Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Peer tutoring in a medical school: perceptions of tutors and tutees

Background: Peer tutoring has been described as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching”. Peer tutoring is well accepted as a source of support in many medical curricula, where participation and learning involve a process of socialisation.
Peer tutoring can ease the transition of the junior students from the university class environment to the hospital workplace. In this paper, we apply the Experienced Based Learning (ExBL) model to explore medical students’ perceptions of their experience of taking part in a newly established peer tutoring program at a hospital based
clinical school.
Methods: In 2014, all students at Sydney Medical School – Central, located at Royal Prince Alfred Hospital were invited to voluntarily participate in the peer tutoring program. Year 3 students (n = 46) were invited to act as tutors for Year 1 students (n = 50), and Year 4 students (n = 60) were invited to act as tutors for Year 2 students (n = 51). Similarly, the ‘tutees’ were invited to take part on a voluntary basis. Students were invited to attend focus groups, which were held at the end of the program. Framework analysis was used to code and categorise data into themes.
Results: In total, 108/207 (52 %) students participated in the program. A total of 42/106 (40 %) of Year 3 and 4 students took part as tutors; and of 66/101 (65 %) of Year 1 and 2 students took part as tutees. Five focus groups were held, with 50/108 (46 %) of students voluntarily participating. Senior students (tutors) valued the opportunity to practice and improve their medical knowledge and teaching skills. Junior students (tutees) valued the opportunity for additional practice and patient interaction, within a relaxed, small group learning environment.
Conclusion: Students perceived the peer tutoring program as affording opportunities not otherwise available within the curriculum. The peer teaching program provided a framework within the medical curriculum for senior students to practice and improve their medical knowledge and teaching skills. Concurrently, junior students were provided with a valuable learning experience that they reported as being qualitatively different to traditional teaching by faculty.

Fibre laser joining of highly dissimilar materials: Commercially pure Ti and PET hybrid joint for medical device applications

Laser transmission joining (LTJ) is growing in importance, and has the potential to become a niche technique for the fabrication of hybrid plastic-metal joints for medical device applications. The possibility of directly joining plastics to metals by LTJ has been demonstrated by a number of recent studies. However, a reliable and quantitative method for defining the contact area between the plastic and metal, facilitating calculation of the mechanical shear stress of the hybrid joints, is still lacking. A new method, based on image analysis using ImageJ, is proposed here to quantify the contact area at the joint interface. The effect of discolouration on the mechanical performance of the hybrid joints is also reported for the first time. Biocompatible polyethylene terephthalate (PET) and commercially pure titanium (Ti) were selected as materials for laser joining using a 200 W CW fibre laser system. The effect of laser power, scanning speed and stand-off distance between the nozzle tip and top surface of the plastic were studied and analysed by Taguchi L9 orthogonal array and ANOVA respectively. The surface morphology, structure and elemental composition on the PET and Ti surfaces after shearing/peeling apart were characterized by SEM, EDX, XRD and XPS.

Laser-fabricated PET-Ti Hybrid Joints for Medical Device Applications

Currently, micro-joining of plastic parts to metal parts in medical devices is achieved by using medical adhesives, For example, pacemakers, defibrillators and neurological stimulators are designed using silicone adhesive to seal the joint between the polyurethane connector module and the titanium can [1]. Nevertheless, the use of adhesive is problematic because it requires a long time to cure and has high tendency to produce leachable products which might be harmful to the human body. An alternative for directly joining plastics to metal without adhesive is therefore required. Laser transmission joining (LTJ) is growing in importance, and has the potential to gain the niche in micro-fabrication of plastics-metal hybrid joints for medical device applications. The possibility of directly joining plastics to metal by LTJ technique have been demonstrated by a number of studies in recent literature [2]. The widely-accepted understanding of LTJ between plastics and metal is that generation and rapid expansion of micro-bubbles at the plastics-metal interface exert high local pressure to press the melted plastics towards the metal surface features during the laser processing [2]. This subsequently creates the plastics-metal hybrid joint by the mechanisms of mechanical interlocking as well as chemical and physical bonds between the plastics and metal surfaces. Although the micro-bubbles can help promote the mechanical interlocking effect to increase the joint strength, the creation of bubble is a random and complex process depending on the complicated interactions between the laser intensity, thermal degradation properties of plastics, surface temperature and topographical features of metal. In an ideal situation, it is desirable to create the hybrid plastics-metal joint without bubbles. However, the mechanical performance of the hybrid plastics-metal joint without bubbles is still unknown, and systematic comparison between the hybrid joints with and without bubbles is lacking in literature. This becomes the objective of this study. In this work, the laser process parameters were carefully chosen from a preliminary study, such that different hybrid joints: with and without bubbles can be produced and compared. Biocompatible PET and commercially pure Ti were selected as materials for laser joining.

