The impact of the introduction of formalised polypectomy assessment on training in the UK.
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ABSTRACT:
SUBMITTER: Patel K
PROVIDER: S-EPMC5318649 | biostudies-other | 2017 Apr
REPOSITORIES: biostudies-other
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Project description:Developments in advanced polypectomy technique provide an alternative to surgery in the management of large and complex colorectal polyps. These endoscopic techniques require expertise and can potentially incur high complication rates. This survey evaluates current UK practice, attitudes and training in advanced polypectomy.Anonymous online questionnaire.Colonoscopists within the UK were asked about their approach to large polyps (>2 cm).Among the 268 respondents (64% of whom were BCSP accredited), 86% were confident in removing lesions >2 cm by endoscopic mucosal resection (EMR). Of these, 27% were classed as low volume operators (<10 lesions resected/annum) and 14% as high volume operators (>50/annum). By comparison, only 3% currently performed endoscopic submucosal dissection (ESD). Referring one or more benign polyps for surgery a year was common among responders of all levels (11-68%). Training deficiencies were common: only 21% of responders had received a period of training dedicated to advanced polypectomy; 58% of responders would welcome a national training scheme and a majority supported the implementation of advanced polypectomy accreditation with national guidelines. However, while 41% wanted nominated regional EMR experts, only 18% would welcome an integrated national referral network for large/complex polyps.EMR is practised widely while ESD service provision is very limited. Most experienced colonoscopists are confident to perform piecemeal EMR, even if their training is suboptimal and annual numbers low. Practices and attitudes were variable, even among self-defined level 4 operators. Improving training and implementation of accreditation were welcomed, but there was little appetite for mandated referral to subspecialist 'experts' and national networks.
| S-EPMC5369560 | biostudies-other
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:AimTo understand the impact of COVID-19 on radiology trainee experience and well-being.Materials and methodsA questionnaire designed to capture the impact of COVID-19 on radiology training, working patterns, and well-being was sent to all speciality trainees in a regional UK radiology school. The survey was distributed at the beginning of May 2020 and responses collected over 2 weeks. Trainees were questioned about changes that had occurred over a time period starting at the beginning of the COVID-19 pandemic. All survey responses (n=29) were anonymised and the results were subsequently analysed.ResultsSixty-two percent (29 of 47) of trainees within the deanery, who were spread across seven different hospital sites, responded to the questionnaire. All trainees felt that overall radiology workload had decreased in response to COVID-19. Seventy-two percent (21/29) stated that their workload had significantly decreased. Seventy percent (19/27) reported decreased subspecialty experience, and 19% (5/27) reported a complete lack of subspecialty training. Twenty-four percent (7/29) of trainees were redeployed from radiology to clinical ward-based work. Forty-eight percent reported experiencing a worsening in their well-being compared to before the pandemic.ConclusionThe first wave of the COVID-19 pandemic had a significant impact on training and well-being. Lessons learnt from this report should help prepare for a second-wave of COVID-19 or future pandemics.
| S-EPMC7420949 | biostudies-literature
Project description:PURPOSE:To determine the effect of the early introduction of cataract surgery training on the complication rates of resident-performed cataract surgery. SETTING:University of California San Diego, San Diego, California, USA. DESIGN:Retrospective case series. METHODS:Two classes of ophthalmology residents were examined, one class with a late introduction of cataract surgery and one with an early introduction of cataract surgery. All cataract cases in which residents acted as primary surgeon were included. Patient charts were reviewed to collect data on patient characteristics, surgical details, and intraoperative and postoperative complications. RESULTS:The late-introduction cohort comprised 3 residents who performed 540 cataract cases, all during their final year of residency. The early-introduction cohort comprised 4 residents who performed 780 cataract cases beginning in the first year of residency. The late-introduction cohort had higher rates of major intraoperative complications than the early-introduction cohort (8.5% versus 3.1%) and of anterior vitrectomy (7.6% versus 2.1%) (both P < .001). Examination of the anterior vitrectomy rate as a function of experience showed the early-introduction cohort had a stable anterior vitrectomy rate of 1% to 2% throughout training, while the late-introduction cohort had a peak anterior vitrectomy rate of 12% at approximately case 20. Multivariable regression analysis showed the early-introduction cohort was independently associated with a lower rate of anterior vitrectomy (hazard ratio, 0.49; 95% confidence interval, 0.36-0.66) after adjusting for differences in patient characteristics and surgical complexity. CONCLUSIONS:Early introduction of cataract surgery training significantly decreased the rate of major intraoperative complications, specifically anterior vitrectomy, in resident-performed cataract surgeries.
