Is it feasible to learn research skills in addition to audit skills through clinical audit? A mixed methods study in general practice

Abstract Background Involving medical students in research in their undergraduate careers may increase the likelihood that they will be research active after graduation. To date, there has been a paucity of published research of students doing research in general practice. Aim The study aims to evaluate the impact of general practice clinical audits on early-stage graduate entry students’ audit and research self-efficacy and explore feasibility issues from the student and GP perspective. Methods Two student questionnaires (pre- and post-intervention), a qualitative GP survey of the 25 participating GPs and semi-structured interviews of a purposeful sample of GPs were conducted. Results Participating students who completed the follow-up survey found that it had a positive educational impact (55%), increased their understanding of the audit cycle (72%) and real-world prescribing (77%). Research confidence wise, there was a statistically significant difference in the student group who completed the audit project compared to those students who did not in knowledge of the audit cycle and the difference between research and audit (p = 0.001) but not in other research skills. Ninety-six percent of responding GPs would be happy for students to do future audits in their practice but some feasibility issues similar to other research initiatives in general practice were identified. Conclusion We found this audit initiative feasible and useful in helping students learn about audit skills, patient safety and real-world prescribing. GPs and students would benefit more if it were linked to a substantial clinical placement, focussed on a topic of interest and given protected time. Separate research projects may be needed to develop research skills confidence.

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A general practice provider federation in a mixed health economy in England: a case study investigation

British Journal of General Practice ◽

10.3399/bjgp18x696929 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696929

Author(s):

Jill Mitchell

Keyword(s):

General Practice ◽

Shared Vision ◽

Health Economy ◽

Structured Interviews ◽

The North ◽

Common Strategy ◽

Common Purpose ◽

Collaborative Working ◽

The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

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An evaluation of Cognitive Stimulation Therapy sessions for people with dementia and a concomitant support group for their carers

Dementia ◽

10.1177/1471301215626851 ◽

2016 ◽

Vol 16 (8) ◽

pp. 985-1003 ◽

Cited By ~ 4

Author(s):

Jan Bailey ◽

Paul Kingston ◽

Simon Alford ◽

Louise Taylor ◽

Edward Tolhurst

Keyword(s):

Support Groups ◽

Support Group ◽

Qualitative Data ◽

Cognitive Stimulation ◽

Structured Interviews ◽

Post Intervention ◽

Cognitive Stimulation Therapy ◽

People With Dementia ◽

Quasi Experimental ◽

The Impact

This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of 10 sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted; data were collected pre- and post-intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data were collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group. Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile.

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Promoting Faculty Scholarship – An evaluation of a program for busy clinician-educators

Canadian Medical Education Journal ◽

10.36834/cmej.36666 ◽

2015 ◽

Vol 6 (1) ◽

pp. e43-e60 ◽

Cited By ~ 11

Author(s):

Stacia Reader ◽

Alice Fornari ◽

Sherenne Simon ◽

Janet Townsend

Keyword(s):

Program Participation ◽

Structured Interviews ◽

Research Skills ◽

Protected Time ◽

Part Time Faculty ◽

Clinician Educators ◽

Apply Research ◽

Busy Clinician ◽

Part Time ◽

One Year

Background: Clinician educators face barriers to scholarship including lack of time, insufficient skills, and access to mentoring. An urban department of family medicine implemented a federally funded Scholars Program to increase the participants’ perceived confidence, knowledge and skills to conduct educational research.Method: A part-time faculty development model provided modest protected time for one year to busy clinician educators. Scholars focused on designing, implementing, and writing about a scholarly project. Scholars participated in skill seminars, cohort and individual meetings, an educational poster fair and an annual writing retreat with consultation from a visiting professor. We assessed the increases in the quantity and quality of peer reviewed education scholarship. Data included pre- and post-program self-assessed research skills and confidence and semi-structured interviews. Further, data were collected longitudinally through a survey conducted three years after program participation to assess continued involvement in educational scholarship, academic presentations and publications.Results: Ten scholars completed the program. Scholars reported that protected time, coaching by a coordinator, peer mentoring, engagement of project leaders, and involvement of a visiting professor increased confidence and ability to apply research skills. Participation resulted in academic presentations and publications and new educational leadership positions for several of the participants.Conclusions: A faculty scholars program emphasizing multi-level mentoring and focused protected time can result in increased confidence, skills and scholarly outcomes at modest cost.

