ABSTRACT
BACKGROUND: We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role. AIMS: To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services. METHODS: Mixed methods comprising a survey and qualitative work. RESULTS: OH survey was completed by 65 of 128 (51%) respondents. Nine accredited specialists and 16 stakeholders contributed qualitative data. Most OH departments were located in acute NHS trusts and additionally provided externally contracted services. We found a large variation in OH staffing and OH services delivered. The COVID pandemic created unprecedented challenges and required expansion in services to meet demand. The majority of respondents described greater recognition and appreciation by others of accredited specialists and OH teams for their specialist contribution during the pandemic. From the qualitative data, we identified two overarching themes. 'Professional credibility has currency' (Theme 1) and 'A visionary future' (Theme 2). A series of sub-themes are described. CONCLUSIONS: Accredited specialists employed in the NHS possess a core set of attributes and capabilities, and are skilful at delivering strong, influential and impactful clinical and strategic leadership across the NHS hierarchy and landscape. The COVID pandemic provided valuable opportunities for them to showcase their specialist clinical and leadership skills. The current wider reorientation of NHS clinical services offers bold new ways to expand their role beyond traditional clinical boundaries.
Subject(s)
COVID-19 , Occupational Health Services , Humans , Leadership , State Medicine , COVID-19/epidemiology , SpecializationABSTRACT
Thirty six volunteer air force personnel were sequentially exposed in a randomized balanced order in a hypobaric chamber to 30 min of baseline (sea level) and mild hypoxia induced by a specified altitude (sea level, 8000 ft and 12,000 ft), followed immediately by breathing 100% oxygen from an oro-nasal mask. Mood and complex cognition were assessed. Analysis of variance indicated that mood (fatigue and vigour) remained the same at 8000 ft but fatigue was increased (p = 0.001) and vigour reduced (p = 0.035) at 12,000 ft and was restored by supplementary oxygen. Complex cognition was not significantly altered by the test conditions. The results of this study do not support prior evidence that mild hypoxia equivalent to either 8000 or 12,000 ft, impairs complex cognition, but suggests that some aspects of mood may be affected at 12,000 ft and can be restored by breathing 100% oxygen.
Subject(s)
Affect , Altitude Sickness/psychology , Cognition , Military Personnel/psychology , Adolescent , Adult , Aerospace Medicine , Air Pressure , Altitude , Altitude Sickness/therapy , Fatigue/etiology , Fatigue/therapy , Humans , Male , New Zealand , Oximetry , Oxygen/administration & dosage , Oxygen/blood , Oxygen Inhalation Therapy , Psychological Tests , Single-Blind Method , Task Performance and Analysis , Young AdultABSTRACT
OBJECTIVE: The relationship between urinary albumin excretion rate (AER) and elevated blood pressure (BP) is unclear as a cause-effect phenomenon in the development of diabetic nephropathy. The aim of this study was to examine the association between AER, HbA1c and BP in children with normoalbuminuria. METHODS: 24-hour ambulatory BP assessment was performed in 78 children with type 1 diabetes mellitus (DM1), age mean +/- SD 13.4 +/- 2.7 yr, range 7.3-18.3 yr, DM1 duration mean +/- SD 6.6 +/- 2.9 yr, range 2.1-11.9 yr. Using generalised linear mixed models with systolic (SBP) and diastolic (DBP) blood pressure as dependent variables, the effects of AER and HbA1c were examined, adjusting for age, gender, DM1 duration and insulin dose. RESULTS: Patients with high normal AER (7-20 microg/min) had higher SBP during daytime and night-time compared to the low normal AER (< or = 7 microg/min) (mean +/- SD 118.20 +/- 7.98 and 110.33 +/- 7.08 mm Hg, p = 0.02; mean +/- SD 108.76 +/- 9.21 and 100.20 +/- 7.75 mm Hg, p = 0.03, respectively). DBP was also higher both during day- and night-time when compared to the < or = 7 microg/min group (mean +/- SD 73.40 +/- 6.50 and 64.86 +/- 5.67 mm Hg, p = 0.002; mean +/- SD 62.50 +/- 6.75 and 56.30 +/- 5.56 mm Hg, p = 0.03 day- and night-time, respectively). CONCLUSION: A rise in SBP and DBP is associated with increased levels of AER even within the normal range.
Subject(s)
Albuminuria/metabolism , Blood Pressure , Diabetes Mellitus, Type 1/complications , Diabetic Nephropathies/etiology , Adolescent , Adult , Albuminuria/urine , Blood Pressure Monitoring, Ambulatory , Child , Circadian Rhythm , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/urine , Diabetic Nephropathies/metabolism , Diabetic Nephropathies/urine , Female , Glycated Hemoglobin/metabolism , Humans , Male , Risk FactorsABSTRACT
At present, sampling of the lymph nodes or bone marrow for the detection of regions of metastatic disease in patients with breast cancer can only be undertaken at the time of initial diagnosis and surgery. However, the sampling of these tissues and the methods used are inaccurate, time consuming, and cannot be used for easy routine screening to determine disease recurrence and response to treatment. Because of the problems encountered with current methods and tissues sampled at the time of breast cancer diagnosis, this review discusses the urgent requirement for and potential development of a quick, simple, and accurate diagnostic test utilising the haematogenous system, a source of circulating tumour cells in patients with breast cancer, and highly sensitive molecular biological techniques, such as reverse transcription polymerase chain reaction. In addition, this review also highlights potential problems that may be encountered and should be avoided when devising such a test.
