The 'Kidney' model for optimising feedback in undergraduate clinical communication: A meta-ethnographic systematic review.

OBJECTIVES: Feedback frameworks/models focus on certain aspects of the feedback process, but a coherent and systematic model is lacking. A meta-ethnography was conducted to identify and synthesise guidance for optimising feedback interactions in undergraduate clinical communication simulations. METHODS: A systematic search of 4 electronic databases and grey literature was conducted. Following Noblit and Hare's seven phases for conducting meta-ethnography, key themes and concepts were synthesised to provide new interpretations of components in effective feedback interactions. RESULTS: 373 publications were identified and 14 included for the final synthesis, which informed the development of a new Feedback Kidney Model. The Model illustrates the interconnections of various components that allow for effective feedback interactions. The main processes include preparation, proactivity, analysis and feedback information, reception and response, and influencing factors. CONCLUSIONS: This meta-ethnography moves beyond providing an up-to-date synthesis of feedback guidance to proposing the brand-new Feedback Kidney Model, which can guide medical education and future research into how feedback is co-constructed and utilised to promote learning. PRACTICE IMPLICATIONS: Clinical communication should incorporate meta-cognitive training and using this Model will help students better utilise on-site face-to-face feedback to enhance their learning and improve future communication with patients.

Consensus statement on an updated core communication curriculum for UK undergraduate medical education.

OBJECTIVES: Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine. METHOD: The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education. RESULTS: The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed. CONCLUSION: Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula. PRACTICE IMPLICATIONS: The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources.

Metal concentrations and toxicity in South African snoek (Thyrsites atun) and yellowtail (Seriola lalandi).

The concentrations of 16 metals were assessed in snoek(Thyrsites atun; n=20) and yellowtail (Seriola lalandi; n=37) sampled from the West and South-East coasts of South Africa. Variability was observed at both small (Al, Cr, Hg, Pb, Mn and Cu) and large (As and Cu) spatial scales while inter-specific examination revealed diverse metal concentrations in snoek (Higher levels: Cr, Mn, Co, Hg and Pb) and yellowtail (higher levels: Fe and Cu). Zn, As and Hg were positively correlated with yellowtail size with no such correlations in snoek. Mean concentrations of As (0.61mg·kg-1; 0.98mg·kg-1), Cd (0.008mg·kg-1; 0.004mg·kg-1), Hg (0.27mg·kg-1; 0.16mg·kg-1) and Pb (0.009mg·kg-1; 0.005mg·kg-1) for snoek and yellowtail respectively were within regulatory guidelines. However, 10% (n=2) of snoek exceeded Hg maximum allowable limit, suggesting caution and further investigation. Overall, two meals (150g) per week of snoek or larger yellowtail (12-15kg) can be safe for human (adult) consumption.

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students.

BACKGROUND: Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice. AIMS: The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students. DESIGN: A qualitative study comprising five focus groups. PARTICIPANTS: Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University. FINDINGS: Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input. CONCLUSION: In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.

Mercury accumulation in Yellowfin tuna (Thunnus albacares) with regards to muscle type, muscle position and fish size.

The concentrations and relationships between individual mercury species and total mercury were investigated in different muscle parts and sizes of Yellowfin tuna (Thunnus albacares). Fourteen Yellowfin tuna caught in the South Atlantic off the coast of South Africa had an average total Hg (tHg) concentration of 0.77 mg/kg wet weight. No differences were detected (p > 0.05) in tHg, MethylHg (MeHg) or inorganic Hg (iHg) accumulation among the four white muscle portions across the carcass, but both tHg and iHg were found in higher concentrations (p < 0.001) in dark muscle than white muscle. Positive linear correlations with fish weight were found for both tHg (r = 0.79, p < 0.001) and MeHg (r = 0.75, p < 0.001) concentrations. A prediction model was formulated to calculate toxic MeHg concentrations from measured tHg concentrations and fish weight (cMeHg = 0.073 + 1.365 · tHg-0.008 · w). As sampling sites and subsampling methods could affect toxicity measurements, we provide recommendations for sampling guidelines.

Heavy metal accumulation and toxicity in smoothhound (Mustelus mustelus) shark from Langebaan Lagoon, South Africa.

