The hidden financial hurdles of commitment to Ophthalmology in the current UK training system.
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ABSTRACT:
SUBMITTER: Nairn J
PROVIDER: S-EPMC7182574 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo investigate changes in the patterns of cumulative surgical experience for ophthalmologists in the UK following the introduction of a new national training scheme.DesignRetrospective review of all surgical training records submitted to the UK Royal College of Ophthalmologists by trainees for the award of Certificate of Completion of Training (CCT) for the period 2009-2015.SettingSecondary level care, UK.Participants539 trainees achieving CCT over the 7-year study period.InterventionsHigher specialist training or ophthalmology specialist training.Outcome measuresNumber of CCT awards by years and procedures performed for cataract surgery, strabismus, corneal grafts, vitreoretinal (VR) procedures, oculoplastics and glaucoma.ResultsCataract surgical experience showed little change with median number performed/performed?supervised (P/PS) 592, IQR: 472-738; mean: 631. Similarly, the median number of strabismus (P/PS 34), corneal grafts (assisted, 9) and VR procedures (assisted, 34) appeared constant. There was a trend towards increasing surgical numbers for oculoplastics (median 116) and glaucoma (57). Overall case numbers for ophthalmic specialist training (OST) trainees (7-year training programme) were higher than higher surgical training (HST) trainees (4.5-year programme) with the exception of squint (P/PS), corneal grafts (P/PS) and VR cases (P/PS).ConclusionsOverall case numbers reported at time of CCT application appear stable or with a marginal trend towards increasing case numbers. HST (4.5-year programme) case numbers do not include those performed before entry to HST, and although case numbers tended to be higher for OST trainees (7-year programme) compared with HST trainees, they were not proportionately so.
| S-EPMC5640272 | biostudies-literature
Project description:The hidden nature of causality is a puzzling, yet critical notion for effective decision-making. Financial markets are characterized by fluctuating interdependencies which seldom give rise to emergent phenomena such as bubbles or crashes. In this paper, we propose a method based on symbolic dynamics, which probes beneath the surface of abstract causality and unveils the nature of causal interactions. Our method allows distinction between positive and negative interdependencies as well as a hybrid form that we refer to as "dark causality." We propose an algorithm which is validated by models of a priori defined causal interaction. Then, we test our method on asset pairs and on a network of sovereign credit default swaps (CDS). Our findings suggest that dark causality dominates the sovereign CDS network, indicating interdependencies which require caution from an investor's perspective.
| S-EPMC6561208 | biostudies-literature
Project description:Residency training in medicine lays the foundation for future medical doctors. In real-world settings, training centers face challenges in trying to create balanced residency programs, with cases encountered by residents not always being fairly distributed among them. In recent years, there has been a tremendous advancement in developing artificial intelligence (AI)-based algorithms with human expert guidance for medical imaging segmentation, classification, and prediction. In this paper, we turned our attention from training machines to letting them train us and developed an AI framework for personalised case-based ophthalmology residency training. The framework is built on two components: (1) a deep learning (DL) model and (2) an expert-system-powered case allocation algorithm. The DL model is trained on publicly available datasets by means of contrastive learning and can classify retinal diseases from color fundus photographs (CFPs). Patients visiting the retina clinic will have a CFP performed and afterward, the image will be interpreted by the DL model, which will give a presumptive diagnosis. This diagnosis is then passed to a case allocation algorithm which selects the resident who would most benefit from the specific case, based on their case history and performance. At the end of each case, the attending expert physician assesses the resident's performance based on standardised examination files, and the results are immediately updated in their portfolio. Our approach provides a structure for future precision medical education in ophthalmology.
