Extension of general practice training from three to four years: experiences of a vocational training programme in Southern Ireland

The aim of this study was to evaluate the experiences of trainees taking part in an extended (four-year) general practice training programme introduced in the South Eastern region of the Republic of Ireland to replace the previous traditional (three-year) programme. In a qualitative design, eight homogeneous focus groups were held to determine the value of the additional year of training. The first cohort of trainees was interviewed towards the start and at the end of their fourth year. Trainees finishing the following year were also interviewed, as were graduates from the final three-year programme. GP trainers and the four members of the programme directing team comprised two further independent focus groups. Trainees reported that the integration of hospital posts and general practice attachments over the four years was particularly beneficial. The exposure to a variety of different general practices and the opportunity to take part in specialty clinics were considered extremely useful. The fourth year of training was felt to be less pressurised than previous years. Professional and personal development was enhanced; improved readiness to practise and confidence were noted. Perceived disadvantages of extended training included a lack of acknowledgment for doctors in their fourth year and excessive emphasis placed on research during the final year of training. The addition of an extra year of vocational training improves professional and personal development and changes the learning experience for doctors. Doctors felt more confident and ready to enter independent practice at the end of the fourth year of training.

The effect of essentialism in settings of historic intergroup atrocities

Three studies tested the effects of essentialist beliefs regarding the national ingroup in situations where a perpetrator group has inflicted harm on a victim group. For members of the perpetrator group, it was hypothesised that ‘essentialism’ has a direct positive association with ‘collective guilt’ felt as a result of misdeeds conducted by other ingroup members in the past. Simultaneously, it was hypothesised to have an indirect negative association with collective guilt, mediated by perceived threat to the ingroup. Considering these indirect and direct effects jointly, it was hypothesised that the negative indirect effect suppresses the direct positive effect, and that the latter would only emerge if perceived ‘ingroup threat’ was controlled for. This was tested in a survey conducted in Latvia among Russians (N?=?70) and their feelings toward how Russians had treated ethnic Latvians during the Soviet occupation; and in a survey in Germany among Germans (N?=?84), focussing on their feelings toward the Holocaust. For members of the victim group, it was hypothesised that essentialism would be associated with more anger and reluctance to forgive past events inflicted on other ingroup members. It was proposed that this effect would be mediated by feeling connected to the ingroup victims. This was tested in a survey conducted among Hong Kong Chinese and their feelings toward the Japanese and the Nanjing massacre (N?=?56). Results from all three studies supported the hypotheses.

'Murder or Mercy?' an innovative module helping UK medical students to articulate their own ethical standpoints regarding end-of-life decisions

Objectives This student selected component (SSC) was designed to equip United Kingdom (UK) medical students to respond ethically and with sensitivity to requests they might receive as qualified doctors in regard to euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and to provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment. Method The module is delivered by specialists from a number of disciplines including law, theology, medicine and nursing, each providing students with a working knowledge allowing them to actively discuss cases, articulate their own views and practise ethical reasoning through group and individual study. Visits to local intensive care units, palliative care wards and hospices are integrated effectively with theory. Student assessment comprises a dissertation, student-led debate and reflective commentary. Module impact was evaluated by analysis of student coursework and a questionnaire. Results Students found the content stimulating and relevant to their future career and agreed that the module was well-structured and that learning outcomes were achieved. They greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to real cases and to debate ethical issues with peers. Students reported an increased discernment of the ethical and legal position and practical considerations and a greater awareness of the range of professional and lay viewpoints held. Student perceptions were confirmed on analysis of their submitted coursework. Many participants were less strongly in favour of euthanasia and assisted dying on module completion than at the outset but all felt better equipped to justify their own viewpoint and to respond appropriately to patient requests. Conclusions The multi-disciplinary nature of this course is helpful in preparing students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position.

Design and Evaluation of a "Pharmacists in Schools" Community Outreach Programme: A Pilot Study.

Aims: To design, evaluate and pilot a novel programme that would allow school children to become “pharmacists for the day”,encouraging them to recognise the importance of science, to contribute to the Department of Health‟s Building the Community Partnership strategy and University Outreach to the community and to provide undergraduate pharmacy students with teaching experience and an opportunity to build their CV.

