An investigation of the clinical experiences of dentists within the national dental foundation training programme in the North West of England.

Objective To investigate the clinical experiences of foundation dentists (FDs) in the North West of England.Methods Three research methods were used: a questionnaire completed by FDs at the end of their training; an analysis of the clinical logs of experience recorded in the educational portfolios; and analysis of NHS Business Services Authority (NHSBSA) activity data for the 12 month period of training of FDs.Results A response rate of 100% (N = 50) was achieved for the questionnaire and complete data for 49 of the 50 FDs was available from the NHSBSA and clinical logs in the educational portfolios.Discussion Trainees were satisfied with the clinical experience and believed their workload and patient mix provided a broad experience of clinical conditions, although 40% felt there were gaps in their clinical experience. There were wide ranges in the number of individual clinical procedures performed by FDs with some providing very few endodontic treatments, crowns, bridges, metal dentures and fissure sealants. There was a statistically significant difference (P <0.0005) in self- reporting of procedures recorded in the portfolio log when compared to the NHSBSA data.Conclusion The results from this study suggest that there is satisfaction amongst FDs with FT, but there is wide range in the level of clinical experience amongst FDs with some gaps which need to be addressed. In order to provide a consistent, cost effective approach to the delivery of FT changes are required to ensure minimum levels of clinical procedures are achieved during FT. The information collected in the training portfolio must be robust in order to make valid judgements on progress.

The personal value of being part of a Tropical Health Education Trust (THET) links programme to develop a palliative care degree programme in Sub Saharan Africa: a descriptive study of the views of volunteer UK health care professionals.

BACKGROUND: There is a global need to expand palliative care services to reach the increasing number requiring end of life care. In developing countries where the incidences of cancer are rising there is an urgent need to develop the palliative care workforce. This paper reports on a UK Department for international development (DFID) initiative funded through the Tropical Health Education Trust (THET) where palliative care staff, both clinical and academic, volunteered to help to develop, support and deliver a degree in palliative care in sub-Saharan Africa. The objective of the study was to explore the personal impact on the health care professionals of being part of this initiative. METHODS: An evaluation approach using a confidential electronic survey containing quantitative and qualitative questions was distributed to all 17 volunteers on the programme, three months after completion of the first cohort. Data were analysed using descriptive statistics and content thematic analysis. Ethical review deemed the study to be service evaluation. RESULTS: 82 % (14) responded and several themes emerged from the data including the positive impact on teaching and educational skills; clinical practice and finally personal development. Using a score of 1-10 (1-no impact, 10 maximum impact) 'Lifestyle choices - life work balance' (rating 7.83) had the most impact. CONCLUSIONS: This approach to supporting the development of palliative care in Sub-Saharan Africa through skill sharing in supporting the delivery of a degree programme in palliative care was successful in terms of delivery of the degree programme, material development and mentorship of local staff. Additionally, this study shows it provided a range of positive impacts on the volunteer health care professionals from the UK. Professional impacts including increased management skills, and being better prepared to undertake a senior role. However it is the personal impact including lifestyle choices which the volunteers reported as the highest impact. Interestingly, several of the faculty have joined other volunteer programmes to continue to support the international development of palliative care.

A national evaluation of workplace-based assessment tools (WPBAs) in foundation dental training: a UK study. Effective and useful but do they provide an equitable training experience?

A questionnaire study was undertaken with trainers and trainees from 12 deaneries in England and Northern Ireland in June 2010 to evaluate workplace-based assessments (WPBAs) in foundation training. From the sample consisting of 741 trainers and 643 foundation trainees, experience of WPBAs was positive overall, playing an important role in trainees' learning during foundation training and building confidence. However, there is a need for comprehensive training in the WPBA tools used to ensure their efficacy.

Evaluation of workplace based assessment tools in dental foundation training.

