OP11 Wearable technology and simulation to support learning. Is it the way forward? A pilot study in primary care with healthcare professionals across the north west

Author(s):  
Pramod Luthra ◽  
Jeremy Brown ◽  
Kevin Henshaw
2018 ◽  
Vol 231 ◽  
pp. 201-209 ◽  
Author(s):  
Jared M. Wohlgemut ◽  
Joseph Davies ◽  
Christopher Aylwin ◽  
Jonathan J. Morrison ◽  
Elaine Cole ◽  
...  

1924 ◽  
Vol 61 (9) ◽  
pp. 416-423 ◽  
Author(s):  
Arthur E. Clark

A few years ago Mr. Carruthers described an aberrant coral, Cryptophyllum hibernicum, from the Lower Carboniferous of Bundoran, Donegal. Cryptophyllum occurred in the Lower Calp shales, which are considered to be about at the horizon of Vaughan's C2 to S1 beds. Another aberrant genus, Heptaphyllum, also from the north-west of Ireland—Lower Carboniferous shales, Sligo—forms the subject of this paper. Cryptophyllum is remarkable, first for the manner in which the earlier major septa appear—irregularly, and nearly simultaneously, instead of regularly, and in consecutive pairs, as is typical for Rugose Corals; and also in the development of only five septa instead of the normal six in the earliest growth stages. Heptaphyllum, as its name implies, develops seven septa in the young corallum. It resembles Cryptophyllum in having an early aseptate corallum, and in the way in which the earlier septa appear.


2021 ◽  
Vol 103 (4) ◽  
pp. 206-210
Author(s):  
M Theodoraki ◽  
TS Hany ◽  
H Singh ◽  
M Khatri

Introduction Physician associates (PAs) are dependent medical practitioners who work alongside doctors and other healthcare professionals. There are approximately 350 PAs working throughout the UK, with another 550 in training. Methods An online questionnaire was sent to healthcare professionals throughout the North West region with a total of 119 responding. Participants were asked nine questions on clinical skills and three on communication skills. These were to be rated as ‘excellent’, ‘good’, ‘satisfactory’, ‘needs to improve’ or ‘unacceptable’. In addition, respondents were asked to indicate their agreement with 14 statements about the role of PAs. There was also a field for free text comments. Results Of the 1,071 individual responses to the survey questions on clinical skills, 859 (80%) were ‘excellent’ or ‘good’. Similarly, among the 357 answers to the questions on communication skills, 317 (89%) were ‘excellent’ or ‘good’. Comments in the free text field included both positive and negative observations, with all negative comments coming from junior doctors. Conclusions Overall feedback for the PA role was overwhelmingly positive. However, the most commonly mentioned problem was that they are not being utilised effectively and in turn, that they are taking learning opportunities from junior doctors. This is an important concern to note and warrants further investigation. PAs are clearly useful assets and are set to increase in number in the NHS over the coming years. It is therefore imperative that this new role works well with the existing roles and training structure of junior doctors.


Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Emily Riding ◽  
Elizabeth MacPhie

Abstract Background Vitamin D deficiency is common in the UK due to a lack of sunlight over the winter months. Risk factors include darker skin and reduced exposure to sunlight (e.g. housebound/institutionalised patients or those who cover skin for religious reasons). As part of the Choosing Wisely campaign, the British Society for Rheumatology recommend that vitamin D testing should be reserved for people at high risk of deficiency and avoided as part of routine investigation of widespread pain alone. They also recommend that repeat testing isn’t usually necessary in patients who are taking vitamin D supplements. The aim of this project was to review the testing of Vitamin D in a Primary Care setting. Methods An EMIS search was conducted for patients who had their vitamin D levels tested in September and October 2017. The following information was collected for each patient: indication for testing, vitamin D level, whether vitamin D had been tested previously or subsequently, treatment offered and the patient’s residence. Results 96 patients had their vitamin D levels checked. Of these, 8 were excluded as they had been tested on the advice of secondary care. Of the remaining 88 patients, 6 (6%) were vitamin D deficient and 34 (38%) had insufficient vitamin D levels. The most common indication for testing was tiredness in 26 patients (30%) followed by generalised aching/lower limb pain 19 (22%). 8 (9%) patients were tested due to pain at specific sites including a single joint or abdominal pain, 5 (6%) due to neurological symptoms, 4 (5%) due to a diagnosis of CKD and 3 (3%) due to skin and hair problems. There was no clearly documented indication for testing levels in the remaining 3 (3%) patients. 35 (40%) patients had previously had their vitamin D levels tested and 19 (22%) patients had subsequent testing. Of the patients with abnormal vitamin D levels, 22 (25%) were prescribed treatment, 16 (18%) advised to buy over the counter and no advice was documented in 16 (18%) patients. None of the patients lived in residential or nursing homes. Conclusion This project identified a range of indications for vitamin D testing and a large number of patients who had repeated testing. This highlights a potential area for education in primary care surrounding the value in both initial and repeated testing of vitamin D levels. The findings show a need for an improvement in documentation as some patients had no clear linked reason for testing and no evidence that abnormal levels were actioned. However, there were limitations to determining whether BSR guidelines were followed as some factors that would lead to patients being at high risk of deficiency (such as skin colour) could not be collected from EMIS. Disclosures E. Riding None. E. MacPhie Other; EM is the secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.


