Clinical medicine (London, England)
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The annual review of competence progression (ARCP) is a high-stakes assessment which all UK postgraduate trainees undertake to ensure competence progression. Previous evaluations of the effectiveness of the ARCP as an assessment have reported deficiencies in both validity and reliability, however, there has been little focus on the educational impact of the ARCP. We conducted a mixed methods case study involving questionnaire, interviews and a focus group examining the impact of the ARCP on a respiratory higher specialist training programme. ⋯ Concerns were raised that the process promoted a reductionist approach to education. This research has resulted in several changes to local training, however, it has potential implications for the ARCP as a wider process. Trainers should be cognisant of the shortcomings of assessments and their impact on trainees, training and the future of the profession.
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Orthostatic hypotension (OH) is very common in older people and is encountered daily in emergency departments and medical admissions units. It is associated with a higher risk of falls, fractures, dementia and death, so prompt recognition and treatment are essential. In this review article, we describe the physiology of standing (orthostasis) and the pathophysiology of orthostatic hypotension. ⋯ We review the evidence and consensus management guidelines for all aspects of management. We also tackle the challenge of concomitant orthostatic hypotension and supine hypertension, providing a treatment overview as well as practical suggestions for management. In summary, orthostatic hypotension (and associated supine hypertension) are common, dangerous and disabling, but adherence to simple structures management strategies can result in major improvements.
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We determined the seroprevalence of SARS-CoV-2 antibodies in NHS healthcare workers (HCWs) in a cross-sectional study from a large general hospital located in a double-sited rural and semi-rural area. The sample size of 3,119 HCWs (mean age 43±13) consisted of 75.2% women, 61.1% White individuals and predominantly (62.4%) asymptomatic individuals. Seroprevalence of SARS-CoV-2 antibodies was 19.7%. ⋯ Regardless of staff role or sex, multivariate regression analysis revealed that non-White HCWs were three times (odds ratio [OR] 3.12, 95% confidence interval [CI] 2.53-3.86, P<0.001) more likely to have antibodies than White staff, and seven times (OR 7.10, 95% CI 5.72-8.87, P<0.001) more likely if there was a history of preceding symptoms. We report relatively high rates of seropositivity in all NHS healthcare workers. Non-White symptomatic HCWs were significantly more likely to be seropositive than their colleagues, independent of age, sex or staff role.