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  1. Article ; Online: Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school.

    Misky, Adam T / Shah, Ronak J / Fung, Chee Yeen / Sam, Amir H / Meeran, Karim / Kingsbury, Martyn / Salem, Victoria

    BMC medical education

    2022  Volume 22, Issue 1, Page(s) 291

    Abstract: Background: Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards "Specialists" and "Generalists" amongst medical ... ...

    Abstract Background: Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards "Specialists" and "Generalists" amongst medical students and junior doctors at Imperial College School of Medicine.
    Methods: A survey exploring medical students' beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors.
    Results: First year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged.
    Conclusion: Perceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.
    MeSH term(s) Career Choice ; Humans ; London ; Schools, Medical ; Specialization ; Students, Medical
    Language English
    Publishing date 2022-04-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-022-03355-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Coronavirus Disease 2019 (COVID-19) Complicated by Acute Respiratory Distress Syndrome: An Internist's Perspective.

    Ahmed, Taha / Shah, Ronak J / Rahim, Shab E Gul / Flores, Monica / O'Linn, Amy

    Cureus

    2020  Volume 12, Issue 3, Page(s) e7482

    Abstract: A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries. In the United States, the first confirmed case was reported on January 20, 2020, and since then, the ... ...

    Abstract A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries. In the United States, the first confirmed case was reported on January 20, 2020, and since then, the number of cases is rising exponentially on a daily basis. We report a case of COVID-19 infection that presented with symptoms suggestive of pneumonia. Due to the major backlog with an immense number of pending tests, it took 48 hours for the result to come back positive, while the patient went into acute respiratory distress syndrome. We provide an internist's perspective of the difficulties encountered in terms of the available management options, as the patient progressively deteriorated on the regular medical floor prompting transfer to the intensive care unit.
    Keywords covid19
    Language English
    Publishing date 2020-03-31
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.7482
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  3. Article ; Online: Diabetes self-management during the COVID-19 pandemic and its associations with COVID-19 anxiety syndrome, depression and health anxiety.

    Distaso, Walter / Malik, Mohammad M A H / Semere, Saba / AlHakami, Amal / Alexander, Emma C / Hirani, Dhruti / Shah, Ronak J / Suba, Kinga / McKechnie, Vicky / Nikčević, Ana / Oliver, Nick / Spada, Marcantonio / Salem, Victoria

    Diabetic medicine : a journal of the British Diabetic Association

    2022  Volume 39, Issue 10, Page(s) e14911

    Abstract: Introduction: The effects of the COVID-19 pandemic on mental health have been profound. Mental health and diabetes self-care are inter-related. We examined whether COVID-19 anxiety, depressive symptoms and health anxiety were associated with domains of ... ...

    Abstract Introduction: The effects of the COVID-19 pandemic on mental health have been profound. Mental health and diabetes self-care are inter-related. We examined whether COVID-19 anxiety, depressive symptoms and health anxiety were associated with domains of diabetes self-management and investigated whether greater COVID-19 anxiety syndrome would independently contribute to suboptimal diabetes self-care.
    Research design and methods: Surveys were sent to people attending diabetes clinics of three London hospitals. Participants completed the Diabetes Self-Management Questionnaire (DSMQ), the COVID-19 Anxiety Syndrome Scale (C-19 ASS), which measures perseveration and avoidant maladaptive coping behaviour, assessed with measures of co-existent depressive symptoms and anxiety, controlling for age, gender and social deprivation. Clinical data, including pre- and post-lockdown HbA
    Results: Depressive symptom scores were high. Both pre-existing health anxiety and depressive symptoms were independently linked to improvable measures of diabetes care, as was lower socio-economic rank. However, avoidant COVID-19 anxiety responses were independently associated with higher diabetes self-care scores. HbA
    Conclusion: During the height of lockdown, avoidant coping behaviours characteristic of the COVID-19 anxiety syndrome may in fact work to improve diabetes self-care, at least in the short term. We recommend screening for depressive symptoms and being aware of the significant minority of people with COVID-19 anxiety syndrome who may now find it difficult to re-engage with face-to-face clinic opportunities.
    MeSH term(s) Anxiety/epidemiology ; Anxiety/psychology ; COVID-19/epidemiology ; Communicable Disease Control ; Depression/epidemiology ; Depression/psychology ; Depression/therapy ; Diabetes Mellitus ; Humans ; Pandemics ; Self-Management
    Language English
    Publishing date 2022-07-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 605769-x
    ISSN 1464-5491 ; 0742-3071 ; 1466-5468
    ISSN (online) 1464-5491
    ISSN 0742-3071 ; 1466-5468
    DOI 10.1111/dme.14911
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Coronavirus Disease 2019 (COVID-19) Complicated by Acute Respiratory Distress Syndrome: An Internist's Perspective

