Age and the anaesthetist: considerations for the individual anaesthetist and workforce planning: Guidelines about the ageing anaesthetic workforce from the Association of Anaesthetists: Guidelines for the ageing anaesthetic workforce from the Association of Anaesthetists

There is clear evidence of a growing workforce gap and this is compounded by demographic data that show the current workforce is ageing. Within the current workforce, more doctors are taking voluntary early retirement and the loss of these experienced clinicians from departments can have wide-ranging effects. Older doctors are at risk of age-related health problems (e.g. sight, musculoskeletal, menopause) and are more susceptible to the effects of fatigue, which may increase the risk of error and or complaint. The purpose of this working party and advocacy campaign was to address concerns over the number of consultants retiring at the earliest opportunity and whether a different approach could extend the working career of consultant anaesthetists and SAS doctors. This could be viewed as 'pacing your career'. The earlier this is considered in a clinician's career the greater the potential mitigation on individuals.

Education provided to outgoing UK medical elective students regarding HIV risk and post exposure prophylaxis

Previous studies suggested medical schools were failing to provide sufficient support for students undertaking electives in areas with high HIV prevalence and despite updated Department of Health (DoH) guidelines, not all were advising post exposure prophylaxis (PEP) starter packs where appropriate. This study assessed whether there has been improvement in risk reduction provided by home institutions. Questionnaires were emailed to all 29 UK medical schools offering an elective. A total of 26 medical schools responded. Only one failed to offer PEP starter packs or advice on where to obtain one. Support and advice provided by the other 25 varied considerably. HIV risk education and provision of PEP to elective students has improved. A discrepancy between advice given, supervision of projects and provision of PEP starter packs across UK medical schools remains. We reiterate recommendations put forward previously that there is a need for regularly updated national guidelines published by experts, issued to all medical schools.

Pre-elective HIV postexposure prophylaxis clinic for medical students: design, protocol, uptake and effectiveness

We sought to evaluate medical student need for HIV postexposure prophylaxis (PEP) prior to their elective and introduce a ‘Pilot PEP Clinic’. We undertook a survey of 388 medical students to assess their elective plans. All were offered an appointment in a clinic, assessed via a protocol and provided a PEP ‘starter-pack’ prescription if criteria were met. A follow-up questionnaire was sent to assess the acceptability of the clinic. The pre-elective questionnaire response rate was 232/388 (60%); 72/232 (31%) of respondents planned their elective in areas of high HIV prevalence and, of these, 32/72 (45%) attended the clinic. Of 32, 31 (97%) met the clinic protocol criteria and received a prescription for PEP. Of 32, 29 (90%) completed the follow-up questionnaire and every respondent rated the clinic as acceptable. The main concern was the cost of antiretroviral medications. We conclude that a ‘Pre-elective HIV PEP Clinic’ is an acceptable way to provide students with safe access to PEP prior to their elective.

Role of the extracellular signal-regulated protein kinase cascade in human neutrophil killing of Staphylococcus aureus and Candida albicans and in migration

Killing of Staphylococcus aureus and Candida albicans by neutrophils involves adherence of the microorganisms, phagocytosis, and a collaborative action of oxygen reactive species and components of the granules. While a number of intracellular signalling pathways have been proposed to regulate neutrophil responses, the extent to which each pathway contributes to the killing of S. aureus and C. albicans has not been clearly defined. We have therefore examined the effect of blocking one such pathway, the extracellular signal-regulated protein kinase (ERK) cascade, using the specific inhibitor of the mitogen-activated protein kinase/ERK kinase, PD98059, on the ability of human neutrophils to kill S. aureus and C. albicans. Our data demonstrate the presence of ERK2 and a 43-kDa form of ERK but not ERK1 in human neutrophils. Upon stimulation with formyl methionyl leucyl phenylalanine (fMLP), the activities of both ERK2 and the 43-kDa form were stimulated. Despite abrogating the activity of both ERK forms, PD98059 only slightly reduced the ability of neutrophils to kill S. aureus or C. albicans. This is consistent with our finding that PD98059 had no effect on neutrophil adherence or degranulation, although pretreatment of neutrophils with PD98059 inhibited fMLP-stimulated superoxide production by 50%, suggesting that a change in superoxide production per se is not strictly correlated with microbicidal activity. However, fMLP-stimulated chemokinesis was markedly inhibited, while random migration and fMLP-stimulated chemotaxis were partially inhibited, by PD98059. These data demonstrate, for the first time, that the ERK cascade plays only a minor role in the microbicidal activity of neutrophils and that the ERK cascade is involved primarily in regulating neutrophil migration in response to fMLP.

Effects of female sex hormones on lipid metabolism in the uterine epithelium of the mouse

1. The effects of oestrogen and progesterone on synthesis and composition of lipids in the uterine epithelium were studied. 2. Oestrogen treatment for up to 18 hr resulted in an increased incorporation of [14C]acetate into all classes of lipids, but particularly into cholesterol. 3. Progesterone treatment increased incorporation into all classes of lipids except cholesterol and completely inhibited the oestrogen-induced incorporation into cholesterol. We suggest that this may be the mechanism whereby progesterone blocks uterine epithelial cell proliferation. 4. Oestrogen increased incorporation into all classes of phospholipids, and progesterone pretreatment inhibited the marked oestrogen-induced incorporation into phosphatidylinositol. 5. Both oestrogen and progesterone, but particularly progesterone, increased the epithelial cell phospholipid to cholesterol ratio. 6. Oestrogen induced changes in epithelial phospholipid fatty acyl composition: particularly marked was a time related reduction in 20:4 which was inhibited by progesterone pretreatment to only a minor degree.