OBJECTIVE: The aims of this survey were to evaluate the effectiveness of workplace based assessments (WPAs) in dental foundation training (formerly vocational training [VT]). METHODS: Two online questionnaire surveys were sent to 53 foundation dental practitioners (FDPs) and their 51 trainers in the Mersey Deanery at month four and month nine of the one year of dental foundation training. The questionnaires investigated the effectiveness of and trainers' and trainees' satisfaction with the WPAs used in foundation training, namely dental evaluation of performance (D-EPs), case-based discussions (DcBD) and patients' assessment questionnaires (PAQs). The questionnaires also investigated the perceived impact of reflection and feedback associated with WPAs on clinical practise and improving patient care. RESULTS: A total of 41 (7.4%) FDPs and 44 (86.3%) trainers responded. Of the 41 FDPs, the majority found that feedback from WPAs had a positive effect on their training, giving them insight into their development needs. Overall 84.1% of the FDPs felt the WPAs helped them improve patient care and 82.5% of trainers agreed with that outcome. CONCLUSIONS: The findings from this study demonstrate the value of WPAs in dental foundation training by the use of feedback and reflection in directing the learning of foundation dental practitioners and that this can lead to improved clinical practise and patient care.

'A bridge to the hospice': the impact of a Community Volunteer Programme in Uganda.

In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. The aim of this qualitative study was to evaluate the impact of the Community Volunteer Programme. Sixty-four interviews, with patients (21), community volunteer workers (CVWs) (32), and the hospice clinical teams (11) were conducted, using semi-structured digitally recorded individual, group and focus group interviews, at the Hospice Africa Uganda sites. The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a 'bridge to the hospice' in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.

The natural history of stenoses within lower limb arterial bypass grafts using a graft surveillance program.

Graft surveillance aims to identify those grafts that are at risk of failure as intervention in a patent but failing graft results in improved long-term patency and limb salvage rates compared to rescue of an occluded graft. Controversy exists as to which types of graft benefit the most from surveillance and whether patient factors such as diabetes and smoking status have an effect on graft survival. Our aims were (1) to clarify the natural history of midterm graft failure as a consequence of myointimal hyperplasia and (2) to identify which patients and grafts are at a higher risk of failure and at what time points this is most prevalent. Serial vascular laboratory and clinical data of 212 infrainguinal lower limb grafts in 197 patients were analyzed. Follow-up within the surveillance program was by focused examination with color flow duplex ultrasound at 0, 1, 3, 6, 12, and 18 months with respect to surgery. Outcomes were correlated with retrospectively collected data regarding patient demographics, smoking status, concurrent medication, comorbidity, and operative factors such as distal target vessel and conduit. During the program, 21.6% of grafts occluded. Overall, 16% of grafts underwent a salvage procedure, 40.5% of which were carried out at the 6-month time point. There were 56.6% of occlusions preceded by a stenotic lesion. Primary occlusions accounted for 95.9% in the prosthetic group and 66.5% in the femorocrural group. As a group, vein grafts were more likely to develop a progressive stenosis prior to occlusion, with 58.3% in this group predated by a stenotic lesion. Fewer than 75% of stenoses were common and had a variable natural history, with over 40% resolving or failing to progress. Throughout the study period, 56.2% of grafts remained stenosis-free. Stenoses were more common at the proximal anastomosis in the vein graft cohort. There were low rates of significant stenoses within the prosthetic group. These lesions were more likely to occur at the distal anastomosis but were poor predictors of occlusion. Statin use postoperatively was protective against the development of significant stenosis and occlusions, particularly in the above-knee grafts (p = 0.03). Surprisingly, preoperative smoking status was predictive of neither occlusion nor development of significant stenosis. The presence of diabetes was not predictive of poor outcome. Our findings suggest that graft surveillance is a valid method for detecting the presence of significant stenoses in vein grafts at high risk of failure without intervention. Despite the intensive follow-up, the program failed to detect lesions prior to occlusion in a large percentage of prosthetic and femorocrural grafts, so perhaps this group is poorly served by graft surveillance.

Hepatocyte growth factor and c-Met expression in pericytes: implications for atherosclerotic plaque development.