    Ahmed, Taha / Shah, Ronak J. / Rahim, Shab E. Gul / Flores, Monica / O039, / Linn, Amy

    Cureus

    Abstract: A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries In the United States, the first confirmed case was reported on January 20, 2020, and since then, the ... ...

    Abstract A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries In the United States, the first confirmed case was reported on January 20, 2020, and since then, the number of cases is rising exponentially on a daily basis We report a case of COVID-19 infection that presented with symptoms suggestive of pneumonia Due to the major backlog with an immense number of pending tests, it took 48 hours for the result to come back positive, while the patient went into acute respiratory distress syndrome We provide an internist's perspective of the difficulties encountered in terms of the available management options, as the patient progressively deteriorated on the regular medical floor prompting transfer to the intensive care unit
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #164114
    Database COVID19

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  5. Article ; Online: Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study.

    Baltas, Ioannis / Gilchrist, Mark / Koutoumanou, Eirini / Gibani, Malick M / Meiring, James E / Otu, Akaninyene / Hettle, David / Thompson, Ameeka / Price, James R / Crepet, Anna / Atomode, Abolaji / Crocker-Buque, Timothy / Spinos, Dimitrios / Guyver, Hudson / Tausan, Matija / Somasunderam, Donald / Thoburn, Maxwell / Chan, Cathleen / Umpleby, Helen /
    Sharp, Bethany / Chivers, Callum / Vaghela, Devan Suresh / Shah, Ronak J / Foster, Jonathan / Hume, Amy / Smith, Christopher / Asif, Ammara / Mermerelis, Dimitrios / Reza, Mohammad Abbas / Haigh, Dominic A / Lamb, Thomas / Karatzia, Loucia / Bramley, Alexandra / Kadam, Nikhil / Kavallieros, Konstantinos / Garcia-Arias, Veronica / Democratis, Jane / Waddington, Claire S / Moore, Luke S P / Aiken, Alexander M

    JAC-antimicrobial resistance

    2023  Volume 5, Issue 4, Page(s) dlad091

    Abstract: Objectives: A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.: ... ...

    Abstract Objectives: A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.
    Methods: An online survey was sent to all infection consultants in NHS acute hospitals in England.
    Results: The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with
    Conclusions: The 'subscription-type' model was viewed favourably by infection consultants in England.
    Language English
    Publishing date 2023-08-01
    Publishing country England
    Document type Journal Article
    ISSN 2632-1823
    ISSN (online) 2632-1823
    DOI 10.1093/jacamr/dlad091
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  6. Article ; Online: Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals.

    Izzi-Engbeaya, Chioma / Distaso, Walter / Amin, Anjali / Yang, Wei / Idowu, Oluwagbemiga / Kenkre, Julia S / Shah, Ronak J / Woin, Evelina / Shi, Christine / Alavi, Nael / Bedri, Hala / Brady, Niamh / Blackburn, Sophie / Leczycka, Martina / Patel, Sanya / Sokol, Elizaveta / Toke-Bjolgerud, Edward / Qayum, Ambreen / Abdel-Malek, Mariana /
    Hope, David C D / Oliver, Nick S / Bravis, Vasiliki / Misra, Shivani / Tan, Tricia M / Hill, Neil E / Salem, Victoria

    BMJ open diabetes research & care

    2021  Volume 9, Issue 1

    Abstract: Introduction: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the ... ...