Implications of divergences in Adult Protection legislation

Purpose – The purpose of this paper is to explore the similarities and differences of legal responses to older adults who may be at risk of harm or abuse in the UK, Ireland, Australia and the USA.
Design/methodology/approach – The authors draw upon a review of elder abuse and adult protection undertaken on behalf of the commissioner for older people in Northern Ireland. This paper focusses on the desk top mapping of the different legal approaches and draws upon wider literature to frame the discussion of the relative strengths and weaknesses of the different legal responses.
Findings – Arguments exist both for and against each legal approach. Differences in defining the scope and powers of adult protection legislation in the UK and internationally are highlighted.
Research limitations/implications – This review was undertaken in late 2013; while the authors have updated the mapping to take account of subsequent changes, some statutory guidance is not yet available. While the expertise of a group of experienced professionals in the field of adult safeguarding was utilized,
it was not feasible to employ a formal survey or consensus model.
Practical implications – Some countries have already introduced APL and others are considering doing so. The potential advantages and challenges of introducing APL are highlighted.
Social implications – The introduction of legislation may give professionals increased powers to prevent and reduce abuse of adults, but this would also change the dynamic of relationships within families and between families and professionals.
Originality/value – This paper provides an accessible discussion of APL across the UK and internationally
which to date has been lacking from the literature.