Intraplaque neovascularization contributes to the progression of atherosclerosis. Our aim is to understand the mobilization of cells and factors involved in this process. We investigated the localization of hepatocyte growth factor (HGF) and its receptor, c-Met, in human atherosclerotic plaques, together with the effects of HGF on pericyte migration in vitro. Atherosclerotic femoral arterial segments were collected and analysed from 13 subjects who were undergoing lower limb amputation. Pericytes were identified in human lesions using a 3G5 antibody. Immunohistochemical analysis localized HGF mainly around microvessels, in association with some, but not all, CD31-positive endothelial cells. c-Met expression was mainly associated with smooth muscle cells and pericytes, around some, but not all, microvessels within the atherosclerotic lesions; no detection was apparent in normal internal mammary arteries. Using RT-PCR, we demonstrated expression of HGF and c-Met in a rat pericyte cell-line, TR-PCT1, and in primary pericytes. HGF treatment of TR-PCT1 cells induced their migration, but not their proliferation, in a dose-dependent manner (10-100 ng/ml, p<0.01), an effect mediated by activation of the serine/threonine kinase Akt, shown by western blot analysis. Treating the cells with the PI3K inhibitors Wortmannin (0.1 microM) or LY294002 (10 microM) abolished these effects. This work demonstrates the expression of c-Met and HGF in human atherosclerotic arteries, in association with SM-actin-positive cells and CD-31-positive cells, respectively. HGF induces pericyte migration via PI3-kinase and Akt activation in vitro. HGF and c-Met may be involved in neovascularization during plaque development, and may recruit pericytes to neovessels. Since pericytes are thought to mechanically stabilize new blood vessels, these factors may function to protect against haemorrhage.

Transfer of radioactive caesium from soil to vegetation and comparison with potassium in upland grasslands.

The distribution and transfer of caesium and potassium between soils and vegetation has been investigated by field sampling and experimental studies on soils and vegetation typical of upland grassland in north west England. Total (137)Cs content to a depth of 0.05 m below root matt ranged from 13 000 to 18 000 Bq m(-2). This caesium content derives from three sources: the Windscale accident of 1957, weapons-testing fallout which peaked in the early 1960s, and the Chernobyl accident in May 1986. From 2200 to 6200 Bq m(-2) is attributed to the first two sources, and the remainder to Chernobyl. In December 1986, 23-78% of pre-Chernobyl (137)Cs was associated with soil underlying root matt and 0.5-5.5% was associated with vegetation. Plant/soil concentration ratios for pre-Chernobyl (137)Cs were in the range 0.5-6.5, the lowest values being associated with patches of Festuca/Agrostis turf. At the same time, 4-19% of (137)Cs deposited from Chernobyl was associated with vegetation, although higher values appeared in conjunction with the moss, Polytrichum commune. Corresponding total potassium contents were in the range 9.6-22 mg m(-2) to 0.05 m soil depth. Lower values were found at the wetter sites where, on average, 5.7% of the total potassium was present in vegetation. At drier sites the potassium content was higher and, on average, 8.9% was present in vegetation. Plant/soil concentration ratios ranged from 2.2 to 9.2. During accelerated growth of vegetation, on monoliths in glasshouse conditions over the winter of 1986/87, (137)Cs was transferred from soil and root matt to new growth, such that concentrations in fresh growth were similar to or higher than those observed in the field during December 1986. Removal of caesium by successive cuts resulted in up to 25% of the original estimated total being removed over a 240 day period. Increased concentrations coincided with the emergence of Carex sp. and Trichophorum caespitosum, as well as the development of Agrostis sp. and Festuca ovina. Observed Cs/K discrimination ratios, particularly for (137)Cs deposited from Chernobyl, were higher than previously reported in the literature. The experimental results were confirmed by field observations during spring 1987 and it is concluded that caesium deposited as a result of the Chernobyl accident will continue to be recycled in organic and low potassium soils.