Mycobacterium avium infection associated with sterile polyarthritis in a dog.

A 1-year-old male neutered Portuguese Podengo dog was presented for lameness, inappetence, pyrexia, diarrhoea and abdominal moderate to severe lymphadenomegaly. Cytology of synovial fluid revealed neutrophilic inflammation in multiple joints suggestive of immune-mediated polyarthritis. Cytology of fine-needle-aspiration material obtained from lymph nodes revealed macrophages with intracytoplasmic, rod-like Ziehl-Neelsen positive staining structures, indicative of mycobacteria. Four-month treatment with enrofloxacin, rifampicin and clarithromycin resulted in clinical improvement and resolution of polyarthritis as evidenced on repeat synoviocentesis, but diarrhoea recurred, Ziehl-Neelsen positive organisms were again found on lymph node cytology and analysis of the 16S rRNA-gene using the Basic Local Alignment Search Tool facility resulted in a match to Mycobacterium avium with 100% sequence identity. Treatment was adjusted to include pradofloxacin, doxycycline, rifampicin and ethambutol and 3 months later the dog is clinically normal. Based on the literature search, this is the first time canine Mycobacterium avium infection associated with immune-mediated polyarthritis is reported. Based on scoping searches, this is the first report of canine Mycobacterium avium infection associated with immune-mediated polyarthritis.

CTSim: Changing teaching practice in radiography with simulation.

INTRODUCTION: Simulation offers radiography students the possibility to experiment with Computed Tomography (CT) in a way not possible in clinical practice. The aim of this work was to test a newly developed simulator 'CTSim' for effectiveness in teaching and learning. METHODS: The simulator was tested in two phases. The first phase used a test-retest methodology with two groups, a group that experienced a Simulation based learning intervention and one which did not. The second phase subsequently tested for changes when the same intervention was introduced as part of an existing CT training module. RESULTS: Phase 1 demonstrated statistically significant improvement of mean scores from 58% to 68% (P < .05) for students who experienced the intervention against no change in scores for the control group. Phase 2 saw mean scores improve statistically significantly in a teaching module from 66% to 73% (P < .05) following the application of the intervention as an active learning component. CONCLUSION: The use of the CTSim simulator had a demonstrable effect on student learning when used as an active learning component in CT teaching. IMPLICATIONS FOR PRACTICE: Simulation tools have a place in enhancing teaching and learning in terms of effectiveness and also introduce variety in the medium by which this is done.

Are there missed opportunities for vaccinating against hepatitis B among people who inject drugs in the UK?

Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015-2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.

Cytokine and Chemokine Concentrations as Biomarkers of Feline Mycobacteriosis.

Mycobacteriosis is an emerging zoonotic disease of domestic cats and timely, accurate diagnosis is currently challenging. To identify differential cytokine/chemokine concentrations in serum/plasma of cats, which could be diagnostic biomarkers of infection we analysed plasma/serum from 116 mycobacteria-infected cats, 16 healthy controls and six cats hospitalised for unrelated reasons was analysed using the Milliplex MAP Feline Cytokine Magnetic Bead multiplex assay. Three cytokines; sFAS, IL-13 and IL-4 were reduced while seven; GM-CSF, IL-2, PDGF-BB, IL-8, KC, RANTES and TNF-α were elevated in mycobacteria-infected cats compared to healthy controls. However, IL-8 and KC concentrations were not significantly different from cats hospitalised for other reasons. Elevations in TNF-α and PDGF-BB may have potential to identify M. bovis and M. microti infected cats specifically while GM-CSF, IL-2 and FLT3L were increased in MTBC infected cats. This study demonstrates potential use of feline tuberculosis as a spontaneously occurring model of this significant human disease. Cytokine profiling has clear diagnostic potential for mycobacteriosis of cats and could be used discriminate tuberculous from non-tuberculous disease to rapidly inform on zoonotic risk. Future work should focus on the in-field utility of these findings to establish diagnostic sensitivity and specificity of these markers.

Assessment of the comparability of CLSI, EUCAST and Stokes antimicrobial susceptibility profiles for Escherichia coli uropathogenic isolates.

