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Reflections on Diversity and Exclusion 关于多样性和排他性的思考
Pub Date : 2022-10-30 DOI: 10.38192/1.7.3.9
Lailah Peel
Personal opinion as a mixed-race woman in the NHS
作为一名在NHS工作的混血女性的个人看法
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引用次数: 0
Efficacy of Primary Prevention in the COVID-19 Pandemic 初级预防在COVID-19大流行中的效果
Pub Date : 2022-10-29 DOI: 10.38192/1.7.3.3
S. Jamal
Background: The COVID-19 treatment protocol has consistently been under modification since its inception, from the omission of drugs once considered lifesavers such as hydroxychloroquine to the addition of newer medications e.g.: remdesivir. In such situations, it is crucial that we reinforce the importance of primary prevention, especially in low-income countries, where issues exist of shortage of resources such as oxygen and ventilators. We demonstrate how primary prevention holds good against the emergence of new variants, and future pandemics.Discussion: Articles predating and postdating the COVID-19 pandemic were analysed. The articles predating the pandemic included those relating to primary preventive methods used during the H1N1 pandemic of 2009, and articles postdating the pandemic included studies which demonstrate higher mortality of COVID-19 in smokers shed light on the importance of primary prevention, and demonstrate how primary prevention and good health education could have saved countless lives.Conclusion: It is essential that Primary prevention be employed, not only in the case of chronic lifestyle conditions such as hypertension and diabetes mellitus but also in the cases of pandemics, where prevention before the chain of infection starts can prove to be lifesaving. As healthcare providers, the responsibility lies with us to emphasize on the importance of primary prevention and comprehensively propagate information.
背景:COVID-19治疗方案自制定以来一直在不断修改,从遗漏羟氯喹等曾被视为救命药物到添加瑞德西韦等较新的药物。在这种情况下,我们必须加强初级预防的重要性,特别是在存在氧气和呼吸机等资源短缺问题的低收入国家。我们展示了初级预防如何有效防止新变种的出现和未来的大流行。讨论:分析了COVID-19大流行前后的文章。大流行之前的文章包括与2009年H1N1大流行期间使用的初级预防方法有关的文章,大流行之后的文章包括证明COVID-19在吸烟者中死亡率更高的研究,这些研究阐明了初级预防的重要性,并展示了初级预防和良好的健康教育如何可以挽救无数生命。结论:不仅在高血压和糖尿病等慢性生活方式疾病的情况下,而且在流行病的情况下,必须采用初级预防,因为在感染链开始之前进行预防可以挽救生命。作为医疗服务提供者,我们有责任强调初级预防的重要性,全面宣传信息。
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引用次数: 0
Musings on the Monarchy 对君主制的思考
Pub Date : 2022-09-22 DOI: 10.38192/1.7.3.1
I. Chakravorty
The events that unfurled in the UK and around the world following the announcement from the Royal household on September 8, 2022, were of a scale hitherto unwitnessed in recent times. Yes, she (HM QE II) did not once acknowledge nor apologise for the historic injustices carried out in the name of the crown before her time and also, as some will point out, during her reign. Perhaps she could have done more, engaged with her subjects, influenced some of her 15 premiers to change the course of history for her Commonwealth subjects, and offered reparation. Perhaps, the new King will change her hands-off approach to politics and engage with justice for humanity and climate change. It is a double-edged sword, as engagement may allow the Commons to remove the last vestiges of the monarchy if one loses step with the mood of the public. As we watch the outpouring of affection, the nearly million people who are predicted to file past her coffin, and billions more who watch around the world, one cannot help but wonder that the best lesson for the new King has to be the masterclass that Queen Elizabeth II demonstrated through her life.
