Climate change has been described as the biggest global health threat of the 21st century. As a result, governments around the world are committing to legislative change in order to reduce greenhouse gas emissions (GHGEs). The healthcare sector makes a significant contribution to GHGEs and in line with national legislation in the UK, the NHS has recently committed to achieving net zero emissions by 2050. The management of asthma and COPD largely depends on the prescribing of medications that are delivered through inhalers. In the UK, the use of pressurized metered dose inhalers (pMDIs), which rely on hydrofluorocarbon (HFC) propellants accounts for 3.5% of the NHS’s total carbon footprint. In contrast, dry powder inhalers (DPIs) have a much lower carbon footprint due to the absence of a HFC propellant. Here we review evidence of the impact of inhaler choices across four domains: environmental impact, clinical effectiveness, cost effectiveness and patient preferences. We find that as well as a lower global‐warming potential, DPIs have additional benefits over pMDIs in other domains and should be considered first line where clinically appropriate.
The framework aims to provide support and guidance for medical schools in the development of competent, well-rounded doctors who are able to provide safe, patient-centered care in all areas of medical practice.
pathways for neurobehavioural testing or management of patients with perioperative NCD. Ultimately, adoption of the recommendations by Evered and colleagues 7 will depend on the greater community of investigators that study cognitive disorders after anaesthesia and surgery, and the policy of journals that publish their work. Other groups have attempted to standardize the diagnosis of POCD to allow comparisons of results between studies. 13 Despite the latter efforts, the criteria for detecting and defining POCD have remained variable and inconsistent over the ensuing quarter of a century since their opinions were published. Evered and colleagues 7 provide a thorough and thoughtful approach to address how to define cognitive changes after anaesthesia and surgery. Nonetheless, with the exception of delirium, neurocognitive decline after anaesthesia and surgery currently remains a research observation.
IntroductionMobile applications (Apps) are popular in medical education; yet, the actual benefits for students are yet to be formally researched. Clinical And Professional Studies Unique Learning Environment (CAPSULE) is an App created by Brighton and Sussex Medical School. The App provides 650 cases offered to students in their final two years of the undergraduate programme. The App performed consistently well in student feedback, and therefore, a study into the educational benefits of the App was constructed.MethodsA cross-sectional study was performed following two years of use by students to investigate the relationship between App usage and decile ranking.ResultsThe study found that the students who completed more cases tended to score higher per case (p value=0.0037). The study also found a trend between having higher case scores and being part of a stronger decile (p value=0.019).ConclusionsGreater App usage was linked with performing better in the App itself and this was further associated with being in a stronger decile rank. From a user perspective, the data generated from the App could help with identifying students who are underperforming or help students to recognise areas on which they need to focus.
School turnaround initiatives have prioritized the school principal as the change lever. Little overall consideration about the critical role district leadership plays. In this study, we analyze the turnaround launch and, improvement plans of school district leaders participating in a university, turnaround program. We find that district leaders identify certain systems, levers as more significant challenges than other ones, but their espoused, ways to address these challenges are disparate if determined at all. Implications for districts and schools are discussed.
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