Conectar
To identify factors that improve retention in under-doctored areas that experience difficulties in maintaining sufficient medical workforce.
Qualitative study based on semi-structured interviews, collected as part of a larger study.
Four purposely sampled geographic case study sites in England. Three case study sites were selected as areas that struggled to recruit and retain doctors and one as an area that is oversubscribed. This comprised 27 NHS Trusts, plus 1449 GP practices.
100 National Health Service (NHS)-employed doctors (including general practitioners, consultant specialists, specialty and specialist doctors, resident doctors/doctors in postgraduate training and locally employed doctors) were interviewed between December 2022 and March 2024.
Participants shared their experiences of organisational levers that impact on decisions about working life and retention in the workforce. Two key themes explained factors influencing retention. First, participants discussed feeling valued by the organisation, both in terms of material circumstances and in relationships with colleagues. Second, the theme of autonomy and opportunity explored why doctors chose to stay in areas that typically experience difficulties in maintaining sufficient staffing.
Many studies focusing on workforce examine why staff leave, but by focusing on factors that influence retention, greater understanding of specific facets of organisational culture can be used to inform policy and practice.
Early MRI use varies in the management of acute wrist injuries in the UK, with only a minority of National Health Service (NHS) centres being able to offer this to patients. In this study, we aim to explore the perspectives of staff and patients on the use of early MRI in the management of wrist injuries.
This is a cross-sectional qualitative study using semistructured, face-to-face and remote interviews. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis.
10 NHS Trusts in the UK.
We interviewed a sample consisting of 37 NHS staff members and 21 patients.
We analysed the data into three overarching themes. The first theme described the negative impact of wrist injuries on both staff and patients. Staff reported an uncomfortable feeling that they had ‘short-changed’ patients with older non-MRI based pathways, and that the consequences of missing a scaphoid fracture could be a ‘horrible thing’ for patients. The second theme described how early MRI was perceived as a ‘win for everyone’. For patients, the win encompassed the relief of a speedy diagnosis which helped them to get better. Staff saw early MRI as a win because it ‘revolutionised care’ and ‘reduced the clinic footprint’. The final theme defined the key ingredients of delivering an early MRI pathway: a simple pathway with clear accountability, timely access to MRI and prompt reporting of results, a safe pathway with safety nets to avoid patients being lost, data and audit of the time to MRI and definitive treatment, bottom-up engagement, clear communication and looking after your team.
Our findings contribute to a better understanding of stakeholders’ perspectives on wrist injury pathways in the UK NHS.
Airway management describes a range of commonly performed procedures undertaken to enable invasive respiratory support for patients. Studies of airway management interventions report heterogeneous outcomes, impeding evidence synthesis and translation of findings into clinical practice. A core outcome set is a consensus-based standardised minimum collection of outcomes to be reported in a given area of healthcare. The Airway Terminology and Outcome Measures project aims to define a core outcome set and select outcome measurement instruments for future airway management research.
Following a systematic literature search, we generated a list of candidate outcomes by extracting outcomes and their measurement instruments from a random sample of included studies until saturation was reached and no new outcomes emerged. The search resulted in a long list of 64 outcomes for inclusion in the consensus building stage. Key stakeholders, including patients, clinicians and researchers, will be invited to participate in a multiround modified Delphi process and a panel meeting to finalise the core outcome set and agree to their measurement instruments.
The study was approved by the Health Research Authority and the London – Fulham Research Ethics Committee (24/LO/0544). All participants will provide informed consent. Study findings will be presented as conference proceedings and published in peer-reviewed medical journals.
20 November 2024
COMET 3146
Background
In the United States, Black adults have the highest prevalence of obesity and hypertension, increasing their risk of morbidity and mortality. Caregivers of persons with dementia are also at increased risk of morbidity and mortality due to the demands of providing care. Thus, Black caregivers—who are the second largest group of caregivers of persons with dementia in the United States—have the highest risks for poor health outcomes among all caregivers. However, the physiological changes associated with multiple chronic conditions in Black caregivers are poorly understood.
Objectives
In this study, metabolomics were compared to the metabolic profiles of Black caregivers with obesity, with or without hypertension. Our goal was to identify metabolites and metabolic pathways that could be targeted to reduce obesity and hypertension rates in this group.
Methods
High-resolution, untargeted metabolomic assays were performed on plasma samples from 26 self-identified Black caregivers with obesity, 18 of whom had hypertension. Logistic regression and pathway analyses were employed to identify metabolites and metabolic pathways differentiating caregivers with obesity only and caregivers with both obesity and hypertension.
Results
Key metabolic pathways discriminating caregivers with obesity only and caregivers with obesity and hypertension were butanoate and glutamate metabolism, fatty acid activation/biosynthesis, and the carnitine shuttle pathway. Metabolites related to glutamate metabolism in the butanoate metabolism pathway were more abundant in caregivers with hypertension, while metabolites identified as butyric acid/butanoate and R-(3)-hydroxybutanoate were less abundant. Caregivers with hypertension also had lower levels of several unsaturated fatty acids.
Discussion
In Black caregivers with obesity, multiple metabolic features and pathways differentiated among caregivers with and without hypertension. If confirmed in future studies, these findings would support ongoing clinical monitoring and culturally tailored interventions focused on nutrition (particularly polyunsaturated fats and animal protein), exercise, and stress management to reduce the risk of hypertension in Black caregivers with obesity. Background
Despite known links between oral health and dementia and the growing understanding of the role of the human microbiome in health, few studies have explored the relationship between the oral microbiome and cognition. Additionally, there is a notable absence of research on how the oral microbiome is associated with cognitive function in Black adult caregivers of cancer patients despite their elevated risk for both oral disease and cognitive impairment.
Objectives
This study aimed to characterize the oral microbiome of Black caregivers of people living with cancer and explore the association of the oral microbiome with cognitive performance.
Methods
Thirty-one self-identified Black or African American caregivers of cancer patients in the greater metropolitan Atlanta area participated in the study. They provided oral microbiome samples. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), depressive symptoms with the Center for Epidemiological Studies-Depression Scale, and individual race-related stress with the Index of Race-Related Stress–Brief. Salivary microbiome diversity was analyzed using alpha and beta diversity metrics, and taxa associated with cognition were identified through differential abundance testing, adjusting for potential confounders.
Results
The mean age of participants was 54.8 years. MoCA scores ranged from 18 to 30, with a mean of 25. Participants were categorized into normal cognition (MoCA ≥ 26, n = 12) and low cognition (MoCA 
FreshRSS 