王室于2022年9月8日宣布这一消息后,在英国和世界各地展开了一系列事件,其规模是近年来前所未见的。是的,她(女王二世)从未承认或为在她的时代之前以及在她的统治期间以王室的名义进行的历史不公正行为道歉。也许她本可以做得更多,与她的臣民接触,影响她的15位总理中的一些人,为她的英联邦臣民改变历史进程,并提供赔偿。也许,新国王会改变她对政治的不干涉态度,参与人类正义和气候变化。这是一把双刃剑,因为如果下议院与公众的情绪不一致,订婚可能会让下议院消除君主制的最后痕迹。当我们看到人们流露出的爱意,预计将有近100万人列队走过她的灵柩,以及全球数十亿人观看她的葬礼时,我们不禁会想,对新国王来说,最好的一课必须是女王伊丽莎白二世(Queen Elizabeth II)一生所展示的大师课。
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引用次数: 0
Personal Perspective on the Systematic Review of Serotonin Imbalance Hypothesis for depression and Mechanism of Action for Antidepressants 5 -羟色胺失衡假说与抑郁症及抗抑郁药物作用机制的系统综述
Pub Date : 2022-08-29 DOI: 10.38192/1.7.2.11
F. Khan
Counselling psychologist Fauzia Khan meets Dr Mark Horowitz, Trainee Psychiatrist and Clinical Research Fellow in the NHS. Mark talks about his journey into psychiatry, his personal experience of using antidepressants and the withdrawal effects he experienced. Mark also discusses his research interests and the recent umbrella systematic review he co-authored with Professor Joanna Moncrieff on the serotonin theory of depression. [1]
咨询心理学家Fauzia Khan会见了NHS实习精神病学家和临床研究员Mark Horowitz博士。马克谈到了他的精神病学之旅,他使用抗抑郁药的个人经历以及他所经历的戒断效应。马克还讨论了他的研究兴趣和最近他与乔安娜·蒙克利夫教授共同撰写的关于抑郁症血清素理论的综合系统综述。[1]
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引用次数: 0
Sharing is Caring & Giving is Winning 分享就是关心,给予就是胜利
Pub Date : 2022-08-09 DOI: 10.38192/1.7.2.10
Shafiah Abdul Gafoor, Navneet Kandhari
The COVID-19 pandemic has been the defining health crisis of our generation. In the UK healthcare industry, where pre-pandemic surveys already demonstrated high levels of stress, it is imperative that actions are taken to support the mental wellbeing of staff from its expected psychological fallout. Feasible, low cost and time efficient interventions are warranted. Rewards-based incentives may carry promise.Our group distributed 129 free wellbeing packages to junior doctors in a busy London Hospital. Open-ended and anonymised surveys were used to gather qualitative data on their effect. Data was analysed thematically and collated into 5 core themes: Emotional Response, Reaction to Initiative, Reaction to Product Choice, Gratitude and Feeling Valued.Overall, the significant majority of respondents (n=50, 96%) were highly appreciative of the intervention, deeming it both useful and relevant to supporting their mental health. This study bears useful findings for other organisations looking to implement similar low-cost wellbeing strategies.  
2019冠状病毒病大流行是我们这一代人面临的决定性健康危机。在英国医疗保健行业,大流行前的调查已经显示出高水平的压力,当务之急是采取行动,支持员工的心理健康,免受预期的心理影响。可行、低成本和高效率的干预措施是必要的。基于奖励的激励可能带来希望。我们小组向伦敦一家繁忙医院的初级医生分发了129个免费福利包。使用开放式和匿名调查来收集其效果的定性数据。数据按主题进行分析,并整理成5个核心主题:情绪反应、对主动性的反应、对产品选择的反应、感激和感觉被重视。总体而言,绝大多数受访者(n= 50,96%)高度赞赏干预措施,认为它既有用又与支持他们的心理健康有关。这项研究为其他寻求实施类似低成本福利战略的组织提供了有用的发现。
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引用次数: 0
Abnormal Calcium, Calcinosis, and Creatinine in Down's syndrome 唐氏综合征中钙、钙沉着和肌酐异常
Pub Date : 2022-07-27 DOI: 10.38192/1.7.2.8
S. Hosdurga, S. Hussain, James Fraser
The hypercalcaemia in association with trisomy 21 (Down's syndrome) is often not recognised and therefore underdiagnosed. Patients present with the tetrad of hypercalcaemia, Down’s syndrome, renal impairment, and nephrocalcinosis. 1-3    A 30-month old child with Down’s syndrome had a long history of nonspecific symptoms, constipation and feeding difficulties. He was on excessive bottle feeds, taking 14 bottles daily, each with six ounces of milk.  He presented with a cardiac arrest having been unwell with an acute illness. Blood tests showed hypercalcemia, raised urea and creatinine which were not explained by any other aetiologies. Post-mortem analysis showed acute pyelonephritis and nephrocalcinosis. In children with Down’s syndrome, early detection of hypercalcaemia and introduction of low calcium feeds may prevent morbidity and mortality. Awareness and monitoring of serum calcium levels along with routine thyroid function tests in children with Down syndrome, would be important to prevent such occurrences.  
