'It's a gamble': A phenomenological exploration of medical students' learning experiences as newcomers to clinical communities of practice.

Background: Medical students become members of the clinical team through participation in their activities, as described by Lave and Wenger's situated learning theory. While there is research into how medical students cognitively engage in clinical learning, there is limited work on clinical experiences using a social theoretical lens such as situated learning theory.

Method: This study explored third year medical students' lived experience as newcomers to clinical teams using a qualitative phenomenological approach.

How well do UK assistantships equip medical students for graduate practice? Think EPAs.

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness.

Social prescribing by students: the design and delivery of a social prescribing scheme by medical students in general practice.

Background Social prescribing is a means of enabling primary care professionals to refer people to a range of local, non-clinical services. Medical students at a large GP surgery in Corby designed, implemented and led a social prescribing service for the practice's patients. Through the project students gained an understanding of social prescribing in an authentic setting.

Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records.

Background: The aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection.

Methods: We undertook a single-centre, retrospective cohort study examining COVID-19-related mortality using electronic health records, for older people (65 and over) with frailty, hospitalised with or without COVID-19 infection. Baseline covariates included demographics, early warning scores, Charlson Comorbidity Indices and frailty (Clinical Frailty Scale, CFS), linked to COVID-19 status.

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

Background: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).

Clinical assessors' working conceptualisations of undergraduate consultation skills: a framework analysis of how assessors make expert judgements in practice.

Undergraduate clinical assessors make expert, multifaceted judgements of consultation skills in concert with medical school OSCE grading rubrics. Assessors are not cognitive machines: their judgements are made in the light of prior experience and social interactions with students. It is important to understand assessors' working conceptualisations of consultation skills and whether they could be used to develop assessment tools for undergraduate assessment.

'What do we do, doctor?' Transitions of identity and responsibility: a narrative analysis.

Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients.

Hypertension treatment for older people-navigating between Scylla and Charybdis.

Hypertension is a common condition in older people, but is often one of many conditions, particularly in frail older people, and so is rarely managed in isolation in the real world-which belies the bulk of the evidence upon which is treatment decisions are often based. In this article, we discuss the issues of ageing, including frailty and dementia, and their impact upon blood pressure management. We examine the evidence base for managing hypertension in older people, and explore some therapeutic ideas that might influence treatment decisions and strategies, including shared decision making.

Identifying frailty in the Emergency Department-feasibility study.

Introduction: identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice.

Methods: consensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement.

Frailty identification in the emergency department-a systematic review focussing on feasibility.

Introduction: risk-stratifying older people accessing urgent care is a potentially useful first step to ensuring that the most vulnerable are able to access optimal care from the start of the episode. While there are many risk-stratification tools reported in the literature, few have addressed the practical issues of implementation. This review sought evidence about the feasibility of risk stratification for older people with urgent care needs.

New horizons: urgent care for older people with frailty.

Urgent care for older people is a major public health issue and attracts much policy attention. Despite many efforts to curb demand, many older people with frailty and urgent care needs to access acute hospital services. The predominant model of care delivered in acute hospitals tends to be medically focussed, yet the evidence-based approaches that appear to be effective invoke a holistic model of care, delivered by interdisciplinary teams embedding geriatric competencies into their service.

Ambulatory blood pressure monitoring in older people with dementia: a systematic review of tolerability.

Background: ambulatory blood pressure monitoring (ABPM) may be helpful for the management of hypertension, but little is known about its tolerability in people with dementia.

Objective: to review the published evidence to determine the tolerability of ABPM in people with dementia.

Methods: English language search conducted in MEDLINE and EMBASE, using 'Ambulatory blood pressure' AND 'Dementia' (and associated synonyms) from 1996 to March 2015.

New horizons in the implementation and research of comprehensive geriatric assessment: knowing, doing and the 'know-do' gap.

In this paper, we outline the relationship between the need to put existing applied health research knowledge into practice (the 'know-do gap') and the need to improve the evidence base (the 'know gap') with respect to the healthcare process used for older people with frailty known as comprehensive geriatric assessment (CGA). We explore the reasons for the know-do gap and the principles of how these barriers to implementation might be overcome. We explore how these principles should affect the conduct of applied health research to close the know gap.

Identifying patient-level health and social care costs for older adults discharged from acute medical units in England.

Background: acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs.

Objective: identifying patient-level health and social care costs for older people discharged from acute medical units in England.

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the 'Emergency Frailty Unit'.

Background: the ageing demographic means that increasing numbers of older people will be attending emergency departments (EDs). Little previous research has focused on the needs of older people in ED and there have been no evaluations of comprehensive geriatric assessment (CGA) embedded within the ED setting.

Methods: a pre-post cohort study of the impact of embedding CGA within a large ED in the East Midlands, UK.

Evaluating interventions to reduce central aortic pressure, arterial stiffness and morbidity--mortality.

Arterial aging is associated with a progressive increase in aortic stiffening, which results in a rise in central aortic pressures. Traditionally, blood pressure (BP)-lowering therapy has been directed at brachial rather than central pressures. However, a key contemporary question is whether this strategy is optimal in reducing aortic pressure and aortic stiffness, and whether specific treatment strategies might be preferred to reduce the process of arterial aging.

Pseudomonas aeruginosa-catecholamine inotrope interactions: a contributory factor in the development of ventilator-associated pneumonia?

Background: Ventilated patients receiving intensive care are at significant risk of acquiring a ventilator-associated pneumonia that is associated with significant morbidity and mortality. Despite intensive research, it is still unclear why Pseudomonas aeruginosa, a microbe that rarely causes pneumonia outside of intensive care, is responsible for so many of these infections.

Methods: We investigated whether medications frequently prescribed to patients in the ICU, the catecholamine inotropes, were affecting the growth and virulence of P aeruginosa .

A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'.

Background: many frail older people who attend acute hospital settings and who are discharged home within short periods (up to 72 h) have poor outcomes. This review assessed the role of comprehensive geriatric assessment (CGA) for such people.

Methods: standard bibliographic databases were searched for high-quality randomised controlled trials (RCTs) of CGA in this setting.

Interface geriatrics: evidence-based care for frail older people with medical crises.

Frail older people are at risk of long hospital stays, and there is growing emphasis on identifying alternative care pathways in the community. Rapid decisions to discharge older people may not always serve the patient well. Specialist assessment from geriatricians could improve outcomes.

Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function Evaluation) study: CAFE-Heart Rate.

Objectives: The CAFE (Conduit Artery Function Evaluation) study showed less effective central aortic pressure lowering with atenolol-based therapy versus amlodipine-based therapy in people with hypertension. The present study examined the importance of heart rate (HR) as a determinant of this effect.

Background: Recent analyses have suggested that beta-blockers are less effective at reducing cardiovascular events than alternative blood pressure (BP)-lowering therapies.

The changing face of hypertension treatment: treatment strategies from the 2007 ESH/ESC hypertension Guidelines.

Hypertension is one of the most important causes of cardiovascular morbidity and mortality and its treatment is a major focus of primary and secondary disease prevention strategies. The treatment of hypertension continues to evolve and the need for guidance on the use of newer screening tools, techniques for blood pressure measurement and different classes of drug therapies led to the first European guidelines for the management of arterial hypertension being issued in 2003 by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). The first update of these guidelines in 2007 crystallized much of the modern thinking about the evaluation and treatment of patients with hypertension with a sharp focus on detailed assessment of subclinical organ damage and cardiovascular disease risk, as well as differential blood pressure treatment targets and thresholds for those at different levels of risk.