Methods: Concept and formulation development, branding work,schools visits,questionnaires and semi-structured interviews.

Results: Suitable formulations were developed and prepared by school children on visits to their schools. The children seemed to enjoy the experience and their teachers gave both positive and constructive feedback. Pharmacy undergraduate students felt they had gained valuable experience that will benefit their future careers.

Conclusion: The Pharmacists in Schools outreach programme has now been successfully piloted and launched and will now be fully implemented in 20 schools in the local community.

Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles

The ankle joint is frequently involved in juvenile idiopathic arthritis (JIA), but it is unclear whether this is predominantly due to synovitis, tenosynovitis, or both. We performed clinic-based ultrasound examination to assess the prevalence of synovitis and tenosynovitis in children with JIA felt clinically to have active inflammatory disease of the ankle.

Children’s views on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To explore the views and perspectives of children on the unlicensed/off-label use of medicines in children and on the participation of children in clinical trials. Methods: Focus-group discussions, involving school children, were carried out in a range of primary and secondary schools in Northern Ireland. A purposeful sample was chosen to facilitate representation of various socioeconomic groupings. Results: A total of 123 pupils, aged from 10 to 16 years, from six schools, participated in 16 focus groups. In general, pupils viewed the unlicensed/off-label use of medicines in children as unsafe and unethical and felt it is necessary to test medicines in children to improve the availability of licensed products. The majority felt that older children should be told, and that parents should be told, about the unlicensed/off-label use of medicines in children, yet they recognised some implications of this, such as potential medication non-adherence. Conclusions: This is the first study to explore the views of healthy children on unlicensed medicine use in children. Children were able to recognise potential risks associated with the unlicensed use of medicines and felt it is necessary to test and license more medicines in children. Practice implications Health care professionals should consider the views of children in decisions that affect their health.

Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

The development of regret

In two experiments, 4- to 9-year-olds played a game in which they
selected one of two boxes to win a prize. On regret trials the unchosen
box contained a better prize than the prize children actually
won, and on baseline trials the other box contained a prize of the
same value. Children rated their feelings about their prize before
and after seeing what they could have won if they had chosen
the other box and were asked to provide an explanation if their
feelings had changed. Patterns of responding suggested that regret
was experienced by 6 or 7 years of age; children of this age could
also explain why they felt worse in regret trials by referring to
the counterfactual situation in which the prize was better. No evidence
of regret was found in 4- and 5-year-olds. Additional findings
suggested that by 6 or 7 years, children’s emotions were
determined by a consideration of two different counterfactual
scenarios.

Does first aid have a place in the medical curriculum? A survey of medical students

Introduction: When a medical emergency occurs in the prehospital environment, there is an expectation from the general public for medical students to offer assistance with a similar level of competence as qualified doctors. However, the question is raised; do medical students have sufficient training in first aid skills to fulfil the role expected of them?

Prior to the publication of the latest version of Tomorrow’s Doctors by the UK General Medical Council, a student selected component (SSC) in first aid was delivered at the medical school in Queen’s University Belfast (QUB), Northern Ireland. The overwhelming popularity of this SSC prompted a desire to investigate and understand students’ experiences of first aid.

Aim: To identify first and second year medical students’ knowledge of, and attitudes towards, first aid and their expectations of the medical curriculum.

Methods: A questionnaire was delivered using TurningPoint Audience Response System® during the second semester of the 2008 - 2009 academic year to all first and second year medical students at QUB.

Results: Less than half of the students felt that they had a good level of first aid knowledge, a third would feel confident helping in an emergency and only 10% would be confident leading an emergency situation. The vast majority of students believed first aid is beneficial, that the general public expect medical students to have the knowledge to handle an emergency situation, and that a full first aid course should be included in the core medical curriculum at an early stage. They did not believe it should be a pre-requisite for medical school.