| S-EPMC6157597 | biostudies-literature
Project description:Farm animal welfare is an increasingly important issue, leading to the need for an efficient methodology to deliver accurate benchmarking. The "Real Welfare" project developed a methodology based on regular recording of a limited number of animal-based measures, so-called welfare outcomes, which allows faster and easier on-farm assessment of finishing pig welfare. The objective of this paper is to estimate, with sufficient robustness and confidence, the prevalence of different mandatory and optional welfare outcomes in the mainstream herd of the finishing farms in the UK based on the "Real Welfare" scheme data and to assess the changes in prevalence over time, inspection visits and seasons. The mean overall prevalence of the four mandatory welfare outcomes (pigs requiring hospitalization, lame pigs, pigs with severe body marks, and pigs with severe tail lesions) was very low (≤0.2%) and a significant decreasing trend was observed for the first three of these mandatory welfare outcomes since the inception of the scheme. This result might reflect either a reduction in factors giving rise to welfare problems in the mainstream herd or increasing awareness about management of compromised pigs. Additional data are required to clarify these possibilities, but both represent improved pig welfare.
| S-EPMC8909812 | biostudies-literature
Project description:To establish the perceived adequacy of the hepatology training component of the unified gastroenterology and hepatology training programme in the UK by assessing the attitudes and experiences of trainees in the programme.Online cross-sectional questionnaire survey linked to the annual British Society of Gastroenterology/Trainee in Gastroenterology survey in 2010.National survey of all specialist gastroenterology trainees in the UK.283/489 (58%) trainees responded, 68% were male. 54% of all trainees wanted to deliver liver services as consultants. 25% of trainees complete training without exposure to a liver unit providing comprehensive specialist hepatology services. Median time spent in such a unit for the others was 8 months (IQR 6). Significantly fewer trainees lacked confidence in managing liver-related conditions if they had spent time training in a specialist liver unit and with increasing years in training. One in three trainees is dissuaded from a career in hepatology. One in five trainees wished to work part time as consultants-an option preferred significantly more by women.Hepatology training in the UK is perceived by trainees as being suboptimal. A national strategy aimed at improving and standardising hepatology training and making specialist liver unit experience available for every trainee is required.
| S-EPMC5517250 | biostudies-other
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. Experimental design : Whole blood collected in tempus tubes from patients with different spectra of TB disease and healthy controls. All patients were sampled prior to the initiation of any antimycobacterial therapy. Active Pulmonary TB: PTB - All patients confirmed by isolation of Mycobacterium Tuberculosis on culture of sputum or bronchoalvelolar lavage fluid. Latent TB: LTB - All patients were screened at a tuberculosis clinic, being either new entrants to the UK from endemic countries or being household contacts of infectious cases. All were positive by tuberculin skin test (>14mm if BCG vaccinated, >5mm if not vaccinated) and were also positive by Interferon-Gamma Release assay(IGRA); specifically Quantiferon Gold In-Tube Assay (Cellestis, Australia). Latent patients had no clinical, radiological or microbiological evidence of active infection and were asymptomatic. Healthy controls - these were volunteers without exposure to TB who were negative by both tuberculin skin test (<15mm if BCG vaccinated, <6mm if unvaccinated); who were also negative by IGRA (as described above). In this dataset: PTB n= 13; LTB n = 17; BCG+ n = 6, BCG-, n =6. Experimental variables : Patient group: Active PTB; Latent TB, Healthy controls (BCG vaccinated and unvaccinated). ethnicity - a wide range of ethnic groups is represented. However all controls in this dataset are broadly Caucasian/White. The active PTB group incorporates a range of smear positive and smear negative disease and a spectrum of disease extent/severity.
