Gillian Vance

Evaluation of an established learning portfolio.

Background:  The trainee‐held learning portfolio is integral to the foundation programme in the UK. In the Northern Deanery, portfolio assessment is standardised through the Annual Review of Competence Progression (ARCP) process. In this study we aimed to establish how current trainees evaluate portfolio‐based learning and ARCP, and how these attitudes may have changed since the foundation programme was first introduced.

The relationship between medical student learning opportunities and preparedness for practice: a questionnaire study

BackgroundAlongside providing a knowledge base and practical skills, undergraduate medical education must prepare graduates to immediately begin practice as qualified doctors. A significant challenge is to provide safe learning opportunities that will optimise students’ preparedness to start work. This study examined UK graduates’ preparedness for clinical practice, and their exposure to real-life and simulated immediate care scenarios during final year placements.MethodA questionnaire measuring students’ perceived preparedness, and their exposure to immediate care scenarios, was distributed to all new Foundation Year 1 doctors (F1s) attending an induction session in one region of the UK.Results356 F1s responded to the questionnaire (91% response rate; 89% of cohort) and data from 344 graduates of UK medical schools were analysed. Respondents were generally prepared for practice, but many reported few ‘hands-on’ experiences of providing immediate care during final year placements (a median of 1–2 experiences).Those who had 1–2 experiences reported no greater preparedness for acute management than those reporting no experience. Several exposures are necessary for a significant increase in perceived preparedness. Real-life experience was a better predictor of preparedness than simulated practice.ConclusionsGaps still remain in medical students’ acute care experience, with a direct relationship to their perceived preparedness. The format and facilitation of placements may need to be addressed in order to enhance the quality of experience during final year.

Learning opportunities in ‘student assistantships’

In order to gain experience of the skills required when they begin practice, all final‐year medical students in the UK undertake a ‘student assistantship’, working alongside first‐year postgraduate doctors. In this study, we examined the learning opportunities open to students in one locality during two periods of assistantship: one in medicine; one in surgery.

Supporting Self-Care of Adolescents with Nut Allergy Through Video and Mobile Educational Tools

Anaphylaxis is a life-threatening allergic reaction which is rapid in onset. Adolescents living with anaphylaxis risk often lack the knowledge and skills required to safely manage their condition or talk to friends about it. We designed an educational intervention comprising group discussion around videos of simulated anaphylaxis scenarios and a mobile application containing video-based branching anaphylaxis narratives. We trialed the intervention with 36 nut allergic adolescents. At 1-year follow-up participants had improved adrenaline auto-injector skills and carriage, disease- and age-specific Quality of Life and confidence in anaphylaxis management. At 3-year follow-up adrenaline carriage improved further and confidence remained higher. Participants expressed how the education session was a turning point in taking control of their allergy and how the app facilitated sharing about anaphylaxis with others. We contribute insights regarding design of mobile self-care and peer-support applications for health in adolescence, and discuss strengths and limitations of video-based mobile health interventions.

Severity and threshold of peanut reactivity during hospital-based open oral food challenges: An international multicenter survey

Peanut allergy is classically managed by food avoidance. Immunotherapy programs are available at some academic centers for selected patients reacting to small amounts of peanut during food challenge. We aimed to determine and compare reaction thresholds and prevalence of anaphylaxis during peanut oral challenges at multiple specialist allergy centers.

Development and evaluation of a digistory about autistic spectrum disorder – a pilot study

ABSTRACT Background: Digital storytelling (‘digistories’) offers a way of sharing the personal impact of a condition, if students have limited direct contact. Autistic spectrum disorder (ASD) exemplifies a common condition, where there is need to improve practise in primary care. Hence, we chose this condition to develop and evaluate a digistory. We considered stigmatising attitudes to ASD and wider educational effects. Methods: In the digistory, a mother of a boy with severe ASD describes her autobiographical experiences, illustrated by customised cartoons. Participants completed, pre-post, a validated attitude questionnaire and word association exercise. Views on educational value were gathered through free text and focus group. Results: Questionnaire scores indicated positive attitudes, with no significant change. In contrast, content analysis of word association responses showed prevalent negative associations. Thematic analysis identified increased empathy of students with the family, enabled by the resource design. The digistory helped students challenge stereotypes associated with the condition and encouraged greater confidence to engage in future clinical encounters. Conclusion: The digistory is an accessible and authentic patient analogue that gives additional insight into living with autistic spectrum disorder, with potential benefits for patient-centred learning.

Respiratory Acute Life-Threatening Event (R-ALTE) admissions to Paediatric Intensive Care Unit (PICU) and the association with Food Allergy (FA) at Great North Children's Hospital (GNCH), Newcastle, UK - Part 1

Markevych, I; Standl, M; Koletzko, S; Lehmann, I; Bauer, C-P; Hoffmann, B; von Berg, A; Berdel, D; Heinrich, J Helmholtz Zentrum M€ unchen, Institute of Epidemiology I, Neuherberg, Germany; Dr. von Hauner Children’s Hospital Munich, Ludwig-MaximiliansUniversity of Munich, Munich, Germany; Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research – UFZ, Leipzig, Germany; Department of Pediatrics, Technical University of Munich, Munich, Germany; IUF – Leibniz Research Institute for Environmental Medicine, D€ usseldorf, Germany; Deanery of Medicine, Medical Faculty, Heinrich-Heine University of D€ usseldorf, D€ usseldorf, Germany; Department of Pediatrics, Marien-Hospital Wesel, Research Institute, Wesel, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany

Educating adolescents at risk of anaphylaxis (the ERA study)

Background: A body of evidence indicates that epigenetic modifications, including DNA methylation, play relevant roles in the differentiation and functions of immune cells. Therefore, these modifications have been increasingly implicated in the pathophysiology of allergic diseases. However, little is known about changes in DNA methylation during oral immunotherapy (OIT) in young children with food allergies. Here, we present genome-wide data of DNA methylation before and after OIT. Method: We gave rush OIT to two pediatric patients with egg allergy. Both the patients became tolerant and could consume eggs 1 year after the initiation of the therapy. CD14-positive monocytes and CD4-positive T cells were positively selected from peripheral blood mononuclear cells by magnetic bead-conjugated antibodies before and one year after starting OIT. Genomic DNA was purified from these cells and subjected to the Infinium Methylation Assay (Illumina). Results: A significant number of methylation-targeted CpG sites were found to be differentially methylated between the monocytes and T cells indicating that the cells represent different epigenetic profiles. DNA methylation profiles before and after starting OIT in the same type of cells were better correlated to each other than those between the two patients either before or after OIT. Gene ontology analysis of genes that displayed significant changes in methylation of promoter sequences in T cells showed that genes involved in the MAPK pathway were enriched the most. Conclusion: These results provide evidence that epigenetics plays a role in acquiring immune tolerance during OIT and can help further our understanding of the mechanisms involved in the immune tolerance of food allergy. 2 Grass pollen subcutaneous and sublingual immunotherapy inhibit allergen-induced nasal responses and local Th2 cytokines: a randomised controlled trialCharacterization of dose-FEV1 response of tralokinumab, an investigational anti-IL13 monoclonal antibody in patients with uncontrolled asthma : a population pharmacokinetic/pharmacodynamic modeling analysis