A systematic scoping review of early interventions for parents of deaf infants.

BACKGROUND: Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful. METHODS: The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment. RESULTS: Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias. CONCLUSION: Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions.

Being the 'med reg': an exploration of junior doctors' perceptions of the medical registrar role.

The role of the medical registrar is challenging and acknowledged as being a disincentive to a career in medicine for some junior doctors. We set out to build a broader understanding of the role through exploration of Foundation Doctors' and Core Medical Trainees' perceptions of the role. Data, gathered from focus groups, were analysed using a framework approach. Six key themes were identified, which were grouped under the headings 'perceptions of the medical registrar role' and 'transition into the role'. Our work builds on existing literature to inform a deeper understanding of how junior doctors perceive the medical registrar role. In light of our findings we offer suggestions on possible training initiatives to tackle the issues identified. We also highlight positive perceptions of the role and emphasise the key ambassadorial role that current medical registrars have in relation to attracting tomorrow's medical registrars to the specialty.

Geriatrics for juniors: tomorrow's geriatricians or another lost tribe?

BACKGROUND: To meet the needs of the ageing population, more geriatric medicine doctors are required. We aimed to determine: (i) career preferences of junior doctors with an interest in geriatric medicine, (ii) factors influencing the likelihood of junior doctors undertaking a career in geriatric medicine and (iii) whether a geriatric medicine conference for junior doctors influenced their views on the specialty and their likelihood of choosing it as a career option. METHODS: All delegates who registered to attend the 'Geriatrics for Juniors' conference (G4J) were invited to complete both a pre- and post-conference survey online. Delegates' free-text responses were subjected to thematic analysis. Differences between paired ordinal data from pre- and post-conference surveys were determined using the Wilcoxon signed rank test. RESULTS: A total of 108 delegates attended G4J. Pre- and post-conference survey response rates were 67% and 51% respectively. Commonly reported deterrents to a career in geriatric medicine included 'being the medical registrar' (27.1% of respondents) and 'second-class specialty' (20.6%). There was a statistically significant difference between pre- and post-conference responses, with a tendency towards less agreement with the statement 'the prospect of being the medical registrar puts me off applying for higher specialty training in geriatric medicine' (Z=-2.512; p=0.012). CONCLUSIONS: The perceived unattractive nature of the medical registrar role may deter some junior doctors from a career in geriatric medicine. A lack of clarity regarding the nature of the specialty still exists. Targeted educational interventions, such as G4J, may positively influence junior doctors' perceptions of the specialty and the role of the medical registrar.

Molecular interactions of the plasma membrane calcium ATPase 2 at pre- and post-synaptic sites in rat cerebellum.

The plasma membrane calcium extrusion mechanism, PMCA (plasma membrane calcium ATPase) isoform 2 is richly expressed in the brain and particularly the cerebellum. Whilst PMCA2 is known to interact with a variety of proteins to participate in important signalling events [Strehler EE, Filoteo AG, Penniston JT, Caride AJ (2007) Plasma-membrane Ca(2+) pumps: structural diversity as the basis for functional versatility. Biochem Soc Trans 35 (Pt 5):919-922], its molecular interactions in brain synapse tissue are not well understood. An initial proteomics screen and a biochemical fractionation approach identified PMCA2 and potential partners at both pre- and post-synaptic sites in synapse-enriched brain tissue from rat. Reciprocal immunoprecipitation and GST pull-down approaches confirmed that PMCA2 interacts with the post-synaptic proteins PSD95 and the NMDA glutamate receptor subunits NR1 and NR2a, via its C-terminal PDZ (PSD95/Dlg/ZO-1) binding domain. Since PSD95 is a well-known partner for the NMDA receptor this raises the exciting possibility that all three interactions occur within the same post-synaptic signalling complex. At the pre-synapse, where PMCA2 was present in the pre-synapse web, reciprocal immunoprecipitation and GST pull-down approaches identified the pre-synaptic membrane protein syntaxin-1A, a member of the SNARE complex, as a potential partner for PMCA2. Both PSD95-PMCA2 and syntaxin-1A-PMCA2 interactions were also detected in the molecular and granule cell layers of rat cerebellar sagittal slices by immunohistochemistry. These specific molecular interactions at cerebellar synapses may allow PMCA2 to closely control local calcium dynamics as part of pre- and post-synaptic signalling complexes.

