The acquisition of clinical experience during GP training - how can we mitigate for the impact of COVID-19?

The COVID-19 pandemic has profoundly impacted the way general practice is run and this is expected to have had a knock-on effect upon GP training. A questionnaire-based study was designed to investigate what was happening to GP trainees 16 months into the pandemic in terms of opportunities to develop clinical experience and clinical decision-making. We also asked trainers and trainees for ideas on how we might mitigate for the effects of COVID-19. In particular, there has been decreased exposure to clinical examination during the pandemic and there appear to be gaps in opportunities to learn from urgent and unscheduled care settings and to develop skills in rapid clinical decision-making. It is interesting to consider what general practice will look like when the pandemic is over and how this will this affect the GP training curriculum going forwards. Although response rates were low, we were able to determine some emerging themes for national, local and educational review going forwards to help shape and improve GP training for the future.

Legislative and regulatory aspects of molluscan health management

The world population is growing quickly and there is a need to make sustainable protein available through an integrated approach that includes marine aquaculture. Seafood is already a highly traded commodity but the production from capture fisheries is rarely sustainable, which makes mollusc culture more important. However, an important constraint to its continued expansion is the potential for trade movements to disseminate pathogens that can cause disease problems and loss of production. Therefore, this review considers legislative and regulatory aspects of molluscan health management that have historically attempted to control the spread of mollusc pathogens. It is argued that the legislation has been slow to react to emerging diseases and the appearance of exotic pathogens in new areas. In addition, illegal trade movements are taken into account and possible future developments related to improvements in areas such as data collection and diagnostic techniques, as well as epidemiology, traceability and risk analysis, are outlined.

Co-infection with Pseudomonas anguilliseptica and Delftia acidovorans in the European eel, Anguilla anguilla (L.): a case history of an illegally trafficked protected species

Inspections by customs agents at Barcelona airport discovered 420 kg of contraband glass eels prepared for shipment to Hong Kong. After confiscation of these animals by police, they were transported to holding facilities to be maintained until after a judicial hearing. Upon arrival, they were separated into two groups and held under ambient flow-through conditions in fresh water. During their captivity period, several peaks in mortality occurred and multiple bacterial strains were isolated from moribund animals. Sequencing of 16S rDNA was used to determine specific identity of the isolates. An initial isolation of Pseudomonas anguilliseptica was treated with oxytetracycline. A subsequent isolation of Delftia acidovorans proved resistant to oxytetracycline and was treated with gentamicin in combination with sulphadiazine-trimethoprim. Once the health condition of the animals was stabilized, they were partitioned into groups and subsequently released as part of a restocking effort for the species following the guidelines of Regulation (EC) 1100/2007 (Anon 2007). This represents the first record for both bacterial species in the host Anguilla anguilla in the Spanish Mediterranean.

The spread of pathogens through trade in aquatic animals and their products

It is well known that the transboundary spread of infectious diseases is aided by trade in live animals and the consequences can be severe if, as a result, a pathogen broadens its host range to new species. Trade in aquatic animal species is increasing, and aquaculture is also expanding to meet the growing human population's demands for animal protein. Moreover, it is clear that aquaculture has created potential new pathways by which pathogens and diseases may be introduced or spread to new areas. The risk of pathogen transfer is generally considered greater for the movement of live aquatic animals than for the movement of processed and dead products. The currently available health standards support the concept of minimising the risk of disease and pathogen incursion while, at the same time, avoiding unjustifiable or unnecessary impediments to trade. Nevertheless, the international spread of diseases through the movement of animals still occurs, despite these standards. Consequently, this paper considers the evidence linking international trade in aquatic animals and aquatic animal-derived products with the transmission and spread of diseases. The authors provide examples of pathogen transfer leading to disease spread and considerthe situation of emerging diseases, as well as the need for a holistic approach to deal with risk-based threats at their source.