Incivility in healthcare: the impact of poor communication.

Incivility is a common issue within healthcare in the UK and internationally. Experienced by at least one-third of staff within the UK National Health Service, incivility has been demonstrated to have significant negative implications on both patient care and healthcare staff. These include contributing to direct medical errors, diagnostic inaccuracy and team communication, with a large associated cost burden, while for staff it has significant negative impacts on retention, productivity and morale. Proposed methods do already exist to both prevent and address incivility, and it is in the interest of healthcare institutions, for their patients and staff, to investigate incivility and adopt these methods. This review explores existing literature on the effects of incivility, researched strategies to address it, as well as the proposed ways of integrating these. Through raising awareness and exploring these issues, our aim is to increase recognition of incivility, as well as inspire healthcare managers and leaders to collectively take efforts to reduce the rates of incivility.

Reflective practice by health professions educators to enhance learning and teaching: AMEE Guide No. 166.

Reflective practice is an essential aspect of the professional development of all health professions educators, with the intention to enhance both learning and teaching. This Guide presents an overview of reflective practice for educators and provides a practical and developmental reflective practice approach for health professions educators. The importance of structured thinking frameworks to stimulate greater understanding of both learning and teaching situations is highlighted. Medical Educator Reflective Practice Sets (MERPS) is an innovative approach for enhancing learning and teaching in health professions education that integrates lesson study and action learning. The key features of the approach are participation in three collaborative sessions, the use of structured thinking frameworks, and solution-focussed teaching in response to the identified problem. The MERPS approach is flexible and can be adapted for implementation across the continuum of health professions education, from undergraduate to postgraduate and continuing professional development.

Dyspraxia in clinical education: a review.

BACKGROUND: The stereotype of the student with dyspraxia as 'clumsy and disorganised' may cause clinical teachers to be concerned about the student's performance in a clinical environment; however, if it is understood that dyspraxic students possess many strengths, as well as weaknesses, it may be that some stereotypical myths will be dispelled and more effective support offered to them. This review considers research surrounding the experiences of students and health professionals with dyspraxia within higher education (HE), alongside the personal experiences of EW, in order to inform the development of clinical teachers with respect to their support for learners with dyspraxia. FINDINGS: A literature review found five relevant articles. Four studies focused on HE students and one on doctors. A significant theme was that dyspraxia impaired learning new skills. Doctors with dyspraxia tended not to disclose their condition, for fear of stigmatisation and negative effects on their career. Positive attributes of dyspraxia included resilience and determination to succeed. Two main adaptations to dyspraxia were highlighted; a 'difference' view focusing on individuals' strengths, and a 'medical/deficit' view, focusing on their weaknesses and the negative perceptions of others. Doctors with dyspraxia tended not to disclose their condition, for fear of stigmatisation DISCUSSION AND RECOMMENDATIONS: It is important for clinical educators to understand and support students with dyspraxia, as clinical environments can be particularly difficult for them. Dyspraxia has both positive and negative effects. Here we discuss the findings of previous studies in the context of EW's personal experiences. We also present a series of practical recommendations, whilst recognising that more research is required to document their impact in clinical education.

Widening participation in medicine: what, why and how?

This article was migrated. The article was marked as recommended. Widening Participation (WP) is 'the process of encouraging underrepresented socioeconomic groups to apply for Higher Education'. This is particularly relevant to medicine, where representation of lower socioeconomic groups is generally poor. Reducing this divide is necessary as socioeconomic diversity enhances social mobility and is likely to improve patient outcomes. This review aims to explore the background to WP, including relevant political theory and also highlights the key methods currently used by medical schools to promote WP. These include pre-application measures (outreach and access to medicine courses), application interventions (contextual data, multiple-mini interviews and situational judgement tests) and post-application measures (foundation courses and ongoing support during medical school). The review also discusses the main criticisms of WP. Finally, it offers recommendations for medical schools regarding the implementation of WP initiatives.

Bayesian decision procedures for dose-escalation based on evidence of undesirable events and therapeutic benefit.

In this paper, Bayesian decision procedures are developed for dose-escalation studies based on bivariate observations of undesirable events and signs of therapeutic benefit. The methods generalize earlier approaches taking into account only the undesirable outcomes. Logistic regression models are used to model the two responses, which are both assumed to take a binary form. A prior distribution for the unknown model parameters is suggested and an optional safety constraint can be included. Gain functions to be maximized are formulated in terms of accurate estimation of the limits of a 'therapeutic window' or optimal treatment of the next cohort of subjects, although the approach could be applied to achieve any of a wide variety of objectives. The designs introduced are illustrated through simulation and retrospective implementation to a completed dose-escalation study.

Survivin as a therapeutic target for radiation sensitization in lung cancer.

Expression of survivin is elevated in most malignancies, especially in radiation-resistant cell lines. In this study, we investigated how radiation affects survivin expression in primary endothelial cells as well as in malignant cell lines. We found that 3 Gy significantly reduced survivin protein level in human umbilical vein endothelial cells (HUVECs) but not in tumor cell lines. Flow cytometry studies suggest that the down-regulation of survivin is independent of cell cycle. In addition, survivin mRNA level was also down-regulatable by irradiation. However, it was abrogated by actinomycin D-mediated inhibition of gene transcription. Luciferase reporter gene assays suggest that irradiation suppressed the survivin promoter. p53 overexpression reduced survivin expression, but overexpression of a p53 mutant failed to abolish the radiation-induced down-regulation in HUVECs. Alteration of p53 status in Val138 lung cancer cell line also failed to restore the radiation-inducible down-regulation. Overexpression of survivin in 293 cells prevented apoptosis induced by irradiation and increased cell viability after irradiation. The inhibition of survivin using antisense oligonucleotides caused a significant decrease in cell viability of irradiated H460 lung cancer cells. These data suggest that radiation transcriptionally down-regulates survivin in HUVECs. This regulatory mechanism is defective in malignancies and is not mediated by p53. Survivin overexpression may lead to resistance to radiotherapy by inhibiting apoptosis and enhancing cell viability. The inhibition of survivin results in sensitization of H460 lung cancer cells to radiation. These studies suggest that survivin may be a target for cancer therapy.

Constitutive expression of BCL-X(L) in the T lineage attenuates collagen-induced arthritis in Bcl-X(L) transgenic mice.

OBJECTIVE: To determine if inhibition of T cell apoptosis through constitutive expression of Bcl-X(L) in the T lineage influences inflammatory arthritis in the mouse collagen-induced arthritis (CIA) model. METHODS: The incidence and severity of arthritis were quantified in Bcl-X(L) transgenic mice and nontransgenic littermates after immunization with type II collagen (CII). To correlate T cell responses with disease phenotype, antigen-specific T cell proliferation was measured by (3)H-thymidine incorporation. Apoptosis and cell cycle progression were analyzed by flow cytometry using propidium iodide. Production of CII-specific interferon-gamma (IFNgamma), interleukin-5 (IL-5), and IL-10 was determined by enzyme-linked immunosorbent assay. RESULTS: Disease severity in CIA was significantly attenuated in Bcl-X(L) transgenic mice compared with their nontransgenic littermates. Inhibition of CIA was associated with decreased T cell apoptosis, delayed cell cycle progression, and reduced IFNgamma production. CONCLUSION: Rather than promoting inflammation, inhibition of apoptosis by expression of the Bcl-X(L) protein in the T lineage attenuates disease progression in CIA, probably through inhibition of IFNgamma production.