Thomas Rouse (shelljeep89)

Background Undergraduate (UG) General Practice (GP) tutors have been identified in the literature and in key UK workforce planning documents as one of the main influences on medical students' decisions about pursuing a career in GP.Aim To explore the attitudes and educational approaches of UG GP tutors in promoting GP as a career.Design and Setting A pragmatic constructivist qualitative study, interviewing 8 UG GP tutors supervising undergraduate final year medical students on placement.Method Interviews were transcribed, coded and grouped into themes using NVIVO11. Analysis was descriptive and interpretive using principles of thematic analysis.Results Tutors saw their role as promoting GP, supporting informed career decisions, correcting misconceptions and giving honest views. They used tutorials, critical reflection, exposure to authentic GP and role-modelling to promote GP, challenge misconceptions, and showcase managing complexities..Discussion By guiding students to identify, discuss and reflect on their beliefs and by using clinical encounters and role modelling with further reflection, tutors enabled students to get a true picture of GP to identify if they could handle the challenges and complexities of the job. Kolb's experiential learning cycle could form a framework to guide tutors in clinical settings supporting students making informed career decisions.CASE HISTORY Two dogs presented separately to the Small Animal Hospital, University of Florida (Gainsville, FL, USA) for ingestion of ibuprofen. The first dog ingested 561.8 mg/kg ibuprofen in addition to paracetamol and caffeine and vomited prior to admission. This patient also received fluid therap y for 8 hours prior to charcoal haemoperfusion. The second dog ingested 500 mg/kg of ibuprofen and the owners induced vomiting with hydrogen peroxide prior to presentation. Due to the severity of clinical signs, both patients were treated with charcoal haemoperfusion. CLINICAL FINDINGS The concentrations of ibuprofen in the blood of the dogs prior to treatment were 478 and 301 mg/L. During the treatment ibuprofen concentrations were reduced by 95.8% and 45.5% respectively with no treatment side effects and minimal clinical signs after treatment. DIAGNOSIS Toxicity due to ingestion of ibuprofen toxicity that was successfully treated with charcoal haemoperfusion. CLINICAL RELEVANCE In the cases described here minimal benefit was seen after 3 hours of treatment using one haemoperfusion cartridge. This is in contrast to a previously published report in which dogs were treated for 6 hours with two charcoal haemoperfusion cartridges. This suggests that one cartridge may be sufficient. The amount of ibuprofen ingested was not a reliable predictor of the concentration in blood at the initiation of treatment. Charcoal haemoperfusion is an effective means of reducing plasma concentrations of ibuprofen however its use may be limited by the cost, and availability.Background Laboratory studies demonstrate glucose-insulin-potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin-glucose ratio of 13 in patients undergoing cardiopulmonary bypass surgery. Methods and Results In this prospective, randomized, double-blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes before anesthesia and continuously for 12.5 hours. The primary outcome was the incidence of in-hospital major adverse cardiac events including all-cause death, low cardiac output syndrome, acute myocardial infarction, cardiac arrest with successful resuscitation, congestive heart failure, and arrhythmia.