Together with several health benefits, fish meat could introduce toxins to consumers in the form of heavy metal contaminants. High levels of mercury (Hg), especially, are frequently detected in certain predatory fish species. Mustelus mustelus fillets were analysed for 16 metals and three individual Hg species (inorganic Hg, ehtylmercury, methylmercury) with inductively coupled plasma mass spectrometry (ICP-MS) and HPLC-ICP-MS respectively. Eleven of the 30 sharks had total Hg levels above the maximum allowable limit with toxic methylmercury found as the dominant mercury species with a strong correlation (r = 0.97; p < 0.001) to total mercury concentrations. Limited correlations between metals and shark size parameters were observed; therefore metal accumulation in M. mustelus is mostly independent of size/age. Average values for arsenic (28.31 ± 18.79 mg/kg) exceed regulatory maximum limits and Hg (0.96 ± 0.69 mg/kg) is close to the maximum limit with all other metals well below maximum limits.

Heavy metals in marine fish meat and consumer health: a review.

The numerous health benefits provided by fish consumption may be compromised by the presence of toxic metals and metalloids such as lead, cadmium, arsenic and mercury, which can have harmful effects on the human body if consumed in toxic quantities. The monitoring of metal concentrations in fish meat is therefore important to ensure compliance with food safety regulations and consequent consumer protection. The toxicity of these metals may be dependent on their chemical forms, which requires metal speciation processes for direct measurement of toxic metal species or the identification of prediction models in order to determine toxic metal forms from measured total metal concentrations. This review addresses various shortcomings in current knowledge and research on the accumulation of metal contaminants in commercially consumed marine fish globally and particularly in South Africa, affecting both the fishing industry as well as fish consumers.

Enhancing student communication during end-of-life care: A pilot study.

BACKGROUND: Quality end-of-life care requires effective communication skills, yet medical and nursing students report limited opportunities to develop these skills, and that they lack confidence and the related competence. OBJECTIVES: Our purpose was to design, implement, and evaluate an educational intervention employing simulated patient actors to enhance students' abilities to communicate with dying patients and their families. METHODS: A study employing a mixed-methods design was conducted with prequalification nursing and medical students recruited from a London university. The first phase involved focus groups with students, which informed the development of an educational intervention involving simulated patient actors. Questionnaires measuring students' perceptions of confidence and competence levels when communicating with dying patients and their families were administered before and after the intervention. RESULTS: The themes from focus groups related to responding to grief and anger, difficulties dealing with emotions, knowing the "right thing" to say, and a lack of experience. A significant increase (p < 0.5) in competence and confidence from baseline levels followed participation in the simulated scenarios. SIGNIFICANCE OF RESULTS: Simulation was found to be an effective means of preparing students to communicate with dying patients and their families. The opportunity to develop communication skills was valued. Integration of educational interventions employing simulated patient actors into nursing and medical curricula may assist in improving the care provided to patients at the end of life.

Influence of carbon monoxide on the colour stability of defrosted yellowfin tuna (Thunnus albacares) muscle stored under aerobic and anaerobic conditions.

BACKGROUND: The use of carbon monoxide (CO) and various packaging types has been suggested to improve/stabilise the colour and oxidative processes of red meats, thereby improving the retail value and revenue. The main aim of this study was to investigate the influence of packaging type and CO treatment on the colour and oxidative stability of tuna. RESULTS: The addition of CO significantly increased the redness (a(*) ) of the tuna steaks but the redness was not equally stable for all treatments. The aerobically packaged steaks showed a temporal decrease in redness while the redness of anaerobically packaged steaks remained relatively stable. The addition of CO did not significantly affect (P >0.05) the brownness (b(*) ) (with one exception) and lightness (L(*) ) of the steaks. The anaerobically packaged steaks showed a significant difference (P <0.05) in the b(*) values. No significant differences (P >0.05) in lipid or protein oxidation were observed between treatments. The aerobically packaged steaks had a significant temporal increase (P <0.05) in lipid oxidation while no such trend was apparent in the anaerobically packaged steaks. Protein oxidation remained relatively stable over time for both aerobically and anaerobically packaged steaks. CONCLUSION: Storing CO treated tuna steaks in anaerobic packaging can improve the oxidative and colour stability of tuna. Such treatment can reduce spoilage and wastage thereby potentially increasing revenue.