Mercury (II) removal from aqueous solutions by microporous materials

O Mercúrio é um dos metais pesados mais tóxicos existentes no meio ambiente, é persistente e caracteriza-se por bioamplificar e bioacumular ao longo da cadeia trófica. A poluição com mercúrio é um problema à escala global devido à combinação de emissões naturais e emissões antropogénicas, o que obriga a políticas ambientais mais restritivas sobre a descarga de metais pesados. Consequentemente o desenvolvimento de novos e eficientes materiais e de novas tecnologias para remover mercúrio de efluentes é necessário e urgente. Neste contexto, alguns materiais microporosos provenientes de duas famílias, titanossilicatos e zirconossilicatos, foram investigados com o objectivo de avaliar a sua capacidade para remover iões Hg2+ de soluções aquosas. De um modo geral, quase todos os materiais estudados apresentaram elevadas percentagens de remoção, confirmando que são bons permutadores iónicos e que têm capacidade para serem utilizados como agentes descontaminantes. O titanossilicato ETS-4 foi o material mais estudado devido à sua elevada eficiência de remoção (>98%), aliada à pequena quantidade de massa necessária para atingir essa elevada percentagem de remoção. Com apenas 4 mg⋅dm-3 de ETS-4 foi possível tratar uma solução com uma concentração igual ao valor máximo admissível para descargas de efluentes em cursos de água (50 μg⋅dm-3) e obter água com qualidade para consumo humano (<1.0 μg⋅dm-3), de acordo com a legislação Portuguesa (DL 236/98). Tal como para outros adsorbentes, a capacidade de remoção de Hg2+ do ETS- 4 depende de várias condições experimentais, tais como o tempo de contacto, a massa, a concentração inicial de mercúrio, o pH e a temperatura. Do ponto de vista industrial as condições óptimas para a aplicação do ETS-4 são bastante atractivas, uma vez que não requerem grandes quantidades de material e o tratamento da solução pode ser feito à temperatura ambiente. A aplicação do ETS-4 torna-se ainda mais interessante no caso de efluentes hospitalares, de processos de electro-deposição com níquel, metalúrgica, extracção de minérios, especialmente ouro, e indústrias de fabrico de cloro e soda cáustica, uma vez que estes efluentes apresentam valores de pH semelhantes ao valor de pH óptimo para a aplicação do ETS-4. A cinética do processo de troca iónica é bem descrita pelo modelo Nernst-Planck, enquanto que os dados de equilíbrio são bem ajustados pelas isotérmicas de Langmuir e de Freundlich. Os parâmetros termodinâmicos, ΔG° and ΔH° indicam que a remoção de Hg2+ pelo ETS-4 é um processo espontâneo e exotérmico. A elevada eficiência do ETS-4 é confirmada pelos valores da capacidade de remoção de outros materiais para os iões Hg2+, descritos na literatura. A utilização de coluna de ETS-4 preparada no nosso laboratório, para a remoção em contínuo de Hg2+ confirma que este material apresenta um grande potencial para ser utilizado no tratamento de águas. ABSTRACT: Mercury is one of the most toxic heavy metals, exhibiting a persistent character in the environment and biota as well as bioamplification and bioaccumulation along the food chain. Natural inputs combined with the global anthropogenic sources make mercury pollution a planetary-scale problem, and strict environmental policies on metal discharges have been enforced. The development of efficient new materials and clean-up technologies for removing mercury from effluents is, thus, timely. In this context, in my study, several microporous materials from two families, titanosilicates and zirconosilicates were investigated in order to assess their Hg2+ sorption capacity and removal efficiency, under different operating conditions. In general, almost all microporous materials studied exhibited high removal efficiencies, confirming that they are good ion exchangers and have potential to be used as Hg2+ decontaminant agents. Titanosilicate ETS-4 was the material most studied here, by its highest removal efficiency (>98%) and lowest mass necessary to attain it. Moreover, according with the Portuguese legislation (DL 236/98) it is possible to attain drinking water quality (i.e. [Hg2+]< 1.0 μg⋅dm-3) by treating a solution with a Hg2+ concentration equal to the maximum value admissible for effluents discharges into water bodies (50 μg⋅dm-3), using only 4 mg⋅dm-3 of ETS-4. Even in the presence of major freshwater cations, ETS-4 removal efficiency remains high. Like for other adsorbents, the sorption capacity of ETS-4 for Hg2+ ions is strongly dependent on the operating conditions, such as contact time, mass, initial Hg2+ concentration and solution pH and, to a lesser extent, temperature. The optimum operating conditions found for ETS-4 are very attractive from the industrial point of view because the application of ETS-4 for the treatment of wastewater and/or industrial effluents will not require larges amounts of adsorbent, neither energy supply for temperature adjustments becoming the removal process economically competitive. These conditions become even more interesting in the case of medical institutions liquid, nickel electroplating process, copper smelter, gold ore tailings and chlor-alkali effluents, since no significant pH adjustments to the effluent are necessary. The ion exchange kinetics of Hg2+ uptake is successfully described by the Nernst-Planck based model, while the ion exchange equilibrium is well fitted by both Langmuir and Freundlich isotherms. Moreover, the feasibility of the removal process was confirmed by the thermodynamic parameters (ΔG° and ΔH°) which indicate that the Hg2+ sorption by ETS-4 is spontaneous and exothermic. The higher efficiency of ETS-4 for Hg2+ ions is corroborate by the values reported in literature for the sorption capacity of other adsorbents for Hg2+ ions. The use of an ETS-4 fixed-bed ion exchange column, manufactured in our laboratory, in the continuous removal of Hg2+ ions from solutions confirms that this titanosilicate has potential to be used in industrial water treatment.

Medical information extraction in European Portuguese

The electronic storage of medical patient data is becoming a daily experience in most of the practices and hospitals worldwide. However, much of the data available is in free-form text, a convenient way of expressing concepts and events, but especially challenging if one wants to perform automatic searches, summarization or statistical analysis. Information Extraction can relieve some of these problems by offering a semantically informed interpretation and abstraction of the texts. MedInX, the Medical Information eXtraction system presented in this document, is the first information extraction system developed to process textual clinical discharge records written in Portuguese. The main goal of the system is to improve access to the information locked up in unstructured text, and, consequently, the efficiency of the health care process, by allowing faster and reliable access to quality information on health, for both patient and health professionals. MedInX components are based on Natural Language Processing principles, and provide several mechanisms to read, process and utilize external resources, such as terminologies and ontologies, in the process of automatic mapping of free text reports onto a structured representation. However, the flexible and scalable architecture of the system, also allowed its application to the task of Named Entity Recognition on a shared evaluation contest focused on Portuguese general domain free-form texts. The evaluation of the system on a set of authentic hospital discharge letters indicates that the system performs with 95% F-measure, on the task of entity recognition, and 95% precision on the task of relation extraction. Example applications, demonstrating the use of MedInX capabilities in real applications in the hospital setting, are also presented in this document. These applications were designed to answer common clinical problems related with the automatic coding of diagnoses and other health-related conditions described in the documents, according to the international classification systems ICD-9-CM and ICF. The automatic review of the content and completeness of the documents is an example of another developed application, denominated MedInX Clinical Audit system.