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Development and implementation of a hospital-based trauma response system in an urban hospital in San Salvador, El Salvador

Trauma ◽

10.1177/1460408616672491 ◽

2016 ◽

Vol 19 (2) ◽

pp. 118-126 ◽

Cited By ~ 2

Author(s):

EC Cioè-Peña ◽

JC Granados ◽

LL Wrightsmith ◽

AL Henriquez-Vigil ◽

RT Moresky

Keyword(s):

Behavior Change ◽

El Salvador ◽

Trauma Care ◽

Skills Training ◽

Post Intervention ◽

Trauma Training ◽

Response System ◽

Significant Difference ◽

Trauma Response ◽

The Impact

Background In El Salvador, over 32% of all deaths are due to trauma. However, El Salvador lacks any established standardized trauma response system to treat the most critical of Salvadoran patients. In an effort to improve trauma response in El Salvador, we assessed the impact of a trauma-specific skills training, which could improve trauma care in a setting where no formal trauma training exists. Methods We used a pre- and post-interventional design study to measure the critical actions performed during a trauma event, as well as the case-fatality rate, emergency ward-to-operating room time, and utilization of ultrasound. The intervention was a primary trauma care course taught to all study participants. Results Eighteen providers were observed over a six-month period and 194 patient encounters (48 pre- and 146 post-intervention) were recorded. There was no significant difference in observed critical actions during major trauma between the pre-intervention and post-intervention periods. There was a significant improvement in ultrasound usage post-intervention (9.5% to 21.4%; p = 0.04). Conclusion The lack of behavior change observed following a two-day trauma training underscores the gap between physician knowledge and applied behavior change. This is a limited single center study, but further examination is necessary to determine the role of two-day training courses in the larger context of behavior change within a health system that has no formal post-graduate training in or defined algorithmic trauma care.

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Facilitating educational opportunities and raised self-esteem in disadvantaged young people in South East Wales: Effects of the Junior Rock Music Academy widening participation programme

Journal of Popular Music Education ◽

10.1386/jpme_00044_1 ◽

2021 ◽

Vol 5 (1) ◽

pp. 71-87 ◽

Cited By ~ 1

Author(s):

Jane Ellis

Keyword(s):

Young People ◽

Rock Music ◽

Age Groups ◽

Self Esteem ◽

Significant Rise ◽

Widening Participation ◽

Structured Interviews ◽

Social And Emotional ◽

Significant Difference ◽

The Impact

This study examined the effects of the Junior Rock Music Academy (JRMA) on participants’ (N = 39) confidence and self-esteem. The JRMA was a widening participation Saturday music programme developed to reduce the influences of poverty on educational underachievement for young people (10–18 years) from poorer families across South East Wales. Participants’ confidence and self-esteem scores reported a significant rise, with no significant difference reported between genders or age groups. Participants (N = 5), programme tutors (N = 3) and participant parents/guardians (N = 4) were interviewed using semi-structured interviews to establish the fidelity of the structure and content of the intervention. The impact of JRMA on the psychosocial, cultural and emotional characteristics of participants and their parents/guardians as barriers to educational attainment and preparedness to thrive in education are discussed; these include enhanced cognitive development, social and emotional skills and learner motivation.

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Dietary Patterns Differentially Affect Microbiome Composition and Function in a Porcine Model of Obesity-related Metabolic Disorder (OR23-04-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz040.or23-04-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Gloria Solano-Aguilar ◽

Jonathan Shao ◽

Joseph Urban ◽

Sukla Lakshman ◽

Saebyeol Jang ◽

...

