Empowering junior doctors: a qualitative study of a QI programme in South West England

Aim To explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare. Methods Twenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques. Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment. Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care

Top predators, habitat complexity and the biodiversity of litter-dwelling ants

Trabalho final de mestrado integrado em Medicina (Geriatria), apresentado á Faculdade de Medicina da Universidade de CoimbraA hipertensão arterial é o principal fator de risco modificável para a morbimortalidade por doenças cardiovasculares, a principal causa de morte a nível mundial. Dado o aumento da sua prevalência com a idade, a hipertensão arterial no idoso é uma patologia cada vez mais frequente. A rigidez arterial e a disfunção endotelial são a base fisiopatológica da hipertensão arterial no idoso, não devendo contudo ser descurada a maior incidência de causas secundárias. O tratamento farmacológico da hipertensão arterial no idoso é recomendado tendo em consideração o seu efeito na redução da mortalidade e morbilidade cardiovascular. O valor-alvo de tensão arterial recomendado para estes doentes é 150/90 mmHg, pela ausência de benefícios com um controlo tensional mais restrito. Não há evidência que suporte a utilização preferencial de uma classe ou combinação farmacológica, devendo o grande enfoque terapêutico ser a redução tensional e não os agentes utilizados. Doentes com comorbilidades ou pertencentes a populações especiais podem apresentar indicações farmacológicas específicas e valores-alvo diferentes. As reações adversas à terapêutica são mais frequentes no idoso. Assim, os idosos hipertensos devem manter vigilância para identificação precoce de reações adversas e aumentar a adesão terapêutica.The arterial hypertension is the main modifiable risk factor for morbimortality of cardiovascular diseases, the main cause of death worldwide. Given the increase of its prevalence with age, the arterial hypertension in the elderly is becoming increasingly frequent. The arterial stiffness and endothelial dysfunction are the pathophysiological basis of the arterial hypertension in the elderly, although it cannot be neglect the higher incidence of secondary causes. The pharmacological treatment of arterial hypertension in the elderly is recommended considering its effects on the reduction of cardiovascular mortality and morbidity. The blood pressure target recommended for these patients is 150/90 mmHg, due to the lack of benefits in a stricter blood pressure control. There is no evidence supporting the preferential utilization of a pharmacological class or combination. The major focus should be on blood pressure reduction and not on the agent used. Patients with comorbidities or from special populations may have specific pharmacologial indications and different target values. The therapy’s adverse reactions are more frequent in the elderly. Thus, the hypertensive elderly must maintain vigilance to identify early the adverse reactions and increase the therapeutic adherenc

Self-healing network of interconnected edge devices empowered by infrastructure-as-code and LoRa communication

This Paper proposes a self-healing, automated network of Raspberry Pi devices designed for deployment in scenarios where traditional networking is unavailable. Leveraging the low-power, long-range capabilities of the LoRa (Long Range) protocol alongside Infrastructure as Code (IaC) methodologies, the research addresses challenges such as limited bandwidth, data collisions, and node failures. Given that LoRa’s packet-based system is incompatible with conventional IaC tools like Ansible and Terraform, which rely on TCP/IP networking, the research adapts IaC principles within a containerised architecture deployed across a Raspberry Pi cluster. Evaluation experiments indicate that fragmenting data packets and retransmitting any missed fragments can mitigate LoRa’s inherent throughput and packet size limitations, although issues such as collisions and line-of-sight interference persist. An automated failover mechanism was integrated into the architecture, enabling unresponsive services to be redeployed to alternative nodes within one second, demonstrating the system's resilience in maintaining operational continuity despite node or service failures. The paper also identifies practical challenges, including the necessity for time-slotting transmissions to prevent data packet overlap and collisions. Future research should explore the integration of mesh networking to enhance range, develop more advanced scheduling algorithms, and adopt cutting-edge low-power wide-area network (LPWAN) techniques

Well being of obstetric patients on minimal blood transfusions (WOMB trial)

Background: Primary postpartum haemorrhage is an obstetrical emergency often causing acute anaemia that may require immediate red blood cell (RBC) transfusion. This anaemia results in symptoms such as fatigue, whic

Empowering junior doctors: a qualitative study of a QI programme in South West England

Aim To explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare. Methods Twenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques. Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment. Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care

Higher harmonic anisotropic flow measurements of charged particles at 2.76 TeV with the ALICE detector

We report the measurements of elliptic flow $v_{2}$, as well as higher harmonics triangular flow $v_{3}$ and quadrangular flow $v_{4}$, in $\sqrt{s_{_{NN}}} =$ 2.76 TeV Pb--Pb collisions, measured with the ALICE detector. We show that the measured elliptic and triangular flow can be understood from the initial spatial anisotropy and its event--by--event fluctuations. The resulting fluctuations of $v_{2}$ and $v_{3}$ are also discussed.Comment: 6 pages, 4 figures, proceeding of Strangeness in Quark Matter 2011, Cracow, Polan

Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation

BACKGROUND: The optimal surgical approach for thoracic disc herniation remains a matter of debate, especially for central disc herniation. In this paper, we present a new technique to remove central thoracic disc herniation, the posterior transdural approach, and report a series of 13 cases operated on in this way at our institute. METHODS: Between September 2004 and October 2010, 13 patients with symptomatic central thoracic disc herniation were operated on, utilising this posterior transdural approach. All patients underwent magnetic resonance imaging (MRI) of the thoracic spine before surgery. All patients were followed at our outpatient department for at least 3 months. In addition, all patients were interviewed in April 2009 and February 2011 to evaluate the final results. A seven-point Likert scale was applied and the Frankel score was determined preoperatively and postoperatively. Additionally, a postoperative MRI was obtained for all but two patients. RESULTS: The most frequently involved levels were T10-11 and T12-L1. Median operative time was 210 min (range 140-360). Three patients experienced reversible complications. No patient required spinal fixation. The median duration of hospitalisation was 6 days (range 4-20 days). With a median follow-up of 18 months, symptoms improved in 12 patients (92%), including the three patients with complications. One patient was unchanged (8%), while none of the patients experienced worsening of symptoms. CONCLUSIONS: The posterior transdural approach is well tolerated by the patient and has a relatively high success rate. It is a relatively simple and safe procedure, suitable for the operative treatment of almost all types of thoracic disc herniation, but especially the centrally located disc herniation