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Background: General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. Methods: A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. Results: Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government–GP relationship; impacts on the patient–doctor relationship; and teamwork within practices and among GPs. Conclusions: The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care. Although general practitioners (GPs) have played a crucial role in Australia's COVID-19 pandemic response, few studies have explored the impact of the COVID-19 pandemic on GPs themselves. In this qualitative study, 15 GPs from South-Eastern Australia were asked to reflect on their experiences working during the first year of the COVID-19 pandemic in semi-structured interviews. Their reflections enhance our understanding of the experience of GPs working during the COVID-19 pandemic and may help guide future research and work to support GPs. [ABSTRACT FROM AUTHOR]

Simple Summary: Fatal injuries in Thoroughbred racehorses typically occur due to an accumulation of bone damage, however, detecting their impending onset can be difficult as there are often no overt signs. In other horse populations, facial grimacing has been shown to be associated with orthopaedic pain. This study, therefore, aimed to investigate facial expressions of Thoroughbred racehorses at the trot to identify if there were subtle signs of pain in mildly lame compared to non-lame horses. Two independent observers assessed 22 facial expression parameters using still photographs of the head from video-recorded trot-ups. There were few expressions associated with lameness except for more exposed whites of the eye in lame horses. Thus, facial pain scoring may not be adequate for the detection of subtle lameness in racehorses who work in a racing stable environment. Musculoskeletal injuries in racehorses are difficult to detect prior to catastrophic breakdown. Lameness is commonly attributed to orthopaedic pain in horses, therefore, subtle lameness may be a pre-clinical sign of injury and, if identified early, could allow for preventative intervention. Our objective was to determine if facial expressions could be used to detect mild lameness as an indicator of orthopaedic pain in 'fit to race' horses. The Horse Grimace Scale (HGS) and the facial expressions in ridden horses (FEReq), were used to score images (n = 380) of mildly lame (n = 21) and non-lame (n = 17) Thoroughbred horses by two independent observers. Using an Equinosis Lameness Locator®, the lameness status of each horse was determined according to published thresholds [forelimb lameness (>|14.5 mm|) and hindlimb lameness (>|7.5 mm|)]. Inter and intraobserver reliability were assessed using two-way random-effects models. Univariable associations between lameness and facial expression parameters were identified using logistic and linear regression. Interobserver reliability was moderate (κ 0.45; 95% CI 0.36, 0.55). Horses with moderate mouth strain (HGS) and tense and extended upper lip (FEReq) were less likely to be lame (p = 0.042 and p = 0.027, respectively). Exposed sclera was associated with lameness (p = 0.045). Higher orbital tightening (HGS) scores were associated with a lower degree of maximum head amplitude (HDmax) lameness (p = 0.044). Tension and moderate tension above the eye, for the HGS and FEReq scores, were associated with increasing amplitude of HDmax (p = 0.048 and p = 0.034, respectively). Inconsistent associations between lameness status and HGS and FEReq scores may limit the potential use of the facial expression for the prediction of mild orthopaedic pain during pre-race lameness examinations. More objective parameters associated with mild orthopaedic pain should be explored. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a clinical pathway in achieving antibiotic administration in less than 60 minutes for children with cancer, presenting with fever and neutropenia. Secondary objectives were to determine association between time to antibiotics (TTA) and other variables including fever duration, location of care and intravenous access types. Methods: Following introduction of the clinical pathway, we collected prospective data about management of all cases that did and did not use the pathway across multiple sites over 16 months. A follow‐up audit was conducted after 12 months. Results: We evaluated a total of 453 presentations. Use of the clinical pathway was significantly associated with achieving TTA in less than 60 minutes (RR 0.69, 95% CI 0.56–0.85, p = <0.001). Despite varying use of the pathway over time, the median time to antibiotics was achieved in both the initial study period (57 minutes) and sustained at follow‐up (60 minutes). TTA was also associated with types of intravenous access device and location of care and with length of stay. We did not find any association between TTA and any other variables. Conclusion: Clinical pathways improve fever management in this patient cohort. Ongoing education and auditing to identify factors which impact processes of care are necessary. [ABSTRACT FROM AUTHOR]