| S-EPMC10002549 | biostudies-literature
Project description:BACKGROUND:There is a high level of interest in international experiences during United States (U.S.) ophthalmology residency training among both program directors and trainees. METHODS:An electronic invitation to a 26-question survey was sent to all 114 U.S. ophthalmology residency program directors. The invitation requested that the survey be completed by the one faculty member who was most involved in overseeing the international experiences for the residents. The survey consisted of multiple choice and Likert-type scale questions. The Mann-Whitney U test was used for analysis of demographic data and Friedman's test and Wilcoxon-Signed Rank test were used to analyze ranked responses. RESULTS:Responses were obtained from 70 faculty mentors representing unique programs, yielding a response rate of 61.4%. The majority of programs that responded (88.6%, n = 62) either offered international ophthalmology experiences for residents or supported residents finding their own experiences to go abroad. International experience participation rate among residents correlated with the number of years the experiences had been offered by the programs (p = 0.001). More than half of the respondents (55.0%, n = 33) felt that the residents benefited more than the hosts during these international experiences. Approximately half of the respondents (51.6%, n = 32) believed that additional training beyond what is covered in the standard curriculum to practice ophthalmology in the U.S. is necessary for practicing ophthalmology in an international setting. CONCLUSIONS:There is high interest and participation in international experiences within U.S. ophthalmology residency programs. This high participation warrants further investigation into the long-term impact of these international experiences and how U.S. residency programs can structure these experiences to maximize the benefits to both the residents and the international host communities.
| S-EPMC6879160 | biostudies-literature
Project description:Chimeric antigen receptor T (CAR-T) cells have emerged as novel and promising immune therapies for the treatment of multiple types of cancer in patients with hematological malignancies. There are several key components critical for development and application of CAR-T therapy. First, the design of CAR vectors can considerably affect several aspects of the physiological functions of these T cells. Moreover, despite the wide use of γ-retrovirus and lentivirus in mediating gene transfer into T cells, optimal CAR delivery systems are also being developed and evaluated. In addition, several classes of mouse models have been used to evaluate the efficacies of CAR-T cells; however, each model has its own limitations. Clinically, although surprising complete remission (CR) rates were observed in acute lymphoblastic leukemia (ALL), lymphoma, and multiple myeloma (MM), there is still a lack of specific targets for acute myeloid leukemia (AML). Leukemia relapse remains a major challenge, and its mechanism is presently under investigation. Cytokine release syndrome (CRS) and neurotoxicity are life-threatening adverse effects that need to be carefully treated. Several factors that compromise the activities of anti-solid cancer CAR-T cells have been recognized, and further improvements targeting these factors are the focus of the development of novel CAR-T cells. Overcoming the current hurdles will lead to optimal responses of CAR-T cells, thus paving the way for their wide clinical application.
| S-EPMC8974909 | biostudies-literature
Project description:OBJECTIVES:Applications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training. DESIGN:Prospective, cross-sectional, questionnaire-based study. SETTING/PARTICIPANTS:A non-mandatory online questionnaire for UK-based trainees was distributed nationally. A similar national questionnaire was distributed for Ireland, taking into account differences between the healthcare systems. Only fully completed responses were included. RESULTS:There were 848 and 58 fully completed responses from doctors based in the UK and Ireland, respectively. Medical students in the UK reported a significant increase in debt on graduation by 55% from £17?892 (2000-2004) to £27?655 (2010-2014) (p<0.01). 41% of specialty trainees in the UK indicated that some or all of their study budget was used to fund mandatory regional teaching. By the end of training, a surgical trainee in the UK spends on average £9105 on courses, £5411 on conferences and £4185 on exams, not covered by training budget. Irish trainees report similarly high costs. Most trainees undertake a higher degree during their postgraduate training. The cost of achieving the mandatory requirements for completion of training ranges between £20 000 and £26?000 (dependent on specialty), except oral and maxillofacial surgery, which is considerably higher (£71 431). CONCLUSIONS:Medical students are graduating with significantly larger debt than before. Surgical trainees achieve their educational requirements at substantial personal expenditure. To encourage graduates to pursue and remain in surgical training, urgent action is required to fund the mandatory requirements and annual training costs for completion of training and provide greater transparency to inform doctors of what their postgraduate training costs will be. This is necessary to increase diversity in surgery, reduce debt load and ensure surgery remains a popular career choice.