与21三体(唐氏综合征)相关的高钙血症通常不被认识,因此未被充分诊断。患者表现为高钙血症、唐氏综合征、肾功能损害和肾钙质沉着症。1-3 1例30个月大的唐氏综合征患儿有非特异性症状、便秘和喂养困难的长期病史。他的奶瓶喂养过量,每天要喝14瓶,每瓶6盎司的牛奶。他因急病而身体不适,心脏骤停。血液检查显示高钙血症、尿素和肌酐升高,这些都不能用其他病因来解释。死后分析显示急性肾盂肾炎和肾钙质沉着。在患有唐氏综合症的儿童中,早期发现高钙血症并引入低钙饲料可能会预防发病率和死亡率。认识和监测血清钙水平以及常规甲状腺功能检查对预防唐氏综合症儿童的发生非常重要。
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引用次数: 0
FIRMST International Conference on Applied Anatomy 国际应用解剖学会议
Pub Date : 2022-03-26 DOI: 10.38192/1.7.2.ficaa22
A. Anon.
https://www.firmst.tech/ Conference Abstracts
https://www.firmst.tech/会议摘要
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引用次数: 0
Perspectives on UK Care Quality Commission’s Inspections of Primary Care Practices 英国护理质量委员会对初级保健实践检查的看法
Pub Date : 2022-01-30 DOI: 10.38192/1.7.2.7
K. Sidhu, Kalindi Tumurugoti, Naureen Bhatti, Abrar Hussein, I. Chakravorty
Background In the middle of a pandemic, when the health and social care services were experiencing their worst challenges and staff were facing burnout, the feedback from primary care professionals raised concerns on the UK Care Quality Commission’s inspection regime and specially on its effectiveness, impact on services and particularly relating to its equality, diversity and inclusion aspects.  Methods An online anonymised survey was carried out in July 2021 and received 130 responses, the majority from the GP partners but also locum and sessional colleagues as well as other members of the general practice team. Results About 80% of respondents reported having a good rating or an outstanding rating. But fewer than 20% of the participants felt that their experience of the CQC inspections was positive. More than 85% of respondents feel that the inspections did not add value to the clinical care or prevent harm. 80% felt that the inspections were not fair, transparent, objective, or replicable and found these to be traumatic rather than being a positive or constructive experience. More than 50% felt that Practices led by Black and AsianGPs small practices and those inner city, and rural practices in areas of deprivation receive disproportionately poorer outcomes. Three in four respondents felt that the inspections were intense and took staff away from direct clinical care. Almost 86% of respondents felt that the inspectors demonstrated insights into the systemic challenges faced by primary care. About half of the respondents did not feel supported by the LMCs and/or their CCG.  Discussion & Conclusion The findings demonstrated that the inspections were not considered to be effective or constructive and took the general practice team away from patient care. Of particular concern was that perception that the system was unfair and discriminatory for Black and Asian GPs small practices and those in inner city or rural locations with multiple deprivation. The authors urge the CQC to ensure that the profession is supported and that any inspection process is fair, non-discriminatory and improves patient care. 