Objectives: Posttraumatic stress disorder (PTSD) affects approximately eight million American adults per year (U.S. Department of Veterans Affairs, 2019). Nearly 70% of rape and sexual assault survivors will experience PTSD or symptoms of severe distress (U.S. Department of Justice, 2016). Sexual assault--specific PTSD has unique components due to the personal and invasive nature of the attack. Though effective for some, traditional approaches to the treatment of PTSD often fail due to the unwanted side effects of the medication, cost of treatment, and the potential for overwhelming the survivor by asking them to talk about their experience. The purpose of this study was to explore the effect of a combined treatment modality of Emotional Freedom Techniques (EFT) and hypnosis on sexual assault--specific PTSD symptoms. Design: This study utilized an explanatory sequential mixed method design. Setting: This study was conducted in a private psychotherapy office. Subjects: 30 individuals with self-identified sexual assault--specific PTSD were recruited and participated in this study. Interventions: EFT and hypnosis combined. Outcome measures: A paired samples t-test analysis between the PCL-5 (PTSD Checklist for DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, 5th Edition]) baseline and post-intervention scores as well as an openended question was utilized. Results: t(29) = 12.198, p < .001, indicating that overall the change in self-reported symptom ratings was statistically different between the two time points. The open-ended qualitative question pointed to a relationship between experience in session and PCL-5 score. Conclusion: This study found an overall decrease of 34.3% on PTSD symptom severity based on PCL-5 assessment scores, after four sessions of the combined EFT and hypnosis treatment. [ABSTRACT FROM AUTHOR]

In Australia, doctors undertaking advanced training to become general practitioners work under the supervision of clinical educators. Primarily clinicians, these clinical educators participate in one day of teaching-related professional development annually, generally a workshop. Shortcomings with this form of professional development led to the development of a quality improvement focused intervention that is facilitated in the workplace and based on the clinical educator's self-identified concerns. Drawing on teacher action research and feasibility study methodologies we explored this novel form of professional development by asking 'Can this intervention work?' We employed an embedded multiple case study design, trialling the intervention in four settings. The intervention's constituent activities were acceptable to participants; including a preparedness to experience discomfort for the purpose of improving their teaching practices. They perceived the intervention as convenient and the workload manageable. Participants were motivated to experiment with new teaching behaviours, but measuring outcomes was challenging. Medical educators facilitating the intervention perceived their tasks as cognitively 'hard work'. The findings provide support for this workplace-based intervention as a feasible form of professional development, which should be implemented on a larger scale and evaluated for impact. [ABSTRACT FROM AUTHOR]

Objective: We present reflections on student evaluation of teaching (SET) in the context of recent higher educational research that assesses SET, as well as concurrent and/or subsequent student performance.Conclusions: In a sense, there is in-built cynicism in SET, with more favourable SET for easier assessment. There is emerging evidence that SET is inversely proportional to the performance of students in subsequent courses, i.e. the higher the ratings, the poorer the students perform in subsequent studies. It is proposed that SET should be combined with contemporaneous formative and summative assessments of student performance in medical school settings, especially in psychiatry education. [ABSTRACT FROM AUTHOR]

Objective: This study examined the feasibility of providing older adults living in residential aged care with group‐based cognitive behavioural therapy (CBT) for depression and anxiety. Method: Eighteen participants with subclinical to mild anxiety and/or depression were divided equally into a treatment group and a control group, with treatment consisting of a manualised CBT program for older adults with depression and anxiety. The residents who participated in the group program provided an accurate representation of “real‐world” residential aged care facilities (RACF) populations; many with comorbid physical problems, mild cognitive impairment and functional decline, and a mean age of almost 80 years. Results: The residents showed that not only could they successfully engage in psychotherapy, they were able to experience the benefits such as building their skills and resilience, receiving validation and emotional support from their fellow residents and fostering friendships and social networks. Encouragingly, the treatment group also showed fewer depressive symptoms post‐treatment. Conclusions: Group‐based psychotherapy should continue to be explored as a strategy to promote good mental health in RACFs, with further studies focusing on the feasibility of recruiting and treating clinical populations in this setting. [ABSTRACT FROM AUTHOR]