Conclusion: Only a small proportion believed their first aid knowledge adequate. An overwhelming proportion believed that first aid training is beneficial and that the public expect competency in managing emergencies. This study clearly demonstrates students’ need and desire for first aid training in the core medical curriculum at an early stage and to the highest training level possible.

Water-based colourimetric optical indicators for the detection of carbon dioxide

Water-based colourimetric indicator films are shown to have increased operational lifetimes under ambient conditions compared to similar solvent-based counterparts. The response and sensitivity characteristics of a water-based, carbon dioxide-responsive ink are characterised and compared and contrasted to those of a similar solvent-based indicator. The changes in the response characteristics of the ink as a function of the amount of base (sodium hydrogen carbonate) and plasticizer (glycerol) contained in the ink are reported, as are the effects of varying ambient temperature and humidity. The ink is incorporated into a felt tip pen and applied to a number of different substrates, producing a distinct, reversible colour change on all tested surfaces, when a sufficient level of carbon dioxide is present. The possible application of the indicator is discussed briefly.

Simple method for the rapid simultaneous screening of photocatalytic activity over multiple positions of self-cleaning films

An intelligent ink, previously shown to be capable of rapidly assessing photocatalytic activity, was simply applied via a felt-pen onto a commercially available piece of Activ (TM) self-cleaning glass. The ink, comprising of redox dye resazurin and the sacrificial electron donor glycerol within an aqueous hydroxy ethyl cellulose (HEC) polymer media, was photocatalytically degraded in a two-step process. The key initial stage was the photo-reductive conversion of resazurin to resorufin, whereby a colour change from blue to pink occurred. The latter stage was the subsequent photo-reduction of the resorufin, where a slower change from pink to colourless was seen. Red and green components of red-green-blue colour extracted from flat-bed scanner digital images of resazurin ink coated photocatalytic films at intervals during the photocatalysis reaction were inversely proportional to the changes seen via UV-visible absorption spectroscopy and indicative of reaction kinetics. A 3 x 3 grid of intelligent ink was drawn onto a piece of Activ (TM) and a glass blank. The photocatalysis reaction was monitored solely by flat-bed digital scanning. Red-green-blue values of respective positions on the grid were extracted using a custom-built program entitled RGB Extractor (c). The program was capable of extracting a number of 5 x 5 pixel averages of red-green-blue components simultaneously. Allocation of merely three coordinates allowed for the automatic generation of a grid, with scroll-bars controlling the number of positions to be extracted on the grid formed. No significant change in red and green components for any position on the glass blank was observed; however, the Activ (TM) film displayed a homogenous photo-reduction of the dye, reaching maxima in red and minima in green components in 23 +/- 3 and 14 +/- 2 min, respectively. A compositionally graded N-doped titania film synthesised in house via a combinatorial APCVD reaction was also photocatalytically tested by this method where 247 positions on a 13 x 19 grid were simultaneously analysed. The dramatic variation in photocatalysis observed was rapidly quantified for all positions (2-3 hours) allowing for correlations to be made between thicknesses and N : Ti% compositions attained from Swanepoel and WDX analysis, respectively. N incorporation within this system was found to be detrimental to film activity for the photocatalysis reaction of intelligent ink under 365 nm light.

