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  • 1
    Online Resource
    Online Resource
    XTRA study protocol: eXploring medical sTudents’ caReer reAdiness—a cross-sectional study in the UK
    Oxford University Press (OUP) ; 2022
    In:  Journal of Surgical Protocols and Research Methodologies Vol. 2022, No. 2 ( 2022-04-01)
    Details
    In: Journal of Surgical Protocols and Research Methodologies, Oxford University Press (OUP), Vol. 2022, No. 2 ( 2022-04-01)
    Abstract: Professional and career enhancing opportunities are essential for developing skills required for a successful career in medicine. Research to date has mainly focused on the extent to which medical schools prepare students for clinical work as junior doctors. However, there remains a need to ascertain how students prepare for their career and what facilitates or hinders learning regarding careers in medicine. The purpose of the XTRA study is to examine career readiness of medical students at UK universities and the support they receive during their studies regarding career planning. Methods The eXploring medical sTudents’ caReer reAdiness (XTRA) study is a national cross-sectional study of all medical students enrolled at a UK medical school. Data collection will occur via a secure online survey designed as a training need analysis based on the principles of Super’s theory (Super, 1953) of career development. A snowball sampling strategy will be used to recruit participants via social media and networks. Results will be analysed using quantitative analysis and thematic analysis to identify themes in qualitative responses. The primary outcome is to understand the perspective of current medical students on how well prepared they are about entering their careers in healthcare. Conclusions We anticipate that findings from this study will help identify career readiness of medical students to facilitate the development of career development programmes and resources to ensure medical students are well equipped for their future careers.
    Type of Medium: Online Resource
    ISSN: 2752-616X
    URL: Article
    DOI: 10.1093/jsprm/snac008
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 3104184-X
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  • 2
    Online Resource
    Online Resource
    Huntington’s disease age at motor onset is modified by the tandem hexamer repeat in TCERG1
    Springer Science and Business Media LLC ; 2022
    In:  npj Genomic Medicine Vol. 7, No. 1 ( 2022-09-05)
    Details
    In: npj Genomic Medicine, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2022-09-05)
    Abstract: Huntington’s disease is caused by an expanded CAG tract in HTT . The length of the CAG tract accounts for over half the variance in age at onset of disease, and is influenced by other genetic factors, mostly implicating the DNA maintenance machinery. We examined a single nucleotide variant, rs79727797, on chromosome 5 in the TCERG1 gene, previously reported to be associated with Huntington’s disease and a quasi-tandem repeat (QTR) hexamer in exon 4 of TCERG1 with a central pure repeat. We developed a method for calling perfect and imperfect repeats from exome-sequencing data, and tested association between the QTR in TCERG1 and residual age at motor onset (after correcting for the effects of CAG length in the HTT gene) in 610 individuals with Huntington’s disease via regression analysis. We found a significant association between age at onset and the sum of the repeat lengths from both alleles of the QTR ( p  = 2.1 × 10 −9 ), with each added repeat hexamer reducing age at onset by one year (95% confidence interval [0.7, 1.4]). This association explained that previously observed with rs79727797. The association with age at onset in the genome-wide association study is due to a QTR hexamer in TCERG1 , translated to a glutamine/alanine tract in the protein. We could not distinguish whether this was due to cis-effects of the hexamer repeat on gene expression or of the encoded glutamine/alanine tract in the protein. These results motivate further study of the mechanisms by which TCERG1 modifies onset of HD.