    Abstract Introduction: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers of poorer outcomes are not fully elucidated. We performed detailed characterization of patients with COVID-19 to determine the clinical and biochemical factors that may be drivers of poorer outcomes.
    Research design and methods: This is a retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between March 9 and April 22, 2020 in a large London National Health Service Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis.
    Results: 62% of patients in our cohort were of non-white ethnic background and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death/admission to the ICU within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were coexisting ischemic heart disease, increasing age and lower platelet count.
    Conclusions: In this large study of a diverse patient population, comorbidity (ie, diabetes with ischemic heart disease; increasing CFS score in older patients) was a major determinant of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomized clinical trials among high-risk patient groups.
    MeSH term(s) Adult ; Age Factors ; Aged ; Aged, 80 and over ; COVID-19/epidemiology ; COVID-19/therapy ; Comorbidity ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy ; Female ; Frailty/diagnosis ; Frailty/epidemiology ; Hospitals, Teaching ; Humans ; Intensive Care Units/statistics & numerical data ; Logistic Models ; London/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Sex Factors ; Survival Rate ; Young Adult
    Language English
    Publishing date 2021-01-06
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2732918-5
    ISSN 2052-4897 ; 2052-4897
    ISSN (online) 2052-4897
    ISSN 2052-4897
    DOI 10.1136/bmjdrc-2020-001858
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  7. Article ; Online: Severe COVID-19 and Diabetes: A Retrospective Cohort Study from Three London Teaching Hospitals

    Izzi-Engbeaya, Chioma / Distaso, Walter / Amin, Anjali / Yang, Wei / Idowu, Oluwagbemiga / Kenkre, Julia S / Shah, Ronak J / Woin, Evelina / Shi, Christine / Alavi, Nael / Bedri, Hala / Brady, Niamh / Blackburn, Sophie / Leczycka, Martina / Patel, Sanya / Sokol, Elizaveta / Toke-Bjolgerud, Edward / Qayum, Ambreen / Abdel-Malek, Mariana /
    Hope, David C D / Oliver, Nick S / Bravis, Vasiliki / Misra, Shivani / Tan, Tricia M / Hill, Neil / Salem, Victoria

    medRxiv

    Abstract: Patients with diabetes mellitus admitted to hospital with COVID-19 caused by infection with the novel coronavirus (SARS-CoV-2) have poorer outcomes. However, the drivers for this are not fully elucidated. We performed a retrospective cohort study, ... ...

    Abstract Patients with diabetes mellitus admitted to hospital with COVID-19 caused by infection with the novel coronavirus (SARS-CoV-2) have poorer outcomes. However, the drivers for this are not fully elucidated. We performed a retrospective cohort study, including detailed pre-hospital and presenting clinical and biochemical factors of 889 patients diagnosed with COVID-19 in three constituent hospitals of a large London NHS Trust. 62% of patients with severe COVID-19 were of non-White ethnic backgrounds and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death or admission to the intensive care unit (ICU) within 30 days of diagnosis. Male gender, advancing age and the Clinical Frailty Scale, an established measure of multimorbidity, independently predicted poor outcomes on multivariate analysis. Diabetes did not confer an independent risk for adverse outcomes in COVID-19, although patients with diabetes and ischaemic heart disease were at particular risk. Additional risk factors which significantly and independently associated with poorer outcomes in patients with diabetes were age, male gender and lower platelet count. Antiplatelet medication was associated with a lower risk of death/ICU admission and should be evaluated in randomised clinical trials amongst high risk patient groups.
    Keywords covid19
    Language English
    Publishing date 2020-08-11
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2020.08.07.20160275
    Database COVID19

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