2010-08-11 | E-GEOD-19439 | biostudies-arrayexpress
Project description:BackgroundIn March, 2016, the UK Government proposed a tiered levy on sugar-sweetened beverages (SSBs; high tax for drinks with >8 g of sugar per 100 mL, moderate tax for 5-8 g, and no tax for <5 g). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries.MethodsWe modelled three possible industry responses: reformulation to reduce sugar concentration, an increase of product price, and a change of the market share of high-sugar, mid-sugar, and low-sugar drinks. For each response, we defined a better-case and worse-case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario on prevalence of obesity and incidence of dental caries and type 2 diabetes. The model combined data for sales and consumption of SSBs, disease incidence and prevalence, price elasticity estimates, and estimates of the association between SSB consumption and disease outcomes. We drew the disease association parameters from a meta-analysis of experimental studies (SSBs and weight change), a meta-analysis of prospective cohort studies (type 2 diabetes), and a prospective cohort study (dental caries).FindingsThe best modelled scenario for health is SSB reformulation, resulting in a reduction of 144 383 (95% uncertainty interval 5102-306 743; 0·9%) of 15 470 813 adults and children with obesity in the UK, 19 094 (6920-32 678; incidence reduction of 31·1 per 100 000 person-years) fewer incident cases of type 2 diabetes per year, and 269 375 (82 211-470 928; incidence reduction of 4·4 per 1000 person-years) fewer decayed, missing, or filled teeth annually. An increase in the price of SSBs in the better-case scenario would result in 81 594 (3588-182 669; 0·5%) fewer adults and children with obesity, 10 861 (3899-18 964; 17·7) fewer incident cases of diabetes per year, and 149 378 (45 231-262 013; 2·4) fewer decayed, missing, or filled teeth annually. Changes to market share to increase the proportion of low-sugar drinks sold in the better-case scenario would result in 91 042 (4289-204 903; 0·6%) fewer adults and children with diabetes, 1528 (4414-21 785; 19·7) fewer incident cases of diabetes per year, and 172 718 (47 919-294 499; 2·8) fewer decayed, missing, or filled teeth annually. The greatest benefit for obesity and oral health would be among individuals aged younger than 18 years, with people aged older than 65 years having the largest absolute decreases in diabetes incidence.InterpretationThe health impact of the soft drinks levy is dependent on its implementation by industry. Uncertainty exists as to how industry will react and about estimation of health outcomes. Health gains could be maximised by substantial product reformulation, with additional benefits possible if the levy is passed on to purchasers through raising of the price of high-sugar and mid-sugar drinks and activities to increase the market share of low-sugar products.FundingNone.
| S-EPMC5543265 | biostudies-literature
Project description:BackgroundOur institution has longstanding post-graduate education and training partnership programs in Emergency Medicine (EM) across India. A programmatic challenge has been the integration and uptake of evidence-based medicine and lifelong learning concepts. Formative assessment (FA) is intended to enable learners to monitor learning, identify strengths and weaknesses, and target areas of growth. As part of a program improvement initiative, we introduced an online FA tool to existing summative assessments. This study investigates how the FA tool was used and perceived by trainees.Methods246 trainees across 19 sites were given access to the FA tool. Usage metrics were monitored over 12 months. Semi-structured interviews were conducted in person with trainees using a purposive sampling methodology. A hybrid thematic analysis approach was used to determine themes. Interviews were coded independently by two blinded researchers using NVivo software. The study was deemed exempt by our institutional review board.ResultsThere was high variability in trainees' utilization of the FA tool. Trainees who used the FA tool more performed better on summative exams (r = 0.35, p < 0.001). Qualitative analysis revealed that trainees were motivated to learn for improved clinical knowledge and to be a good physician, not only passing exams. Benefits of the tool included the relationship to clinical practice and thorough explanation of answers, while disadvantages included topics unrelated to India.ConclusionThe integration of a FA tool has provided positive outcomes for trainees in EM education programs in India. Lessons learned may apply globally to other contexts and programs.
| S-EPMC10908017 | biostudies-literature
Project description:INTRODUCTION:The novel coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organisation on 11 March 2020. The aim of this study is to assess the impact of COVID-19 on orthopaedic practice and training in the UK. METHODS:Surgeons throughout UK hospitals were asked to complete an electronic survey relating to orthopaedic practice and training in their hospital. The nationwide survey was conducted during the first peak of COVID-19 cases in the UK between 20 March 2020 and 20 April 2020. RESULTS:All 202 UK participants reported disruption to their daily practice. 91% reported all elective operating had been cancelled and trauma continued as normal in only 24% of cases. 70% reported disruption to trauma operating. Elective clinic capacity significantly reduced with no elective clinics running as normal. 55% reported their elective clinics completely cancelled, whilst 38% reported elective clinics running at a reduced capacity, with non-urgent appointments postponed. Only 9% of fracture clinics ran as normal, and 69% had a reduced service. 67% reported teaching and study leave cancelled. Significantly, 69% of participants felt the pandemic would result in a delay to completion of registrar training programmes. CONCLUSION:This is the first nationwide survey assessing the impact of the coronavirus disease 2019 on UK orthopaedic practice and training, during the peak of the pandemic. It highlights the scale of the challenge ahead for the specialty, including during the recovery phase and post-recovery phase of the pandemic.
| S-EPMC7382703 | biostudies-literature