Mental health practices are not working for older people with anxiety in residential care, as there is a persistent lack of recognition and treatment. This suggests that alternative ways of reaching and meeting the needs of this population need to be explored. One possibility involves enabling older adults themselves to seek help. The current work explored various factors impacting on help-seeking behaviours. In total, 105 participants from independent living units in a residential care setting completed a questionnaire focusing on attitudes and stigma towards anxiety, likelihood to seek help, help-seeking barriers and literacy around the symptoms of anxiety. Participants in the main did not hold negative attitudes towards other people with anxiety, despite concerns that other people could view them negatively if they were experiencing anxiety. Barriers to help-seeking included: difficulties recognising physical anxiety symptoms as being indicative of anxiety; the effectiveness of treatments; costs; misdiagnosis; privacy; medication usage and the associated side-effects; and, uneasiness about the skills and knowledge of health professionals. Although concerns were not held by all participants, the fact remains that anxiety is largely undiagnosed and untreated for this population and these stoppages to appropriate care must be addressed. [ABSTRACT FROM AUTHOR]

Objectives:: We explore the relative roles of student evaluation of teaching (SET) and teachers' assessment of student performance (ASP) in medical school education in psychiatry.Conclusions:: We conclude that SET and ASP need to be better researched as outcome measures, and input from both processes needs to be balanced in evaluating psychiatric medical education. [ABSTRACT FROM AUTHOR]

Background The Prevocational General Practice Placement programme ( PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy. Methods All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure ( PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations. Results In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales. Discussion This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community. [ABSTRACT FROM AUTHOR]

Keywords: Academic; medical; mental disorder; logorrhoea; obsessive-compulsive EN Academic medical mental disorder logorrhoea obsessive-compulsive 104 105 2 02/08/21 20210201 NES 210201 Dear Sir, We describe diagnostic criteria for a debilitating new mental disorder emergent during the COVID-19 pandemic: "COVID-19 isolated-academic logorrhoea". This disorder has emerged in the university academic population, but we have noted particular prevalence among medical school academics, possibly as their COVID-19 pandemic clinical duties have impeded their research and teaching. [Extracted from the article]

• The quality of staff care has pervasive effects on resident quality of life • Increasing relevance and applicability of staff training and qualifications is key • Staff upskilling is required in empathic care, communication and restraint reduction • Mealtime assistance and increased recreational activities improve QOL • Experienced nurse managers and rotating staff shifts improve QOC : Despite the integral role residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia. : Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of NSW/ACT. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors. : Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables. : The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals. [Display omitted] [ABSTRACT FROM AUTHOR]

Keywords: video-meeting; overuse; Zoom; mental disorder; medical education EN video-meeting overuse Zoom mental disorder medical education 669 669 1 11/23/20 20201201 NES 201201 Dear Sir, We highlight a new diagnosis of paramount significance during the COVID-19 pandemic public health measures, and which may be included in international diagnostic classifications (e.g. the I Diagnostic and Statistical Manual of Mental Disorders i or I International Classification of Diseases i ) in the future. Our proposed diagnosis is based on clinical observations of an insidious and debilitating video-meeting-mediated disorder afflicting medical students and their clinical academic teachers over the last 6 months, during social distancing for the COVID-19 pandemic in Australia. We consider that this disorder may be usefully classified under the rubric of a trauma or stressor-related disorder; analogous to similar COVID-19 emergent mental disorders (to be discussed in forthcoming papers) such as COVID-19-related Isolated-Academic Logorrhoea (an obsessive-compulsive and related disorder) - the product of which may be exemplified by this letter - or, COVID-19-related Specific Communication Disorder (a bullshit or related disorder). [Extracted from the article]

