Aims: The aim of this study was to examine recent research studies published from 2000 to 2008 focusing on availability of alcohol: hours and days of sale and density of alcohol outlets. Methods: Systematic review. Results: Forty-four studies on density of alcohol outlets and 15 studies on hours and days of sale were identified through a systematic literature search. The majority of studies reviewed found that alcohol outlet density and hours and days of sale had an impact on one or more of the three main outcome variables, such as overall alcohol consumption, drinking patterns and damage from alcohol. Conclusions: Restricting availability of alcohol is an effective measure to prevent alcohol-attributable harm.

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Hours and Days of Sale and Density of Alcohol Outlets: Impacts on Alcohol Consumption and Damage: A Systematic Review

Background Clinicians use fibrosis in a liver biopsy to predict clinical outcomes of chronic liver disease. The performance of non-invasive tests has been evaluated against histological assessment of fibrosis but use of clinical outcomes as the reference standard would be ideal. The enhanced liver fibrosis (ELF) test was derived and validated in a large cohort of patients and shown to have high diagnostic accuracy (area under the curve (AUC)=0.80 95% CI 0.76 to 0.85) in identification of significant fibrosis on biopsy. Objective To evaluate ELF performance in predicting clinical outcomes by following up the original ELF cohort. Methods Patients recruited to the ELF study at seven English centres were followed up for liver morbidity and mortality by examination of clinical data. Defaulting/discharged patients were followed up by family practitioner questionnaires. Primary outcome measure was liver-related morbidity/liver-related death. Results 457 patients were followed up (median 7 years), with ascertainment of clinical status in 92%. There were 61 liver-related outcomes (39 deaths). Survival analysis showed that the ELF score predicts liver outcomes, with people having the highest ELF scores being significantly more likely to have clinical outcomes than those in lower-score groups. A Cox proportional hazards model showed fully adjusted HRs of 75 (ELF score 12.52–16.67), 20 (10.426–12.51) and 5 (8.34–10.425) compared with patients with ELF Conclusions An ELF test can predict clinical outcomes in patients with chronic liver disease and may be a useful prognostic tool in clinical practice.

https://gut.bmj.com/content/gutjnl/59/9/1245.full.pdf

Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease

Workplace based assessments (WBAs) are now commonplace in postgraduate medical training. User acceptability and engagement is essential to the success of any medical education innovation. To this end, possessing an insight into trainee and trainer perceptions towards WBAs will help identify the major problems, permitting strategies to be introduced to improve WBA implementation. A review of literature was performed to identify studies examining trainee and trainer perceptions towards WBAs. Studies were excluded if non-English or sampling a non-medical/dental population. The identified literature was synthesised for the purpose of this critical narrative review. It is clear that there is widespread negativity towards WBAs in the workplace. This has negatively impacted on the effectiveness of WBA tools as learning aids. This negativity exists in trainees but also to an extent in their trainers. Insight gained from the literature reveals three dominant problems with WBA implementation: poor understanding as to the purpose of WBAs; insufficient time available for undertaking these assessments; and inadequate training of trainers. Approaches to addressing these three problems with WBA implementation are discussed. It is likely that a variety of solutions will be required. The prevalence of negativity towards WBAs is substantial in both trainees and trainers, eroding the effectiveness of learning that is consequent upon them. The educational community must now listen to the concerns being raised by the users and consider the range of strategies being proposed to improve the experiences of trainees, and their trainers.

Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings

Controlled trials in the prophylactic value of progesterone in the treatment of pre-eclamptic toxaemia.

Since the introduction of Modernising Medical Careers in 2005, the electronic portfolio (ePortfolio) and workplace based assessments (WPBAs) have become integral, yet anecdotally controversial, components of postgraduate medical training. In this multi-centre, survey-based study, we looked at core medical trainees and trainers in the Northwest London region and their opinions of the ePortfolio and WPBAs. Our results demonstrate mixed feelings regarding these tools, with 60% of trainees stating that their training had not benefited from the use of an ePortfolio. 53% of trainers felt that feedback sessions with their trainees were useful; however 70% of them cited difficulties in fitting the required number of assessments within their clinical schedule. Overall, if implemented correctly, the ePortfolio and WPBAs are potentially powerful tools in the education and development of trainee doctors. However, improvements in mentoring and feedback may be needed to experience the full benefits of this system.

https://www.rcpjournals.org/content/clinmedicine/14/5/510.full.pdf

Opinions of the ePortfolio and workplace-based assessments: a survey of core medical trainees and their supervisors

The action of progesterone and its synthetic analogues on the reproductive organs has been extensively studied, but the effects of these substances on electrolyte metabolism have received less attention. Thorn and Engel (1938) and Gaunt and Hays (1938) reported that progesterone caused sodium retention in animals such as the dog and ferret, but Landau et al. (1955, 1957a, 1957b) have presented evidence that in man it increased sodium excretion. Landau and Lugibihl (1958) further demonstrated that in patients suffering from Addison's disease an increase in urinary sodium could only be obtained with progesterone if aldosterone were given concurrently, and concluded that the action was that of an aldosterone antagonist. In the treatment of the syndrome of premenstrual tension, of which recurrent oedema is the most important objective feature, progesterone has for many years been advocated, largely on the hypothesis of an oestrogen-progesterone imbalance (Israel, 1938). Later the oral synthetic progestational compounds, such as ethisterone (Greene and Dalton, 1953) and, more recently, norethisterone (Dalton, 1959) have been used on account of their greater convenience. It therefore seemed useful ta investigate the action of progesterone and norethisterone on urinary electrolyte excretion in cases of oedema related to the menstrual cycle. It was also thought to be of interest, in view of its reported anti-aldosterone action, to study the effect of progesterone in hepatic cirrhosis with ascites, since in this condition there is marked sodium retention and aldosterone secretion is usually raised (Dyrenfurth et al., 1957).

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Progesterone and norethisterone in cyclical oedema and ascites.

David Kessel, John Jenkins, and Ed Neville describe the new supervised learning events that replace workplace based assessments for foundation doctors

Workplace based assessments are no more

New professionalism in the 21st century

Exposure to cold undoubtedly gives rise to oedema and hardening of the skin in neonates, but is generalized sclerema always due to cold ? It would be of interest to know how many of Bower's cases had generalized sclerema without oedema, and whether any of these occurred in the later months of the year. Scleroedema would have been a better term for the oedematous babies. Naturally a rigid baby will have a low temperature, but this may be the effect rather than the cause. The distinction may not be entirely academic, because a case I reported in 19563 seemed to respond dramatically to cortisone and others have recorded the same experience. Bower and his co-authors make no mention of cortisone as a therapeutic measure and their case mortality for.\" sclerema \" was 35%. Perhaps the administration of cortisone would have reduced it.-I am, etc., Stock, Essex. IAN G. WICKEs. REFERENCES Henoch, E., Lectures on Children's Diseases, translated by John Thomson. 1889, vol. 1. New Sydenham Society, London. Underwood, M., A Treatise on the Diseases of Cthildren, with General Directions tor the Management of Infants from the Birth, 1819, 7th ed. J. Callow, London. Wickes, I. G., Arch. Dis. Childh., 1956, 31, 419.

John Jenkins

Papers

Progesterone and norethisterone in cyclical oedema and ascites.

Workplace based assessments are no more

New professionalism in the 21st century

Steroids and Steatorrhoea.