BACKGROUND: As many clinical laboratories convert between Stokes, Clinical and Laboratory Standards Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) methods, the problem of comparing differently derived sets of antimicrobial susceptibility testing (AST) data with each other arises, owing to a scarcity of knowledge of inter-method comparability. The purpose of the current study was to determine the comparability of CLSI, EUCAST and Stokes AST methods for determining susceptibility of uropathogenic Escherichia coli to ampicillin, amoxicillin-clavulanate, trimethoprim, cephradine/cephalexin, ciprofloxacin and nitrofurantoin. METHODS: A total of 100 E. coli isolates were obtained from boric acid urine samples from patients attending GP surgeries. For EUCAST and CLSI, the Kirby-Bauer disc diffusion method was used and results interpreted using the respective breakpoint guidelines. For the Stokes method, direct susceptibility testing was performed on the urine samples. RESULTS: The lowest levels of agreement were for amoxicillin-clavulanate (60%) and ciprofloxacin (89%) between the three AST methods, when using 2017 interpretive guidelines for CLSI and EUCAST. A comparison of EUCAST and CLSI without Stokes showed 82% agreement for amoxicillin-clavulanate and 94% agreement for ciprofloxacin. Discrepancies were compounded by varying breakpoint susceptibility guidelines issued during the period 2011-2017, and through the inclusion of a definition of intermediate susceptibility in some cases. CONCLUSIONS: Our data indicate that the discrepancies generated through using different AST methods and different interpretive guidelines may result in confusion and inaccuracy when prescribing treatment for urinary tract infection.

No longer 'written off' - times have changed for the BBV-infected dental professional.

There is a recognised potential risk of transmission of blood-borne viruses (BBVs) from infected healthcare workers to patients during exposure prone procedures (EPPs). The restrictions placed on performance of EPPs by infected clinicians in the UK have had a particularly significant impact on dentists because of the exposure-prone nature of most dental procedures and the difficulties in identifying alternative career pathways in the profession that do not involve EPPs. More recently, the significant positive impact of antiviral drugs on viral load, together with a re-categorisation of EPPs in dentistry have resulted in evolution of the guidance with a consequent significant improvement to the career prospects of dentists infected with BBVs. This paper provides an update for practitioners on the progress that has been made and outlines the current position with respect to practice restrictions.

Developing common learning: the new generation project undergraduate curriculum model.

This paper describes the curriculum model developed for an ambitious interprofessional education programme for health and social care professions implemented in two universities in the south of England (the New Generation Project). An outline of how the New Generation Project has interpreted the meaning of interprofessional learning is presented first. This is followed by an outline of the structure of the programme, describing both learning in common and interprofessional learning components. The pedagogies underpinning this curriculum initiative are presented and an integrated pedagogical model, facilitated collaborative interprofessional learning, is proposed. The New Generation Project curriculum is then discussed as an extension of an established typology of interprofessional education.

Can a postgraduate course for general practitioners deliver perceived benefit for learners, patients and the NHS?: a qualitative study.

The focus of continuing professional development in general practice is shifting towards professional development and away from following personal areas of interest. Previous work has suggested that much CPD has not had an obvious impact in the three areas of professional development: the needs of individual doctors, patients and the needs of the NHS. We report on the results of a programme of study where developments in all three were perceived as being achieved. This outcome was realized by basing learning around real problems course members encountered in their daily work, using these real situations to identify theory, then reinforcing this learning through practical application.

Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales.

INTRODUCTION: This paper reviews the literature on self-evaluation and discusses the findings of a small-scale qualitative study which explored the terms 'confidence' and 'competence' as useful measures in a self-evaluation scale. Four pre-registration house officers took part in interviews and completed a provisional instrument to assess their perceived competence. FINDINGS: Competence and confidence are useful terms for house officers expressing beliefs about their ability to perform their job but the terms should not be used synonymously. In our study, 'competent' represented what individuals knew about their ability and was based on the individual's previous experience of the task. 'Confident' described a judgement which influenced whether an individual was willing or not to undertake an activity. Confidence was not necessarily based on known levels of competence and therefore performance of tasks which were unfamiliar to the house officer also involved the assessment of risk. The authors give examples of task and skill scales which may be useful in the process of self-evaluation by pre-registration house officers. CONCLUSIONS: The authors suggest that the process of assessing oneself is complicated, and by its very nature can never be objective or free from the beliefs and values individuals hold about themselves. Therefore self-evaluation instruments are best used to help individuals analyse their work practices and to promote reflection on performance. They should not be used to judge the 'accuracy' of the individual's evaluation.

Identifying appropriate tasks for the preregistration year: modified Delphi technique.

OBJECTIVES: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. DESIGN: Literature review and modified Delphi technique. SETTING: Northern Deanery within the Northern and Yorkshire office NHS executive. SUBJECTS: 67 educational supervisors of preregistration house officers. MAIN OUTCOME MEASURES: Percentage of agreement by educational supervisors to tasks identified from the literature. RESULTS: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. CONCLUSIONS: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent.

