General practice is "different": a qualitative study of adaptation experiences of East Staffordshire general practice speciality trainees.

BACKGROUND: Undergraduate medical education and foundation training are still largely hospital based. General practice trainees also spend nearly half of their speciality training in hospitals. Aims: To explore adaptation experiences of general practice speciality trainees throughout the training. Method: Semi-structured participant-observer interviews with 18 purposively selected trainees on the East Staffordshire vocational training scheme, observation, stakeholder discussions and concurrent inductive thematic analysis. Results: Undergraduate and early general practice experience during speciality training, general practice trainer role modelling and mastering core general practice skills, facilitated transition. An inclusive and supportive general practice environment, facilitating engagement with a community of practice involving peers, general practice trainers and vocational training programme fostered belongingness. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, signposting to general practice relevant duties and mastery of secondary care relevant competencies helped gain belongingness in hospital. While some international graduates required assistance in specific areas; overall, general practice trainees had optimistic views of their future. Conclusion: The main contribution of this study was to relate the adaptation experiences of trainees to learning and practice based on Wenger's communities of practice to enable a better understanding of how they can be influenced to enhance training.Abbreviations: CoP: Community of practice; GP: General practice; GPST: General practice speciality trainee; M: Male; F: Female; ST1: First-year GPST; ST2: Second-year GPST; ST3: Third-year GPST; UKG: UK-based primary medical qualification; IMG: Non-UK primary medical qualification.

Withholding consent to participate in clinical trials: decisions of pregnant women.

OBJECTIVE: To identify factors affecting the decision of pregnant women to withhold their consent to participate in a clinical trial. DESIGN: A qualitative, cross-sectional, retrospective study using semi-structured interviews with thematic content analysis. SETTING: Patients' homes. PARTICIPANTS: Eighteen women who had been invited previously to participate in a clinical trial in pregnancy, but who had declined. RESULTS: The invitation to participate in a clinical trial when pregnant has different implications for different women, and the meanings they ascribe to the invitation to participate will affect the likelihood of them participating. A pregnant woman may feel the pressure of conflicting duties: a protective duty to the fetus and to be a 'good citizen' when asked to participate in research. The sharing of information during the recruitment phase has a crucial bearing on how the invitation will be received. The design of the trial, the type and style of information available, the manner in which it is conveyed, the timing and process of the invitation and by whom it is made all affect the likelihood of a woman agreeing to take part. CONCLUSION: By asking for the contribution of these women, this study identified factors that can influence the chances of an individual entering a trial or not. Contextualising and personalising risk is important in the consent process as recruiting women when pregnant can be difficult and hinder research. From these comments recommendations for future research involving pregnant women have been drawn up.

Adhesion to HeLa cells of Campylobacter jejuni and C. coli outer membrane components.

Adhesion of Campylobacter jejuni and C. coli to epithelial cells is thought to be a decisive step in enteritis. In this work, we tried to determine which bacterial components are responsible for this phenomenon. Outer membrane (OM) extracts were prepared from strains of C. jejuni (3 strains) and C. coli (2 strains). These strains had been isolated from stools of febrile patients with diarrhoea and were able to adhere to HeLa cells in culture. After incubation of bacterial OM extracts with HeLa cells in culture, bacterial adherent material was recovered, subjected to electrophoresis and immunoblotted. Bacterial adherent antigens were revealed by a rabbit antiserum raised against whole bacterial cells. Antigenic fractions, ranging from 26 to 30 kDa, were found to preferentially bind to HeLa cells (cell-binding fractions; CBF). These antigens were proteins and were distinct from flagellin and lipopolysaccharide. Bacteria incubated with a rabbit antiserum raised against homologous CBF, were unable to bind to HeLa cells. Moreover, the inhibitory effect decreased when the antiserum was diluted. Under the same conditions, a rabbit antiserum raised against a non-adherent OM fraction of 92 kDa did not prevent bacteria from binding to HeLa cells.

Effect of histamine on leukocyte migration tests in vertebrates. II. Study of the lack of species specificity of leukocyte inhibiting factor--production inhibitor (LIF-PI).

Immune regulatory effects of histamine are now well established. We have previously demonstrated that human T lymphocytes having histamine receptors, produce a soluble factor inhibiting the production of LIF. In this present paper we have shown that production and function of this factor is not species specific. Indeed the leukocyte inhibiting factor-production inhibitor (LIF-PI) produced by human, guinea pig or dog lymphocytes inhibits the production of LIF by human, guinea pig and murine lymphocytes to a similar extent. This property allows for easier testing of LIF-PI particularly from human subjects.