• What staff do and the way they do it has a real impact on the overall quality of life of residents with dementia. • The impact of staff care has a lasting effect on resident quality of life (at least 6 months). • Eradicating physical restraint is a worthwhile, affordable and achievable target in order to improve resident quality of life. • Care staff need to be upskilled to treat and interact empathetically and humanely with residents to improve quality of life. • Ongoing support and mentoring is required in order for any upskilling of care staff to take effect and be sustained. Residential dementia care staff are often the most important people in a resident's social world. It is a symbiotic relationship and the work can involve highly emotional interactions as well as physical and technical demands. This study focused on narrowing down the most useful targets for intervention in quality of care (QOC) in order to improve quality of life (QOL) for people with dementia in residential care. Over six months we followed: 247 older adults with dementia from 12 residential care facilities, their families/care partners (n = 225), managers (n = 12) and staff (n = 232). Facilities ranged from 10 to 137 beds, located across remote, rural and metropolitan areas. Measures: Staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. The QOC provided had an immediate impact on resident's pain, depression, QOL scale score, Body Mass Index, ease/engagement with staff, and food and fluid intake. This influence was still evident six months later, with baseline QOC leading to improved ease and engagement with staff, QOL scores, and fluid intake. Restraint use featured heavily as a predictor of poor outcomes for residents. QOC did not significantly impact agitated behaviours, frailty, nor physical/verbal expressions of well-being. What staff do and the way they do it has a real and lasting impact on the QOL of residents. The most useful targets for improving QOL are: eradicating physical restraint and supporting and upskilling care staff so that they treat and interact empathetically and humanely with residents. [ABSTRACT FROM AUTHOR]

This paper reports the impact of a major life event–death–on the physical, psychological and social well-being of the deceased’s close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002–2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent’s satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people’s support networks may be a fruitful approach to minimising these negative outcomes. [ABSTRACT FROM AUTHOR]

\nContribution to the field People living in residential aged care homes in Australia often have limited opportunities for meaningful social engagement. The present study aimed to characterize the state of intergenerational programs in residential aged care within a nationwide Australian sample. A total of 572 valid survey responses were received. A large number of aged care homes had existing programs, but only 18.2% had active programs; 44.4% reported their programs as temporarily suspended, predominantly due to COVID-19. The most common activities included singing (67.8%), games (56.8%), reading (51.1%) and craft (41.5%). Mental health and wellbeing, opportunity to socialize, and connection with the community were considered as the main benefits. There is consensus on the benefits of well-placed programming and engagement. Several barriers and challenges to engagement exist, including the COVID-19 pandemic. Aged care homes need adequate information and support to increase their ability to offer intergenerational programs between residents and community members. The survey provides insight into intergenerational programs in Australian aged care homes during the COVID-19 pandemic Staff completing the survey reported positive views of the benefits of the programs to both old and young participants The findings highlight the diversity of participants’ ages, places, mode of delivery and types of activities – frequently singing, games, reading and craft, but also dancing and reminiscence, and even robotics. While COVID-19 posed significant challenges, there were creative solutions including written letters and shared journals, virtual interaction and simple strategies such as access to areas where residents could observe children at play or in passing. The survey provides insight into intergenerational programs in Australian aged care homes during the COVID-19 pandemicStaff completing the survey reported positive views of the benefits of the programs to both old and young participantsThe findings highlight the diversity of participants’ ages, places, mode of delivery and types of activities – frequently singing, games, reading and craft, but also dancing and reminiscence, and even robotics. While COVID-19 posed significant challenges, there were creative solutions including written letters and shared journals, virtual interaction and simple strategies such as access to areas where residents could observe children at play or in passing. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present secondary analysis of data collected in a grounded theory study was to explore the perceptions of Registrars and new Fellows to practice ownership and management. Methods. Focus groups and interviews with Registrars and recent Fellows were undertaken to explore the desire to become an owner, facilitators and barriers to practice ownership and delivery models for practice ownership education. A secondary thematic analysis was conducted to understand emerging concepts related to perceptions of general practice ownership. Results. A surprisingly strong theme of fear was evident across focus group and interview participants. Expressed fear was specifically related to financial concerns, lack of relevant knowledge and skills and concern over balancing different roles. Moderating factors included previous life and educational experiences, as well as role modelling. Conclusions. Graduation of a cohort of new general practitioners (GPs) who express fear towards practice ownership is concerning. Creating more positive learning environments and opportunity for open discussion regarding practice management and ownership is an important step in providing adequate support for new GPs to give serious consideration to career options. [ABSTRACT FROM AUTHOR]