A study of new photocatalyst indicator inks

This article reports the behaviour of three photocatalyst indicator inks, based on the redox dyes: methylene blue (NIB), resorufin (Rf) and 2,6-dichloroindophenol (DCIP), and assess their performance in comparison to the pioneering resazurin (Rz)-based ink for the rapid assessment of the activity of very thin, photocatalyst films, such as Activ (TM) self-cleaning glass. From a commercial 'demonstrator of photocatalysis' perspective, all three redox dyes appear more attractive compared to Rz since all generate colourless products in the ink formulation when photoreduced on Activ (TM) under anaerobic conditions, whereas, the reduced product from Rz, the redox dye resorufin, Rf. is pink in colour. However, the ink based on Rf is far too slow to effect the rapid measurement of photocatalytic activity even in the absence of oxygen, and in the presence of oxygen the latter inhibits the overall kinetics of photoreduction by re-oxidising the reduced product, dihydroresorufin, HRf, back to Rf. Similarly, despite the attractive rapid rate of photobleaching for NIB under anaerobic conditions, compared to the other redox dyes, the reduced product of the MB-based ink. leuco-MB, is so oxygen-sensitive that the ink cannot be photoreduced under aerobic conditions, thus rendering the ink unsuitable for use in the field. The DCIP-based ink is slightly less easy to photoreduce under both anaerobic and ambient atmospheric conditions compared to the Rz-based ink. However. in addition to its more attractive colour change, the DCIP-based ink is unaffected by the ambient level of oxygen present (%O-2) and the relative humidity (%RH), whereas, for the Rz-based ink, both parameters effect the photoreduction kinetics. By incorporating the DCIP ink into a felt-tipped pen, the ink is suitable for use in the laboratory and field to perform not only a qualitative test, but also to allow a semi-quantitative analysis of photocatalytic activity by eye. (C) 2007 Elsevier B.V. All rights reserved.

Method of rapid assessment of photocatalytic activities of self-cleaning films

An ink, comprising the redox dye resazurin (Rz) and the sacrificial electron donor glycerol, is shown to be capable of the rapid assessment of the photocatalytic activities of self-cleaning films. In the key initial stage of photocatalysis the ink changes from blue to pink. Prolonged irradiation bleaches the ink and eventually mineralizes it. The kinetics of the initial photoinduced color change is studied as a function of UV irradiance, [glycerol], [Rz], and temperature. The results reveal an apparent approximate quantum yield of 3.5 x 10(-3) and an initial rate, r(i), which increases with [glycerol] and decreases with [Rz]. It is proposed that the reduction of Rz, dispersed throughout the thick (ca. 590 nm) indicator film, may take place either via the diffusion of the dye molecules in the ink film to the surface of the underlying semiconductor layer and their subsequent reaction with photogenerated electrons and/or via the diffusion of alpha-hydroxyalkyl radicals, produced by the oxidation of the glycerol by photogenerated holes, or hydroxy radicals, away from the surface of the semiconductor into the ink film and their subsequent reaction with the dye molecules therein. The decrease in r(i) with [Rz] appears to be due to dimer formation, with the latter impeding the reduction process. The activation energy for the initial color-change process is low, ca. 9.1 +/- 0.1 kJ mol(-1) and not unlike many other photocatalytic processes. The initial rate of dye reduction appears to be directly related to the rate of destruction of stearic acid. The ink can be applied by spin-coating, stamping, or writing, using a felt-tip pen. The efficacy of such an ink for assessing the photocatalytic activity of any photocatalytic film, including those employed on commercial self-cleaning glasses, tiles, and paving stones, is discussed briefly.

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

What now for the contact hypothesis? Towards a new research agenda

This article begins with a review of recent research on the Contact Hypothesis. It will be shown that the literature in this area has become essentially closed and self-referential where the core political and theoretical premises that underpin the Hypothesis have been taken for granted and the debates have therefore become restricted simply to how best to measure the influence of inter-group contact. One of the key reasons for this is the lack of critical engagement with the Contact Hypothesis from those of a more structuralist and/or ‘radical’ perspective. This may be because the individualistic focus of the Hypothesis is seen from such a perspective as largely irrelevant to addressing racial and ethnic divisions and/or because it may be felt that to engage with the concept is to give it undue legitimacy. It will be argued in this article, however, that the wholesale dismissal of the Contact Hypothesis is a little premature. Just as recent research on racial and ethnic divisions has drawn attention to the way in which such divisions exist at a number of layers within the social formation – from the structural, political and ideological through to the sub-cultural, interactional and biographical – so must any initiatives aimed at addressing these divisions be similarly ‘multi-layered’ in their approach. However, it will be argued that for research to help inform specific strategies at the interactional level, there needs to be a significant change in the way that inter-group contact, and the Contact Hypothesis more generally, is studied. The article will ‘model out’ one potentially fruitful way in which such research can develop through the use of an ethnographic case study involving a cross-community scheme arranged for Protestant and Catholic children in Northern Ireland.