背景:在大流行期间,当保健和社会保健服务面临最严重的挑战,工作人员面临倦怠时,初级保健专业人员的反馈对联合王国护理质量委员会的检查制度提出了关切,特别是对其有效性、对服务的影响,特别是对其平等、多样性和包容性方面的影响。方法在线匿名调查在2021年7月,共收到了130个进行反应,大多数的医生合作伙伴还临时代理和开会的同事以及全科团队的其他成员。结果约80%的受访者给出了良好或优秀的评价。但只有不到20%的参与者认为他们的CQC检查经历是积极的。超过85%的受访者认为检查没有增加临床护理的价值或防止伤害。80%的人认为检查不公平、不透明、不客观或不可复制,并认为这些检查是创伤性的,而不是积极或建设性的经历。超过50%的人认为,在贫困地区,由黑人和亚裔的小型诊所、市中心诊所和农村诊所主导的诊所,其效果更差。四分之三的答复者认为检查是激烈的,使工作人员远离直接的临床护理。几乎86%的答复者认为,检查人员对初级保健面临的系统性挑战表现出了深刻的见解。约有一半的受访者认为没有得到地方管理公司和/或其CCG的支持。讨论与结论调查结果表明,检查不被认为是有效的或建设性的,使全科医生团队远离患者护理。特别令人关切的是,人们认为该制度对黑人和亚洲家庭医生、小型诊所以及内城或农村地区的家庭医生不公平和歧视。作者敦促CQC确保该行业得到支持,任何检查过程都是公平的,非歧视的,并改善患者护理。
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引用次数: 0
Validation of the All Wales Covid-19 Risk Assessment tool in Practice 在实践中验证全威尔士Covid-19风险评估工具
Pub Date : 2022-01-23 DOI: 10.38192/1.7.2.6
Archit Singhal, Alan Abraham, Parag Singhal, D. Raje, K. Singhal
Background: The All-Wales Covid-19 Risk Assessment tool (WRA) was developed to support managers in undertaking individual risk assessments for employees in public facing work settings, and put in place appropriate mitigation. Although a tool for all employees, it’s development was prompted in part by the observation that Covid-19 was disproportionately affecting Black, Asian and Minority Ethnic (BAME) employees, particularly those in health and social care settings.  This simple, self-administered tool estimates an individual’s risk of severe Covid-19 disease by scoring  personal risk factors, based on those previously identified in the emerging literature. The aim of this study was to assess the performance of this tool, by measuring concordance between an individual respondants self perceived risk and the risk indicated by the tool in a sample of healthcare professionals. Methods: The WRA was distributed amongst BAME healthcare professionals around Wales, UK with additional questions  to understand participant concordance with the risk stratification from the tool. Statistical analyses were applied to establish the degree of concordance. The initial survey was followed by a more widespread survey across Wales where the sample size of the respondents was 3728 Results: A total of 136 participants responses were included in the analyses. The majority of participants were below 50 years of age (median age, range), male,  and of BAME ethnicity. The weighted kappa coefficient indicated significant concordance between the tool outcome and respondent’s self perceived risk (k=) . Younger respondents considered themselves at lower risk, which was correctly predicted by the tool. The association between risk tool outcome and self-perceived risk was not affected by participant characteristic. Of the larger Welsh cohort of 3728 respondents, 93.8% felt that the tool correctly identified their risk and was in concordance with their own risk perception.      Conclusions: There was a high level of concordance between the tool user's self-perceived risk and risk assessment tool outcome.  Where there was disagreement, self-perception of risk was lower than that of the tool, indicating a more precautionary approach taken by the tool. The high concordance provides user confidence that the All Wales Covid-19 risk assessment tool is likely to provide a correct risk stratification and mitigation strategies in this occupational group.