    Type of Medium: Online Resource
    ISSN: 2056-7944
    URL: Article
    DOI: 10.1038/s41525-022-00317-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2813848-X
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  • 3
    Online Resource
    Online Resource
    Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data
    Wiley ; 2022
    In:  Diabetic Medicine Vol. 39, No. 9 ( 2022-09)
    Details
    In: Diabetic Medicine, Wiley, Vol. 39, No. 9 ( 2022-09)
    Abstract: There has been a dramatic increase in hypoglycaemic agent expenditure. We assessed the variability in prescribing costs at the practice level and the relationship between expenditure and the proportion of patients achieving target glycaemic control. Methods We utilized national prescribing data from 406 general practices in Wales. This was compared against glycaemic control (percentage of patients achieving a HbA1c level  〈  59 mmol/mol in the preceding 12 months). Analyses were adjusted for the number of patients with diabetes in each general practice and the Welsh Index of Multiple Deprivation. Results There was considerable heterogeneity in hypoglycaemic agent spend per patient with diabetes, Median = £289 (IQR 247–343) range £31.1–£1713. Higher total expenditure was not associated with improved glycaemic control B (std)  = −0.01 (95%CI –0.01, 0.002) p  = 0.13. High‐spend practices spent more on SGLT2 inhibitors (16 vs. 9% p   〈  0.001) and GLP‐1 agonists (13 vs. 11% p   〈  0.001) and less on insulin (34 vs. 42% p   〈  0.001), biguanides (9 vs. 11% p  = 0.001) and sulphonylureas (2 vs. 3% p   〈  0.001) than low spend practices. There were no differences in the pattern of drug prescribing between high spend practices with better glycaemic control (mean 68% of patients HbA1c 〈 59 mmol/mol) and those with less good metabolic control (mean 58% of patients HbA1c 〈 59 mmol/mol). Conclusions Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycaemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents has important cost implications.
    Type of Medium: Online Resource
    ISSN: 0742-3071 , 1464-5491
    URL: Issue
    URL: Article
    DOI: 10.1111/dme.v39.9
    DOI: 10.1111/dme.14908
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2019647-7
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  • 4
    Online Resource
    Online Resource
    Do We Know if You Drive? a Quality Improvement Project Improving Compliance With DVLA Guidelines
    Royal College of Psychiatrists ; 2022
    In:  BJPsych Open Vol. 8, No. S1 ( 2022-06), p. S103-S104
    Details
    In: BJPsych Open, Royal College of Psychiatrists, Vol. 8, No. S1 ( 2022-06), p. S103-S104
    Abstract: Background: The Driving & Vehicle Licensing Agency (DVLA) states: “Doctors and other healthcare professionals should: advise individuals on the impact of their medical condition for safe driving ability and also advise the individual on their legal requirement to notify DVLA of any relevant condition”. Within mental health, the guidance states that depression or anxiety associated with “Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts” must be reported to the DVLA. Aims: Identify whether information was collected on driving status of patients presenting with depression/anxiety and self harm. Identify whether accurate advice was provided and documented. Implement changes that would improve compliance with guidance. Methods We reviewed notes to collect baseline data for 3 weeks prior to commencing interventions, then weekly for 2 months from November 2021. Cases were defined as: those presenting to Liaison Psychiatry (LP) with an act of self-harm either on antidepressants or with a confirmed diagnosis of depression/anxiety on their record. Each week, the notes of 10 cases were reviewed for evidence of documentation of driving status and advice regarding DVLA guidelines. Weekly Interventions Week 1: Email communication to team highlighting the guidance, responsibilities and where to document. Week 2: Driving status discussed in handover daily to increase awareness and identify/address concerns. Week 3: Repeat email to team. Week 4: DVLA guidance posters placed in LP office. Week 12: Teaching session by Occupational therapist from regional driving assessment centre. Results Data were analysed for 90 patients over 9 weeks. 52% were female, and average age was 33 years. Relevant documentation was only made on week 1 (10%) and week 4 (20%). No documentation of either driving status or advice given were made in any of the other weeks analysed. Conclusion Achieving compliance with guidance was difficult. Email communication was the most effective intervention. A group discussion to identify drivers of poor compliance found that clinicians failed to ask as the questions were not routine practice, and some voiced concerns about the potential implications of advice (worsening therapeutic relationship or increasing social isolation/implications for employment). Future plans include adding a prompt about driving on the electronic risk assessment, and specific training in the staff induction.
    Type of Medium: Online Resource
    ISSN: 2056-4724
    URL: Issue
    URL: Article
    DOI: 10.1192/bjo8_s1
    DOI: 10.1192/bjo.2022.318
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2022
    detail.hit.zdb_id: 2829557-2
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