The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

Air flow influences on local climate: observed and simulated mean relationships for the United Kingdom

Synoptic-scale air flow variability over the United Kingdom is measured on a daily time scale by following previous work to define 3 indices: geostrophic flow strength, vorticity and direction. Comparing the observed distribution of air flow index values with those determined from a simulation with the Hadley Centre’s global climate model (HadCM2) identifies some minor systematic biases in the model’s synoptic circulation but demonstrates that the major features are well simulated. The relationship between temperature and precipitation from parts of the United Kingdom and these air flow indices (either singly or in pairs) is found to be very similar in both the observations and model output; indeed the simulated and observed precipitation relationships are found to be almost interchangeable in a quantitative sense. These encouraging results imply that some reliability can be assumed for single grid-box and regional output from this climate model; this applies only to those grid boxes evaluated here (which do not have high or complex orography), only to the portion of variability that is controlled by synoptic air flow variations, and only to those surface variables considered here (temperature and precipitation).

Sustainable horticultural supply chain: the case of local food networks in the United Kingdom

In the UK there is widespread support from Government, media and consumers for local food networks. These have the potential to provide a more sustainable supply chain and are well suited to the unique production and consumption characteristics of horticultural products. In terms of food marketing, local food is in its relative infancy and is still without any formal definition. This lack of clarity hampers research activities. Although the profile of local food buyers and their expectations has been explored, our knowledge of its social, economic and environmental aspects is minimal. This research contributes by exploring the structure and scope of local food activities in the UK in terms of profiling those specialised retail outlets who provide consumers with the opportunity to purchase locally grown horticultural products.