Context Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients. Methods We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways. Results We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being. Conclusions There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education. [ABSTRACT FROM AUTHOR]

Introduction and aim The Australian general practitioner ( GP) teaching workforce will need to expand in order to provide for the increasing number of medical students and doctors-in-training. Understanding factors that motivate GPs to become involved in teaching in their clinical practice environments is important for developing recruitment and retention strategies. Method Thirty-one semi-structured interviews were conducted with a cross section of GP teachers and were subjected to thematic analysis. Themes were identified and further classified as motivations and prerequisites for teaching. Results The desire to update clinical knowledge was the most frequently mentioned motivation for teaching, and was described as a strategy for GP teachers to preserve clinical competence through the opportunity to learn new aspects of medicine from junior colleagues. Other motivations included personal fulfillment and enjoyment of teaching, the opportunity to pass on general practice skills and knowledge, promoting general practice as a career, and fulfilling a sense of responsibility to the profession and community. Peers, students and patients also influenced the decision to teach. Most GPs identified that time, workload, availability of space and adequate financial remuneration were prerequisites for teaching. Practice owners also often determined the GP teachers' capacity to teach. Discussion To increase the recruitment and retention of GP teachers, it is recommended that teaching organisations give more recognition to teaching as a clinical professional development activity, place more emphasis on GPs' personal enjoyment, professional responsibility and pride in teaching, and increase engagement with practice owners. [ABSTRACT FROM AUTHOR]

Background and Objectives Volunteer-delivered programs to assist people with dementia and/or delirium in-hospital can provide person-centered one-on-one support in addition to usual care. These programs could mitigate hospital resource demands; however, their effectiveness is unknown. This review evaluated literature of volunteer programs in acute hospital settings for people living with dementia and/or delirium. Research Design and Methods Four databases were searched. Studies that reported patient or program outcomes were included (i.e. delirium incidence, length of stay, number of falls, satisfaction). Risk of bias was completed. Meta-analysis was performed where 2 or more studies measured the same outcome. Narrative synthesis was performed on the qualitative results. Results Eleven studies were included in the review, with varied design, participant groups and outcomes measured. Risk of bias averaged 71%. Volunteer-delivered programs addressed delirium risk factors, for example, hydration/nutrition, mobility, use of sensory aids. Eight patients and 6 program outcomes were captured, but only 3 patient outcomes could be pooled. Meta-analyses demonstrated a reduction in delirium incidence (rate ratio = 0.65; 95% confidence interval [CI] 0.47, 0.90) but no reduction in length of stay (mean difference −1.09; 95% CI −0.58, 2.77) or number of falls (rate ratio = 0.67; 95% CI 0.19, 2.35). Narrative synthesis identified benefits to patients (e.g. less loneliness), volunteers (sense of meaning), and staff (timesaving, safety). Discussion and Implications Volunteer-delivered programs for inpatients with dementia and/or delirium may provide benefits for patients, volunteers, and staff. However, studies conducted with more robust designs are required to determine overall effectiveness on program outcomes. Further high-quality research appropriate for this vulnerable population is required to identify volunteer program effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: People with dementia often have decreased opportunities to engage in higher level intellectual or sensory activities. This programme investigated the effect of taking people with dementia to discuss artworks at the National Gallery of Australia (NGA). Method: Fifteen people from the community and eight from residential care attended the gallery once a week for 6 weeks. They discussed artworks with NGA Educators trained in dementia skills. Sessions were filmed and the level of engagement analysed using time sampling methods. Focus groups with participants, carers, and educators provided qualitative data. Results: Participants were engaged from the outset and remained engaged. They became animated, gained confidence and were able to discuss and interact with the artworks and the social process. This included the more impaired RACF groups, who were more withdrawn or behaviourally disturbed in their usual environment, raising the concept of excess disability. In focus groups these participants had impoverished memory for the programme but community participants remembered it with pleasure and wanted it to continue. Carers confirmed these sentiments but reported no lasting change in participants. Educators spoke mostly about what they had learned, including new ways to present to other clients. Conclusion: The programme went beyond many dementia activities. Despite no evidence for lasting effects, all involved wanted the programme to continue. A carer quote: You do it for the moment encapsulates a sense that an activity is worthwhile even if it gives benefit only whilst running. The programme is continuing and expanding. [ABSTRACT FROM AUTHOR]