Portuguese georesources suitability for medical hydrology applications

In Portugal, there is an old tradition in using clayey materials for therapeutic purposes. They are applied in pelotherapy, at several beaches of the Atlantic coast in the form of clay-sea water mixtures (peloids) to treat skin and rheumatic diseases. During many generations, peloids have been applied without scienti c studies that prove their therapeutic validity. In the last decade, the Portuguese scienti c community has become increasingly more interested in assessing the properties that make clayey materials suitable for therapeutic purposes. The abundance of clayey formations and the established practices of medical hydrology in our country turned this interest into a new perspective of application. The studied materials include di erent clays (in age and origin) mainly collected from well-known Mesozoic-Cenozoic formations, in some cases outcropping at beaches where empirical applications occur. This thesis focus in the study of silt-clay fraction (< 63 m).To determine their suitability for therapy, compositional, physicochemical, technological, thermal and rheological properties were assessed. Conventional techniques (XRD, XRF and Sedigraph) were used to assess compositional features of silt-clay fraction. Electron microscopy (SEM, VPSEM, HREM) was used to study the micromorphology and composition of clay fraction (< 2 m). Physicochemical properties (cation exchange and speci c surface) were assessed using the Ammonium Acetate and BET methods. Technological properties (plasticity and abrasivity indices) were assessed using the Atterberg limits and Einlehner abrasion tests. Thermal properties (speci c heat and cooling kinetics) were estimated by DSC analysis and cooling tests. Pharmacotechnical tests (compressibility index, sediment volume and Brook eld viscosity) were used to assess the powder owability as well as the physical stability and viscosity of clay-water dispersions. We selected as suitable Portuguese clays for health applications the samples A-Pe, A-Be2, A-Sd, J-Fr , M-To, C-Lu1, C-Lu2, Pl-Ba, M-Ga and J-Ab because they represent safe materials, with an adequate composition, good technological, physicochemical and thermal properties for application, also presenting an adequate rheology when dispersed in water. Their most relevant characteristics are the high clay minerals content, abundant smectite, illite and kaolinite, and safe hazardous concentrations. They also showed moderate capacity to exchange Ca 2+, high plasticity, low abrasivity, high speci c heat and slow cooling kinetics. They evidenced fair powder owability and good potential to formulate viscous dispersions when stabilized. Because the majority of the assessed characteristics are in accordance with those presented by clays applied in European spas for pelotherapy, we considered this group of clays also suitable for medical hydrology treatments in Portuguese spas.

Hole-type gaseous detectors for medical imaging and HEP experiments

This work presents the results on the development of a high pressure Xe gaseous detector envisaging medical imaging. The detector uses two VUV photosensors operating face-to-face, based on the CsI-MHSP with position discrimination capability. The known effect of the charge gain decrease with the gas pressure is compensated with a light gain using the electroluminescence process. Studies of signal amplitude, energy and position resolution are presented. On the second part, gaseous detectors based on THGEM where studied in order to fulfill the requirements of present and future high energy physics experiments. The work is focused on the application of THGEM in RICH detectors elements: a triple THGEM detector using CsI photocathodes in Ne mixtures was suggested. The ion backflow to the photocathode remains a concern and a limitation; to minimize it, the application of a new hole-structure, THCOBRA, was suggested. Preliminary results foresee good perspectives for the successful application of THCOBRA in ion back-flow suppression. This work contains several methods and measurements of the CsI photocathodes behaviour in radiation gaseous detectors. A long discussion on its issues and possible solutions are presented.