1881 ◽  
Vol 13 (2) ◽  
pp. 183-207
Author(s):  
William Simpson

On leaving for India to accompany the army into Afghanistan in 1878, Colonel Yule, among other hints of places of interest of an archæological character to be looked out for, mentioned Nagarahara, the capital of the Jelalabad Valley in the Buddhist period. In the time of Hiouen-Thsang the district bore the same name as the capital, and it had no king of its own, but belonged to Kapisa, a city situated somewhere in the direction of Kabul. The district of Nagarahara extended to about 600 Chinese Li, from east to west, which would be over 100 miles. This might reach from about Jugduluck to the Khyber, so that in this last direction it would thus border on Gandara, and on the other extremity would touch Kapisa, which was also the name of the district as well as the capital of that name. The Valley of Jelalabad is small in comparison to that of the province which formerly belonged to it. From Darunta on the west to Ali-Boghan on the east is fifteen miles, but, on the left bank of the Kabul River, the flat land of Kamah extends the valley on that side, about five or six miles further to the east. The termination of the Valley at this place is called Mirza Kheyl, a white rocky ridge comes down close to the river, and there are remains of Buddhist masonry on it, with caves in the cliff below. On the right bank opposite Mirza Kheyl is Girdi Kas, which lies in a small valley at the northern end of a mass of hills which terminates the Jelalabad Valley on that side at Ali-Boghan, separating it from the Chardeh Plain, which again extends as far as Basawul. I got a kind of bird's-eye view of this one day from a spur of the Sufaid Koh, 8,000 feet high, near to Gundumuck, and the Jelalabad Valley and the Chardeh Plain seemed to be all one, the hills at Girdi Kas appearing at this distance to be only a few slight mounds lying in the middle of this space, which would be altogether about 40 miles in extent. When in the Jelalabad Valley, the Girdi Kas hills are undoubtedly the eastern barrier, while the Siah Koh Range is the western. The Siah Koh Range trends to the south-west, and then turns due west, forming a distinct barrier on the north till it is lost at Jugduluck; there are only some low-lying ridges between Futteeabad and Gundumuck, but they are so small that it might be said to be a continuous valley all the way from Ali-Boghan to the plain of Ishpan. The eastern end of the Siah Koh Range terminates at Darunta, which is the north-west corner of the Jelalabad Valley. The Kabul River, instead of going round the extreme end of this range, has, by some curious freak, found a way through the rocky ridge so close to the extremity, that it leaves only what might be called one vertebra of this stony spine beyond. The river here has formed for itself a narrow gorge through perpendicular cliffs, in which it flows, from the district of Lughman, into the level plain of the Jelalabad Valley. The Surkhab pours down from the Sufaid Koh, starting close to Sikaram, the highest point of the range, which our surveyors found to be 15,600 feet above the sea. It passes over the western end of the Ishpan plain, towards the Siah Koh Range, and it then keeps to the contour of its base all the way to the Jelalabad Valley, and joins the Kabul River about two miles below Darunta.


2021 ◽  
pp. 107755872110352
Author(s):  
Esmaeil Khedmati Morasae ◽  
Tanith C. Rose ◽  
Mark Gabbay ◽  
Laura Buckels ◽  
Colette Morris ◽  
...  

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.


2021 ◽  
Vol 28 ◽  
pp. 72-89
Author(s):  
Bruce Scates

Memorials to white explorers and pioneers long stood (virtually) unchallenged in the heart of Australia’s towns and cities. By occupying civic space, they served to legitimise narratives of conquest and dispossession, colonising minds in the same ways ‘settlers’ seized vast tracts of territory.  The focus of this article is a memorial raised to the memory of three white explorers, ‘murdered’ (it was claimed) by ‘treacherous natives’ on the north west frontier. It examines the ways that historians and the wider community took issue with this relic of the colonial past in one of the first encounters in Australia’s statue wars. The article explores the concept of ‘dialogical memorialisation’ examining the way that the meanings of racist memorials might be subverted and contested and argues that far from ‘erasing’ history attacks on such monuments constitute a reckoning with ‘difficult heritage’ and a painful and unresolved past. It addresses the question of whose voice in empowered in these debates, acknowledges the need for white, archival based history to respect and learn from Indigenous forms of knowledge and concludes that monuments expressing the racism of past generations can become platforms for truth telling and reconciliation.


1909 ◽  
Vol 6 (2) ◽  
pp. 75-76 ◽  
Author(s):  
T. Mellard Reade

Mr. Osmond Fisher, in an article in the January number of this Magazine, entitled “Convection Currents in the Earth's Interior”, speaks of my views in a way that may give a false conception of what they are on the subject of overthrusts. He appears (inadvertently, no doubt) to credit me with a disbelief in the thrust-planes occurring in the North-West Highlands. I may say at once that I am one of those who admire the way in which a band of enthusiastic geologists have worked out the structure of this most difficult tract of country, and thoroughly believe in the correctness of their conclusions. The principal object of my little paper in the November number of this Magazine (1908) was to caution geologists not to push their new-born views too far in trying to account for structural difficulties by overthrusts. It must be remembered that the Moine thrust-plane has been proved to no more than 10 miles overlap, but may, of course, be much more. Incidentally, I thought the paper likely to elicit a correspondence helping the interpretation of the phenomena of overthrusts.


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