Increased restrictive action has been taken to limit tobacco smoking in a variety of public and occupational settings without regard to the behavioural effects of these actions on smokers. Two studies were undertaken; one examining the performance of 16college female cigarette smokers under conditions of smoking or deprivation, and the second study investigating 16 males from the same population. Performance scores, taken from an instrumented complex psychomotor device, wereadjusted for ability as determined from a training period on the deviceand then compared between smoking conditions. In both studies, deprived smokers performed significantly less well on the pursuit tracking task while reaction time, vigilance and mental arithmetic tasks' were not affected. Results are discussed in terms of the negative effectson performance and the possible implications for work situations.
Aims: Royal College of Paediatrics and Child Health subspecialist training in Paediatric Clinical Pharmacology and Therapeutics has been delivered in the UK for 20 years, but no specialist clinical services have been set up previously. Methods: Prospective audit and service evaluation of paediatric clinical pharmacology service pilot phase and dedicated service at a UK children's hospital. Results: Pilot scheme (May-October 2019), then weekly service (established June 2020). Service covers the High Dependency Unit, and inpatients with polypharmacy.The pilot demonstrated high levels of acceptance, with 89% of suggested medication changes agreed by lead clinical team, and success, with 97.5% of suggested changes continued until discharge/pilot completion. Economic analysis estimated direct annualised cost savings on medications of up to £10 000. After 20 ward rounds of the established service, 270 potential medication changes were identified, 213 were carried out (78.9%). The most common were deprescribing (n = 143), prescribing (n = 47) and dose adjustment (n = 8). Seventy-five different medications were deprescribed, most commonly chloral hydrate (n = 12), Lactulose, ibuprofen, Bio-Kult and sodium alginate (all n = 4). The percentage of inpatients prescribed ≥10 medications decreased from 38.5 to 32.1%, while the subset prescribed ≥20 medications decreased from 11.0 to 5.67%. The mean number of medicines prescribed decreased from 9.0 to 8.0, while the median was unchanged at 7. Annual Yellow Card reports of suspected adverse drug reactions more than doubled (n = 66). Conclusion:A UK model for subspecialist paediatric clinical pharmacology service delivery has demonstrated a positive clinical impact and could be replicated at other UK secondary/tertiary children's hospitals.
The combination of lower saving rates in the 1980s, high consumer debt, and the impact of the baby boomer generation moving into retirement in an uncertain economic environment creates increasing concern for the financial state of the American household. This study explored the saving behaviours of baby boomers. The family management‐systems model was used as the framework for the study. Research questions included whether saving behaviours were related to income, education and presence of dependent children. Data are from the 1983 National Survey of Consumer Finances. The 1980s represent a decade critical to first wave baby boomers and their continued influence on American society. A study of their saving behaviours provides information necessary to help plan for their future needs. Frequency counts and cross‐tabulations of demographic data provide a profile of saving behaviours and attitudes toward risk and liquidity. Marital status and presence of children were significantly related to reasons for savings. Income, marital status, education and presence of children indicated a significant effect on net worth and attitude towards risk. Income and presence of children affected attitude towards liquidity. Income level was the strongest predictor of net worth as a measure of saving behaviours.
The House of God is a seminal work of medical satire based on the gruelling internship experiences of Samuel Shem at the Beth Israel Hospital. Thirteen 'Laws' were offered to rationalise the seemingly chaotic patient management and flow. There have been large shifts in the healthcare landscape and practice since, so we consider whether these medical truisms are still applicable to contemporary National Health Service practice and propose updates where necessary:People are sometimes allowed to die.GOMERs (Get Out of My Emergency Room) still go to ground.Master yourself, join the multidisciplinary team.The patient is the one with the disease, but not the only one suffering.Placement (discharge planning) comes first.There is no body cavity that cannot be reached with a gentle arm and good interventional radiologists.Fit the rule to the patient rather than the patient to the rule.They can always pay you less.The only bad admission is a futile one.If you don't take a temperature you can't find a fever and if you are not going to act on it, don't do the test.Show me a BMS (best medical student) who ONLY triples my work, and I'll show you a future Foundation Year 1 doctor (FY1) who is an asset to the firm.Interpret radiology freely, but share your clinical findings with the radiologist and in a timely fashion.Doing nothing can be a viable option. These were developed in conversation with Samuel Shem, who also offers further insight on the creation of the original laws.
Background: Multi-disciplinary team (MDT) cancer care was introduced to improve cancer outcomes in UK. Teaching of MDTs involves observation from the "back of the room". A flipped classroom approach was used as a tool for experiential learning of participation in a meeting. Team dynamics, shared decision-making and representing patient views are important in MDTs.Methods: Four true-to -life cancer cases requiring a multi-modality approach were developed. A flipped classroom was developed following feedback from students. Participants were given cases; individual roles with speciality-specific information; links to cancer resources and guidelines for case discussions. Following preparation facilitators set the scene and supported the groups to run the case discussion. Observers gave feedback on the decision-making, team dynamics and how the patient's views were voiced. Participants gave feedback on their participation within the team, reflections on their role, and their learning of cancer care.Results: Eighty 4th year medical students each participated in two cases, with on average of 10 participants per case. Students compared their learning with their observational experiences of attending MDTs. Students rated this experience highly as a learning experience. Attendance was high, although not all students had prepared their roles. Feedback on the sessions was positive with the majority of students preferring this as a method for learning about MDTs. Results included reflections on how it felt be to be a member of the team with a different opinion, how group dynamics affected decision-making and suggestions for improvements for the flipped classroom approach.Conclusions: A flipped classroom approach to teaching cancer management was rated highly by students. This approach offers a flexible, learning tool that stimulates knowledge application and conceptual understanding. Other professional skills were developed by chairing, presenting evidence from prior preparation and considering the patient's wishes and values. The evaluation of a new innovative way to teach cancer care was well-supported by the students who overwhelmingly have advised to implement the pilot fully into the undergraduate clinical course
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