Keyword(s):

Dietary Patterns ◽

Dietary Intervention ◽

Diversity Index ◽

Early Stage ◽

Saturated Fat ◽

Post Intervention ◽

Fecal Microbiome ◽

Microbiome Composition ◽

And Function ◽

The Impact

Abstract Objectives To determine the impact of two isocaloric diets containing (38% ,15% and 47% energy from fat, protein and carbohydrate, respectively): Western diet (WD) rich in saturated fat, refined carbohydrate, low in fiber and high in cholesterol, and a heart healthy diet (HHD) rich in unsaturated fat, unrefined carbohydrate, fruits/vegetables, high in fiber and low in cholesterol, on the composition and function of the gut microbiome Methods Thirty-Ossabaw pigs were fed WD or HHD diets with half within each group therapeutically treated with statin (atorvastatin [Lipitor]). The fecal microbiome was analyzed one and six months after dietary intervention by 16S rRNA sequencing and metagenomic function was empirically inferred Results Genus diversity was transiently affected with a reduced Shannon Diversity index one month after feeding the WD or HHD (FDR P < 0.05) with no change between groups at 6 months. Bacterial communities were clustered and separated by diet independent of gender and separated by treatment with statin in the HHD only. Verrucomicrobiaceae (Akkermansia) and Methanobacteriales (Methanobrevibacter) were increased in pigs as early as one month after feeding the HHD, as was Clostridiales and Bifidobacterium (associated with optimal intestinal health). There was an enrichment of Proteobacteria (Succinivibrionaceae, Desulfovibrionaceae) in pigs fed the WD. Additional members of the Firmicutes phylum were detected. Diet-dependent associations (all P < 0.05) were identified between Lachnospiraceae members and early host dyslipidemia, inflammation, and atheromatous lesions in the left anterior descending proximal (LAD) and LAD/Left circumflex (LCX) bifurcation six months post-intervention. Conclusions These data document for the first time a distinctive bacterial profile in Ossabaw pigs with a diet-induced dyslipidemia and early stage atherosclerosis. Taken together these results represent a new model to examine mechanistic pathways of dietary patterns and/or drug interactions and its effect on modulating microbiome in developing atherosclerosis. Funding Sources USDA project 8040-51530-056-00 and Inter Agency USDA Agreement 588-1950-9-001 between BHNRC and Jean Mayer USDA-HNRCA

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The role of radiotherapy in elderly women with early-stage breast cancer treated with breast conserving surgery

Tumori Journal ◽

10.1177/0300891618792465 ◽

2018 ◽

Vol 104 (6) ◽

pp. 429-433 ◽

Cited By ~ 1

Author(s):

Mariacarla Valli ◽

Simona Cima ◽

Paola Fanti ◽

Barbara Muoio ◽

Alessandra Vanetti ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Elderly Women ◽

Early Stage ◽

Conservative Surgery ◽

Early Stage Breast Cancer ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Significant Difference ◽

The Impact

Objective: To analyze the impact of adjuvant radiotherapy (RT) on ipsilateral breast recurrence (IBR) and overall survival (OS) in patients older than 69 years with early-stage breast cancer. Methods: From January 2007 to June 2015, we analyzed retrospectively 137 women with estrogen receptor–positive T1–2 invasive breast cancer, with negative axillary lymph nodes, dividing them into 2 subgroups: 70 to 79 years and older than 79 years. Results: After a median follow-up of 43.2 months, the 3-year IBR-free survival in patients treated with surgery plus RT was 98.8% and 92.1% in patients treated with surgery alone, with a significant difference ( p = .01). Radiotherapy did not impact overall survival ( p = .10). A higher percentage of patients aged between 70 and 79 years received RT after conservative surgery if compared with the older subgroup ( p < .01). Conclusions: In elderly women, adjuvant RT reduced the IBR, but did not improve OS.

