Enhancing Equity in a Widening Participation Scheme for School Students.

OBJECTIVES: The Royal College of Surgeons (RCS) Diversity Review 2021 found that premedical school students from ethnic minority backgrounds were dissuaded from pursuing a surgical career. Gloucestershire is in the bottom 20% of disadvantaged counties; there is no widening participation (WP) scheme in the county. We implemented a fully inclusive WP scheme in Gloucester, with means of accessing virtual and face-to-face work experience, to enhance the equity of work experience. METHODS: A three-stage project was conducted. Stage 1; two separate virtual Q and A sessions, to allow students to ask questions about life as a doctor. Stage 2; conversation between student and patient held virtually, to gain insight into working as a doctor to help determine whether medicine is the career for them. Stage 3; face-to-face work experience. Distribution sent to all 58 schools (state and private) in the county, targeted at secondary school children. RESULTS: One hundred twenty-nine people attended the Q and A; 70 feedback responses received. Of the total, 86% female and 56% of ethnic minority background. 26% did not have an immediate family member that attended university, 10% had care-giving responsibilities. Eighty-one percent rated the session >8/10 for usefulness. Twenty-seven undertook the virtual conversation, feedback from 11; 91% female, 45% of ethnic minority background, and 27% did not have an immediate family member that attended university. All rated the session 10/10 for usefulness. 10 attended the face-to-face experience, 50% from an ethnic minority background. CONCLUSION: The RCS Report identified barriers to aspiring students from less-privileged backgrounds pursuing a medical career. More needs to be done with WP schemes to promote equity. Targeted distribution of WP schemes to all schools, utilization of a variety of means of offering work experience, and accessibility to any school-aged student were aspects of our WP to improve exposure to the medical profession.

A learning health systems approach to improving the quality of care for patients in South Asia.

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs. However, training for healthcare workers in quality improvement (QI) methodology without buy-in from multidisciplinary stakeholders and without identifying setting-specific priorities is unlikely to be successful. The Care Quality Improvement Network (CQIN) was established between Network for Improving Critical care Systems and Training (NICST) and University College London Centre for Perioperative Medicine, with the aim of building capacity for research and QI. A two-day international workshop, in collaboration with the College of Surgeons of Sri Lanka, was conducted to address the above deficits. Innovatively, the CQIN adopts a learning health systems (LHS) approach to improving care by leveraging information captured through the NICST electronic multi-centre acute and critical care surveillance platform. Fifty-two delegates from across the CQIN representing clinical, civic and academic healthcare stakeholders from six countries attended the workshop. Mapping of care processes enabled identification of barriers and drivers to the delivery of care and facilitated the selection of feasible QI methods and matrices. Six projects, reflecting key priorities for improving the delivery of acute care in Asia, were collaboratively developed: improving assessment of postoperative pain; optimising sedation in critical care; refining referral of deteriorating patients; reducing surgical site infection after caesarean section; reducing surgical site infection after elective general surgery; and improving provision of timely electrocardiogram recording for patients presenting with signs of acute myocardial infarction. Future project implementation and evaluation will be supported with resources and expertise from the CQIN partners. This LHS approach to building capacity for QI may be of interest to others seeing to improve care in LMICs.

Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka.

In this study we examined the costs and effectiveness of using larvivorous fish, Poecilia reticulata, and a chemical larvicide, temephos, in anopheline mosquito control in the riverbeds below the major dams in Sri Lanka. Five riverbeds below the dams, namely Laxapana, Kotmale 1, Kotmale 2, Nilambe, Rantembe and Victoria, were selected. Riverbed pools in Laxapana and Kotmale 1 were treated with P. reticulata; Rantembe and Victoria were treated with temephos; and Kotmale 2 and Nilambe were kept as controls. In each area, the anopheline larval density, before and after application of fish/temephos, was estimated. The cost of application of fish/temephos was estimated by activities involved for each treatment. After intervention, there was a significant reduction in anopheline larval density in the fish-treated areas compared with the temephos-treated and control areas. Application of P. reticulata was 2.67 times less costly than that of temephos. The cost of fish application can be further reduced if the community is involved in the application.

Larvivorous potential of the guppy, Poecilia reticulata, in anopheline mosquito control in riverbed pools below the Kotmale dam, Sri Lanka.

The larvivorous potential of Poecilia reticulata was studied in the laboratory and in the field. In the laboratory, the number of anopheline larvae consumed per fish per day and the number of larvae in fecal matter per fish were determined. In the field study, 29 of 60 selected riverbed pools in Kotmale oya, below the Kotmale dam, were stocked with P reticulata, whereas the rest served as controls. Anopheline larval surveys were carried out starting from 1 day prior to stocking of fish and on selected days subsequently. P. reticulata consumed an average of 117 +/- 32.33 larvae per fish per day. Fecal matter of P. reticulata contained an average of 2.7 +/- 2.68 larvae per fish . There was a significant reduction in the number of pools positive for anopheline larvae (P < .001) after stocking fish and the number of larvae per pool (P < .001) and per 100 dips (P < .001) as compared with controls.

Anopheline breeding in river bed pools below major dams in Sri Lanka.

Anopheline mosquito larval surveys were carried out from September 2000 to August 2002 in Mahaweli and Kelani river beds, below five major dams in the wet and intermediate zones of Sri Lanka, to study the prevalence of anopheline species in these areas. In each study site, all permanent and semi-permanent pools were surveyed fortnightly by dipping at 6 dips/m(2) surface area of water. Larvae were collected in separate containers, staged and identified at their third and fourth stages. During each survey, the surface area and depth of pools were recorded and each reading was considered as an individual observation. River bed pools below the dams contained stagnant clean water with a little or no aquatic vegetation. The majority of pools were < or =1m(2) in surface area and < or =75 cm in depth. Anopheline mosquito breeding was seen throughout the year in each study site. The average percentage of pools positive for anopheline larvae, the number of larvae per 100 pools and 100 dips were 14.85%, 32.34 and 9.29, respectively. Thirteen anopheline species, including 10 potential vectors, namely, An. barbirostris, An. culicifacies, An. jamesii, An. maculatus, An. nigerrimus, An. peditaeniatus, An. subpictus, An. tessellatus, An. vagus and An. varuna were found breeding in the river bed pools.

Larvivorous potential of fish species found in river bed pools below the major dams in Sri Lanka.

Malaria in Sri Lanka is closely associated with the river systems in the country. Construction of major dams across rivers has resulted in year-round pooling and anopheline mosquito breeding in river beds below the dams. This study was carried out to determine the larvivorous activity of fish found in river bed pools below the dams to identify the potential fish species for anopheline larval control in these areas. Fish species in five river beds below the dams, namely, Laxapana, Kotmale, Nilambe, Victoria, and Rantembe, were identified in June 2000. The larvivorous potential of the 12 fish species collected was determined in the laboratory based on the number of larvae consumed per fish within 10 min and an hour. Danio malabaricus Jerdon, Oreochromis mossambicus Peters, Oreochromis niloticus L., and Poecilia reticulata Peters consumed nine or more larvae per fish within 10 min. Aplocheilus dayi Steindachner and Rasbora daniconius Hamilton consumed nine and eight larvae, respectively, within 1 h. O. mossambicus, O. niloticus, and P. reticulata consumed 10 larvae per fish within 10 min. Despite some species having a high larvivorous potential in the laboratory, field studies are required to determine the feasibility of using these fish for anopheline mosquito control in the river bed pools below the dams.