背景:开发全威尔士Covid-19风险评估工具(WRA)是为了支持管理人员对面向公众的工作环境中的员工进行个人风险评估,并采取适当的缓解措施。虽然这是一个适用于所有员工的工具,但它的开发部分是由于观察到新冠病毒对黑人、亚洲和少数族裔(BAME)员工的影响不成比例,尤其是那些在卫生和社会护理领域工作的员工。这个简单的、自我管理的工具,根据新兴文献中先前发现的个人风险因素,通过评分来估计个人患严重Covid-19疾病的风险。本研究的目的是评估该工具的性能,通过测量单个应答者的自我感知风险和医疗保健专业人员样本中该工具所指示的风险之间的一致性。方法:在英国威尔士的BAME医疗保健专业人员中分发WRA,并附加问题以了解参与者对工具风险分层的一致性。采用统计分析来确定一致性程度。最初的调查之后,在威尔士进行了更广泛的调查,受访者的样本量为3728人。结果:共有136名参与者的回答被纳入分析。大多数参与者年龄在50岁以下(年龄中位数,范围),男性和BAME种族。加权kappa系数表明工具结果与被调查者的自我感知风险之间存在显著的一致性(k=)。年轻的受访者认为自己的风险较低,这是该工具正确预测的。风险工具结果与自我感知风险之间的关联不受参与者特征的影响。在3728名受访者的较大威尔士队列中,93.8%的人认为该工具正确识别了他们的风险,并与他们自己的风险感知一致。结论:工具使用者的自我感知风险与风险评估工具结果之间存在高度的一致性。在存在分歧的情况下,对风险的自我感知低于工具,表明工具采取了更预防性的方法。高度一致性为用户提供了信心,即全威尔士Covid-19风险评估工具可能为该职业群体提供正确的风险分层和缓解策略。
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引用次数: 0
The Impact of COVID-19 lockdown on Indian medical undergraduate students COVID-19封锁对印度医学本科生的影响
Pub Date : 2021-12-27 DOI: 10.38192/1.7.2.5
Meemansa Jindal, A. Singla, A. Khan
Background and Aims: With the implementation of the COVID-19 lockdown, conventional teaching had to be replaced with online teaching, to ensure the continuity of medical education. This has impacted the clinical training of medical undergraduates. We aimed to explore their perceptions and differences before and during the COVID-19 lockdown.Methods: A cross-sectional online survey using a self-administered, retrospective pre-post questionnaire, was conducted among students from pre-final and final year between December 2020 and March 2021. Agreement scores with 15-items about the various domains of clinical training were recorded. Open-ended question was asked to know about the reasons for the students’ preferences. Chi-square test and Wilcoxon signed rank test were used to compare the proportion and medians respectively.Results: We received 1000 responses from students of 191 medical colleges {Median (IQR): 6 (2,10) per college}. Most (81.6%) opined that their experience with clinical training was better before COVID-19 lockdown, irrespective of the mode of teaching in clinical skills (P<0.001). In addition, despite being more comfortable, focused, and interactive, online clinical training could not offer interaction with patients, residents and colleagues. Students who had gone through in-person training during lockdown period also perceived disadvantages like limited exposure to patients, limited time for faculty to teach, and less time for clinical practice.Conclusion: The learning experiences of clinical training during COVID-19 lockdown were perceived as inferior than that before lockdown by the medical undergraduate students, irrespective of the mode of clinical training.
背景与目的:随着新冠肺炎疫情防控措施的实施,为保证医学教育的连续性,必须将传统教学改为在线教学。这影响了医学本科生的临床培养。我们旨在探讨他们在COVID-19封锁之前和期间的看法和差异。方法:在2020年12月至2021年3月期间,对期末前和期末的学生进行了横断面在线调查,采用自我管理的回顾性前后问卷。记录临床培训各领域15项的同意分数。通过开放式问题来了解学生偏好的原因。比例和中位数的比较分别采用卡方检验和Wilcoxon符号秩检验。结果:我们收到了来自191所医学院学生的1000份回复{中位数(IQR):每所学院6(2,10)}。无论临床技能教学模式如何,大多数(81.6%)认为封锁前的临床培训经验更好(P<0.001)。此外,尽管在线临床培训更舒适、更专注、更互动,但无法提供与患者、住院医师和同事的互动。在封锁期间接受过面对面培训的学生也意识到了与患者接触有限、教师教学时间有限、临床实践时间较少等不利因素。结论:无论采用何种临床培训模式,医学本科学生对封锁期间临床培训的学习体验都不如封锁前。
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引用次数: 1
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The Homoeopathic physician
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