helping adolescents cope with stressful situations are discussed. Health care providers are encouraged to assess how adolescents cope with acute and chronic stressors and provide adolescents with information about coping with stressful situations.