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Impact of Health Education on Mothers' Knowledge of Preventive Health Practices

Tropical Doctor ◽

10.1177/004947559702700405 ◽

1997 ◽

Vol 27 (4) ◽

pp. 199-202 ◽

Cited By ~ 5

Author(s):

Mubina Agboatwalla ◽

Dure Samin Akram

Keyword(s):

Health Education ◽

Breast Feeding ◽

Intervention Study ◽

Intervention Group ◽

Preventive Health ◽

Slum Area ◽

Post Intervention ◽

Community Based ◽

Significant Difference ◽

The Impact

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).

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Exercise and Time Perception: An Exploration of the Impact of High Intensity Cardio Exercise (Zumba) on Human Timing

Timing & Time Perception ◽

10.1163/22134468-00002073 ◽

2016 ◽

Vol 4 (4) ◽

pp. 343-353 ◽

Cited By ~ 1

Author(s):

Jeevita S. Pillai ◽

Aoife McLoughlin

Keyword(s):

Time Perception ◽

High Intensity ◽

Interval Timing ◽

Attentional Focus ◽

Post Intervention ◽

Future Directions ◽

Temporal Bisection ◽

Experience Of Time ◽

Significant Difference ◽

The Impact

Time is an important aspect of people’s lives and how it is perceived has a great impact on how we function, which includes whether we engage in activities such as exercise that are beneficial for our health. These activities can also have impact on our experience of time. The current study aims to investigate human interval timing after completion of one of two tasks: listening to an audiobook, or engaging in a Zumba workout. Participants in this study completed two temporal bisection tasks (pre and post intervention). Bisection points (point of subjective equality) and Weber’s ratios (sensitivity to time) were examined. It was hypothesised that individuals in the Zumba condition would experience a distortion in their timing post workout consistent with an increase in pacemaker speed. Unexpectedly there appeared to be no significant difference in bisection points across or within (pre/post) the conditions, suggesting that neither intervention had an impact on an internal pacemaker. However, there were significant differences in sensitivity to timing after Zumba Fitness suggesting a potential attentional focus post workout. Implications and future directions are also discussed.

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Performance of healthy elderly with Alzheimer's disease at an early stage in executive function and language

European Psychiatry ◽

10.1016/s0924-9338(11)72205-2 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 498-498

Author(s):

M.T. Santos ◽

G.C. Couto ◽

J.C. Achieri ◽

C.A. Júnior

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Early Stage ◽

The Elderly ◽

Screening Tests ◽

Healthy Elderly ◽

Initial Stage ◽

Significant Difference ◽

Common Causes ◽

The Impact

Dementia are increasingly prevalent in population. The most common causes of dementia is Alzheimer's disease (AD). Screening tests have been used for the premature diagnosis of Alzheimer Disease (AD), specifically in the executive functions and language, which are compromised at an initial stage. However, the necessity standardized means and validated for our middle, to show oneself a pressing subject.ObjectiveTo analyze the impact of the length of sentences in the abstraction of proverbs in the Screening Test for Alzheimer's disease with Proverbs (TRDAP), healthy elderly and with Alzheimer's disease at early stage.MethodSurvey document in the database, analyzing the responses of the elderly (abstract or concrete interpretation of proverbs), relating the length of sentences (sayings) of stage B of TRDAP with the diagnosis of Alzheimer's disease and the interference of age and schooling.ResultsHealthy older people showed greater capacity for abstraction than those with AD. There was Significant differences, in the sayings 1 (p = 0.033) and 2 (p = 0.001), corresponding to lower sentences, which did not occur with the proverb 3. As for age no verified significant difference among the healthy and only saying 3 in AD patients, however schooling differenced the healthy.ConclusionElderly with Alzheimer's disease at an initial stage have lower performance in the comprehension of ambiguous sentences, interpretation and abstraction of proverbs, corroborating with the data of the literature. The size of these sentences appears to be inversely proportional to the correctness of interpretation in elderly patients with and without AD.

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