The efficacy of preparation for surgery and invasive medical procedures.

In this article, we review published research evaluating the effectiveness of preparation interventions for adult patients undergoing surgery or invasive medical procedures. This review is meant to assist practitioners in selecting or designing an intervention. In general, preparation interventions have been shown to be effective across a range of health outcomes. However, the relative efficacy of different strategies has been difficult to assess, as has the contribution of several patient variables to outcome. Considering interventions used prior to surgery, there is not a clear demonstration of effectiveness, in part because large numbers of outcome variables have been used. In contrast, the preparation intervention literature using adult patients facing invasive medical procedures has shown the relative superiority of modeling procedures and coping strategies. In this review, we consider methodological weaknesses in previous research, and make suggestions for improving future research.

Evaluation of resident applicants by letters of recommendation: a comparison of traditional and behavior-based formats.

RATIONALE AND OBJECTIVES: Traditional, narrative letters of recommendation solicited by medical students applying for radiology residency are widely used as a selection tool. Letters of recommendation are considered a source of reliable information about the attitudes and behaviors (non-cognitive variables) of the resident applicant. However, in many instances, this information is not present or is highly encoded and cannot be extracted. This study attempted to document the deficiencies of traditional letters of recommendation and determine the effectiveness of a structured letter of recommendation in obtaining information regarding noncognitive variables. METHODS: One hundred thirteen randomly selected letters of recommendation were analyzed by two radiologists with experience in residency selection. Deficiencies in inclusion of information or the ability to extract information about noncognitive variables were documented. A standard behavioral assessment was sent to the writers of these letters of recommendation and these results tabulated. RESULTS: The traditional letters of recommendation were frequently deficient in data regarding the noncognitive variables. In letters that contained such data, two experienced reviewers could not reliably extract the information. The structured form produced clearly identifiable information about the letter writer's assessment of noncognitive variables. CONCLUSIONS: Traditional letters of information are frequently deficient in data regarding noncognitive variables. A standardized statement is effective in eliciting information on noncognitive variables related to applicant performance.

Critical performance behaviors of radiology residents: evaluation of two category systems.

OBJECTIVE: Previous research has suggested that certain behavioral aspects of job performance are critical for successful performance in a diagnostic radiology residency. We report two studies conducted to determine the long-term stability of critical performance behaviors for radiology residents and refine their definitions. SUBJECTS AND METHODS: A trained psychology graduate student conducted critical incident interviews with 20 senior faculty in diagnostic radiology. From these interviews, the faculty generated 120 descriptions of exemplary or poor resident performance. These descriptors were then independently sorted by two radiologists into the previously defined categories of behaviors to evaluate consistency of the behaviors. As a second study, the 120 descriptors were sorted into an expanded behavioral definition system and the reproducibility, using the expanded system, was compared with the original results. RESULTS: The interrater reliability for placing the current incidents in the originally described behavioral categories was good (Cohen's kappa 0.70). The overall distribution of incidents showed strong similarity to the original data. Sorting into the expanded categories improved the Cohen's kappa from 0.70 to 0.92, indicating that the expanded behavioral definitions improved reliability for categorizing a behavioral incident. CONCLUSION: The critical behaviors necessary for successful performance in diagnostic radiology residency are stable over time. The expanded and refined system of definitions of these behaviors is more efficacious than the original system was.

Referral expectations of radiology.

In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base.

The predictive utility of behavior-based interviewing compared with traditional interviewing in the selection of radiology residents.

RATIONALE AND OBJECTIVES: This study compares the predictive use of measures based on traditional faculty and resident interviews of residency applicants with measures obtained through behavior-based interviewing. A special emphasis was placed on predicting residents' noncognitive abilities. METHODS: One hundred fifty-one resident applicants, over a 3-year period, were interviewed using standard interviews by faculty and residents. These residents also were interviewed with an experimental behavior-based accomplishment interview. Four years later, during their diagnostic radiology residency, evaluations of performance were gathered on these applicants from their residency director. RESULTS: Results indicated that scores based on responses given during the accomplishment interviews added considerable predictive utility to the low prediction demonstrated by traditional interviews. CONCLUSIONS: These findings imply that improving unstructured faculty and resident interviews to obtain, in a more rigorous manner, desired information about noncognitive abilities may be a key to successful resident selection.