Effects of a single dose of cortisol on the neural correlates of episodic memory and error processing in healthy volunteers.

RATIONALE: Neuropsychological impairments seen in depression may be secondary to hypercortisolaemia. Repeated cortisol administration impairs episodic memory with an alteration in event-related potentials (ERPs) recorded during information retrieval. It is unclear whether such ERP effects are specific to episodic memory, or whether repeated cortisol administration is required. OBJECTIVE: To investigate the effect of a single dose of hydrocortisone on the neural correlates of episodic memory and error detection. METHODS: Twenty healthy subjects were treated with hydrocortisone (100 mg) or placebo orally, in a double-blind, two-way crossover study. ERPs were recorded during an episodic memory and a Stroop task, 1-3 h following the medication. RESULTS: Cortisol increased error rates during the Stroop task but had no effect on episodic memory. The magnitude of ERPs associated with incorrect response in the Stroop task between -250 ms and +500 ms post-response was increased by cortisol, with no effect on correct-response ERPs. There was no effect of cortisol on episodic memory-retrieval-dependent ERPs. CONCLUSIONS: Cortisol can impair not only episodic memory but also processes involved in error detection. In contrast to repeated cortisol administration, a single dose of cortisol does not alter the behavioural performance or the electrophysiological correlates of episodic memory. However, it increases error rates in a choice response task with associated quantitative changes in incorrect-response ERPs. This probably reflects an alteration in anterior cingulate cortex activity. Such changes may contribute to the neuropsychological impairment seen in depression. This study also demonstrates the utility of ERPs for investigating the effect of neuroendocrine manipulations on the neural correlates of neuropsychological function.

Resource management progress of the program in the NHS in England.

1. HISTORY. The program began in 1986 as the Resource Management Initiative and had just six pilot sites. In 1989, Ministers decided to establish a national Resource Management Programme covering all general acute Hospitals in England with more than 250 beds--some 250-260 sites in all. A range of community units also embarked on a program of pilot projects aimed at testing the RM principles in those services. 2. ELEMENTS OF THE PROGRAM. A site joining the program was expected to submit a case based on readiness for inclusion, supported by an outline project plan before approval could be given. The plan encompassed a range of elements, but was individual to each unit; the philosophy being that each unit was being assisted to reach its own objectives within an overall framework. The elements of the framework were as follows: a) A vision of what was expected to be achieved by the project and the benefits being sought; b) A focus on improving the quality of patient care in the unit; c) Involving clinicians in the management process; d) The availability of clinical information to support decision-making; this included the hardware and software for Case-Mix Management and Nurse Management Systems, but also extended to coding, classifying, and grouping systems. e) A greater awareness of the financial implications of clinical decisions; f) A project management approach to implementation; g) An approach based on developing both the organization and its staff, with training. 3. THE KEY TO RM IMPLEMENTATION IS CULTURAL CHANGE AT THE UNIT LEVEL. While steps to achieve this change can be planned and driven forward via the project plan, the very nature of the project means that a more flexible and "soft systems" view of success is appropriate. Local ownership of the process is essential and can lead to a very specific view of "success." 4. BENEFITS. Demonstrating primary causality is difficult as eight years have elapsed since the program was started, and this has coincided with a period of radical change. However certain matters are beyond dispute: The vast majority of units have adopted one form or other of Clinical Directorate structure. Many clinical staff are formally engaged in the operational and general management process. Some RM sites are advantageous when it comes to negotiating with their purchaser organizations because they have better quality data on which to base the process. The use of Casemix Management and Nurse Management Systems is seen in some RM sites as improving the quality of patient care provided. RM has focused attention on clinical coding and grouping. RM has exposed the need to develop or reassess Information Strategies at unit level. RM has stimulated staff training and development at site level and has been instrumental in improving the quality of training facilities, resources, and materials that are available. RM is recognized as having had a catalytic effect on changes associated with the NHS Reforms. 5. CONCLUSION. Good quality services require well-managed and competent provider organizations. The RM program was designed to assist the improvement of provider unit management. There is general agreement that the principles of RM should be taken forward in the broader context of provider development, with a focus on quality as well as financial issues.