| S-EPMC5695344 | biostudies-other
Project description:ImportanceThe ophthalmology residency application process is critical for applicants and residency programs, and knowledge about the preferences of applicants would assist both groups in improving the process.ObjectiveTo evaluate the experiences and preferences of ophthalmology residency applicants.Design, setting, and participantsThis cross-sectional, nonvalidated survey was conducted online. All applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2018-2019 application cycle were invited to complete the survey. Data collection occurred from April 1, 2019, to April 30, 2019.Main outcomes and measuresApplicant demographics, application submissions, interview experiences, financial considerations, match results, and suggestions for improvement of the application process.ResultsResponses were received from 185 applicants (36.4%), including 77 women (41.6%). A successful match into an ophthalmology residency was achieved by 172 respondents (93.0%). There was a mean (SD) US Medical Licensing Examination Step 1 score of 245.8 (13.3) points. Respondents applied to a mean (SD) of 76.4 (23.5) ophthalmology residency programs, received 14.0 (9.0) invitations to interview, and attended 10.3 (4.4) interviews. Choices regarding applications and interviews were based mostly on program reputation, location, and advisor recommendation. A usual lead time of at least 3 weeks between the invitation and interview was reported by 126 respondents (69.2%), which was reduced to 14 respondents (15.1%) when a wait-list was involved. The ophthalmology residency application process cost a mean (SD) of $5704 ($2831) per applicant. Respondents reported that they were most able to reduce costs through housing choices (hotel stays or similar arrangements) and least able to reduce costs by limiting the number of programs to which they applied or at which they interviewed.Conclusions and relevanceThe ophthalmology residency application process is complex and poses substantial challenges to applicants and residency programs. These findings suggest that many current applicants have difficulty selecting programs to apply to, and most respondents desired changes to the current system of interview invitations and scheduling.
| S-EPMC7068667 | biostudies-literature
Project description:Despite setbacks, the clinical development of antiangiogenic agents has accelerated remarkably over the past 3-4 years. Consequently, there are currently three direct inhibitors of the VEGF pathway approved for use in cancer therapy. Other agents that block the VEGF pathway are in advanced stages of clinical development and have shown promising results. With these exciting developments come crucial questions regarding the use of these new molecular-targeted agents, alone or in combination with standard cytotoxic or targeted agents. Importantly, the mechanisms of action of anti-VEGF therapy remain unknown. Here, we discuss several potential mechanisms of action such as tumor vascular normalization, bone marrow-derived cell recruitment blockade and cytostatic effects of anti-VEGF therapy. We review the current progress, the major stumbling blocks and the future directions for anti-cancer therapy using anti-VEGF agents, emphasizing clarification of the underlying molecular mechanisms of action and biomarker identification and validation.
| S-EPMC2686126 | biostudies-literature
Project description:The aim of the project was to define transcriptional signatures in whole blood of TB patients (before drug treatment) and healthy controls to distinguish the signature of Latent and Active TB patients from each other and from healthy controls. This will help in diagnosis of active tuberculosis which normally relies on culture of the bacilli, which can take up to 6 wks, and sometimes the bacilli cannot be obtained from sputum thus requiring invasive techniques obtaining bronchoalveolar lavage (BAL). In some cases the bacill cannot be grown from sputum or BAL. Secondly the aim was to determine whether Latent patients have a homogeneous or heterogeneous signature, one may expect the latter since it is not possible to determine by the present tests (Tuberculin skin test - TST - or MTb antigen responsiveness of blood cells to produce IFN-gamma - IGRA assay) whether the mycobacteria has been cleared, is still present but is controlled, or if patients are recently infected or reactivated and will develop active TB. The latter situation may be determined if Latent patients have a blood transcriptional signature similar to that in Active patients. The transcriptional signature in Active TB patients may also provide information as to the factors leading to immunopathogenesis, thus possibly identifying therapeutic targets. The transcriptional profile in Latent TB may give information as to the protective factors controlling the infection, thus important for monitoring vaccine development. A further aim was to examine the transcriptional blood profile of active TB patients at the time of recruitment (before drug treatment) and then subsequently at specific time points after drug treatment to determine whether the signature is extingsuihed with treatment and when. London is a site of intermediate burden of TB - the study was initiated in London, across a broad range of ethnicities to obtain a robust signature that could be used in different developing countries where there is a high burden TB disease.
2010-08-11 | GSE19439 | GEO
Project description:Glioblastoma is the most frequent primary neoplasm of the central nervous system and still suffers from very poor therapeutic impact. No clear improvements over current standard of care have been made in the last decade. For other cancers, but also for brain metastasis, which harbors a very distinct biology from glioblastoma, immunotherapy has already proven its efficacy. Efforts have been pursued to allow glioblastoma patients to benefit from these new approaches, but the road is still long for broad application. Here, we aim to review key glioblastoma immune related characteristics, current immunotherapeutic strategies being explored, their potential caveats, and future directions.
| S-EPMC8036548 | biostudies-literature