Background: Recent global increases in medical student numbers and shifts in medical education from teaching hospitals to community settings call for effective strategies to meet the demand for general practice teaching placements. It has been proposed that "multi-level learning" (MLL), in which learning and teaching are shared across different levels of learners, may provide teaching efficiencies and valuable experiences for learners and teachers. Aims: To identify, evaluate and synthesize the evidence related to the types, benefits, challenges, and facilitators of MLL in community-based general practice, and the underlying mechanisms and associated contexts to explain the reported outcomes. Method: A realist synthesis approach guided the systematic review. Results: Fifteen papers were identified, providing primary evaluation data predominantly from interviews with or surveys of key stakeholders. Generally, all levels of learners reported overall satisfaction with their MLL experiences. Medical students appreciated learning from prevocational doctors and registrars due to social and cognitive congruence. Mechanisms and contexts that supported our hypotheses regarding successful MLL outcomes were identified, with "a strong teaching culture" being a major mechanism. Conclusions: The findings can help inform practices considering the implementation or enhancement of MLL initiatives in general practice. Further research should include measuring defined learning outcomes. [ABSTRACT FROM AUTHOR]

Understanding the magnitude of responses to vaccination during the ongoing SARS-CoV-2 pandemic is essential for ultimate mitigation of the disease. Here, we describe a cohort of 102 subjects (70 COVID-19-naïve, 32 COVID-19-experienced) who received two doses of one of the mRNA vaccines (BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna)). We document that a single exposure to antigen via infection or vaccination induces a variable antibody response which is affected by age, gender, race, and co-morbidities. In response to a second antigen dose, both COVID-19-naïve and experienced subjects exhibited elevated levels of anti-spike and SARS-CoV-2 neutralizing activity; however, COVID-19-experienced individuals achieved higher antibody levels and neutralization activity as a group. The COVID-19-experienced subjects exhibited no significant increase in antibody or neutralization titer in response to the second vaccine dose (i.e., third antigen exposure). Finally, we found that COVID-19-naïve individuals who received the Moderna vaccine exhibited a more robust boost response to the second vaccine dose (p = 0.004) as compared to the response to Pfizer–BioNTech. Ongoing studies with this cohort will continue to contribute to our understanding of the range and durability of responses to SARS-CoV-2 mRNA vaccines. [ABSTRACT FROM AUTHOR]

Background: Medical school is a challenging environment that requires students to deal effectively with stress borne out of the medical education environment, as well as their personal lives. Previous research has not systemically distinguished between academic and personal sources of stress, and in particular has not explored the independent contribution that academic stressors make to medical student depression.Purposes: This study aimed to investigate whether academic stressors make a unique contribution to the level of depressive symptoms in medical students, over and above the contribution made by personal stressors alone.Methods: Sixty-seven medical students completed an online questionnaire designed to measure the total number of recent life events (personal and academic), and their perceived impact, using a modified version of the Psychiatric Epidemiology Research Interview Life Events Scale. Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale.Results: Both the total number of personal stressors,r(67) = .363,p= .003, and their perceived impact,r(67) = .412,p= .001, were found to be positively related to depressive symptoms. A positive relationship was also observed between depressive symptoms and the total number of academic stressors,r(67) = .321,p= .008, and their perceived impact,r(67) = .489,p< .001. In addition, it was found that the perceived impact of academic stressors was able to explain higher levels of depressive symptoms in medical students over and above the effect afforded by personal stressors alone.Conclusion: The findings of this study suggest that stress borne out of the medical school environment contributes to depressive symptoms in medical students over and above the contribution made by personal stressors alone. This indicates that although it is important to help students cope with stress borne out of their personal lives, interventions by medical schools aimed at reducing the impact of academic stressors on medical student depression may also be of great importance. [ABSTRACT FROM PUBLISHER]