Using e-learning to support the Basic Medical Training programme in South Sudan

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Helping Student Nurses Learn the Craft of Compassionate Care: A Relational Model.

This on the horizon article proposes a relational model for enabling the development of skills and attributes associated with‘compassionate craftsmanship’ in the developing nurse. This pedagogic model was informed by findings from the author’sresearch with patients, nurses and students, all of which focused on aspects of care and compassion. While the studies werelocated in varying contexts and involved diverse stakeholders, findings consistently revealed a connection between the provisionof compassionate person-centred care and the development of tacit knowledge in the nursing profession. These will be teasedout and explicated in a future paper; this article focuses on the proposed model.The proposed model was developed by drawing on the literature of craftsmanship in a range of disciplines, where tacitknowledge is commonly regarded as a vital underpinning factor. In consequence, the compassionate craftsmanship modelemphasises the importance of tacit knowledge in the design of appropriate pedagogic approaches to foster an ethos ofcompassionate craftsmanship in nursing. The very nature of tacit knowledge, however, means it is a challenging educational areato address. Hence the model, which illuminates a series of inter-related enabling factors that underpin the development of keyabilities associated with compassionate craftsmanship. It also highlights anticipated long-term outcomes for those who developand apply these in clinical practice.The model will be of particular interest to healthcare practitioners, nurse leaders and those working in higher education. Whilethe underpinning abilities and associated outcomes are specific to nursing, they are likely to be relevant to different disciplineswhere effective interaction with others is essential

Hormone replacement therapy for women with type 1 diabetes mellitus

Background: There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established.Objectives: To assess the effects of HRT for women with type 1 diabetes mellitus.Search methods: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO from their inception to June 2012. The last search was run for all databases on 18 June 2012.Selection criteria: We selected randomised controlled trials or controlled clinical trials that involved peri‐ or postmenopausal women with type 1 diabetes undergoing HRT as an intervention.Data collection and analysis: Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreements were resolved by discussion or by intervention by a third party. Descriptive analysis was conducted for the review.Main results: Ninety‐two publications were screened. No studies met the inclusion criteria exclusively but one study that included both type 1 and type 2 diabetes participants was considered. This randomised clinical trial (RCT) compared HRT (N = 27) with placebo (N = 29) over 12 months. The outcome measures were cardiovascular risk factors, including lipid profile, glycaemic control, blood pressure and body weight. No significant differences between placebo and HTR were detected. Patient‐important outcomes like all‐cause mortality, cardiovascular disease, diabetic complications or health‐related quality of life were not investigated.Authors' conclusions: There is a lack of evidence around the use of HRT in women with type 1 diabetes. The one study that has been undertaken in this area is underpowered. More RCTs are required in the area to examine the impact of HRT on glycaemic control and cardiovascular outcomes.https://doi.org/10.1002/14651858.CD008613.pub2pubpub

Using student expertise in co-creating resources to foster feedback literacy

Recognising that research-driven approaches to fostering feedback literacy do not always draw upon authentic student voices, this project set out to co-create (Bovill, 2016) a suite of materials that would be produced in partnership with third year students. The mutually agreed resources were co-produced as a toolkit for neophyte nursing students about to go out on work-based placement in complex and extremely busy clinical environments. Building on a previous project (Adamson, 2018), a pedagogic action research approach (Norton, 2018) was used, with six steps in the action research cycle. Each step engaged group of final-year undergraduate student consultants, and the implementation phase drew extensively on the participating students’ expertise in learning to engage productively in feedback processes during their own clinical placements. Narrative approaches elicited individual students’ views, based on the students’ lived experience. Concept-driven coding of the resultant data was then used to identify overall themes, which were then used as the basis for the co-produced materials. These were initially drafted within a workshop setting, and subsequently produced as laminated flash-cards, which aimed to help neophyte students engage productively in feedback processes. During the conference presentation the cards will be shared, so that delegates may read and review them fully afterwards. This paper, however, will focus on our research findings from one aspect of the evaluation phase of the pedagogic action research cycle. A focus group following the workshop gathered participating students’ perceptions of their involvement in the process of co-creating feedback-related resources. The data was analysed and six themes identified. These themes will be reported, together with powerful illustrative quotations. They will be linked to recent literature on feedback literacy (Carless & Boud, 2018), and to ‘new’ paradigms of feedback, including student engagement and agency within feedback processes (Winstone & Carless, 2019). The particular resonance of the students’ outlook with ‘informal feedback’ derived from extended participation in situated practice (Sambell et al, 2013) will also be illuminated. The presentation will thus build on and critically engage with existing research in the field by drawing attention to the relevance and importance of research and pedagogic practices which illuminate students’ lived experience and developed expertise in using feedback in such complex situated contexts (Noble, 2019). The discussion phase of the session will enable participating delegates to debate the theoretical implications and practical implications of our approach in relation to developing students’ feedback literacy in their own research and/or pedagogic contexts

Evidence based spinal surgery or the “journal of anecdotal medicine?” Using qualitative interviews with spinal surgeons to understand how the drivers of orthopaedic decision making can influence the creation and adoption of surgical trial evidence

Background: There is uncertainty regarding the best available treatment for stable thoracolumbar fractures without spinal cord injury. We explore what influences surgical decision making for the treatment of stable thoracolumbar fractures in the UK and discuss the implications of variation in spinal surgical work on the creation and adoption of future evidence. Methods: Qualitative semi-structured interviews with 19 spinal surgeons from 13 UK hospitals. Data were collected as part of a mixed methods randomised pilot study (PRESTO). A conceptual framework of drivers of variation in orthopaedic surgical work informed how we analysed and reported our findings. Results: We identified various patient, surgeon, organisational and cultural factors to influence surgical decision making and variation in the treatment of stable thoracolumbar fractures. We then use our findings to present the ‘cycle of uncertainty,’ to illustrate how a lack of evidence is a justification for a Randomised Controlled Trial (RCT) and the reason why a trial is not deemed feasible. Conclusion: Surgical decision-making is complex, particularly in the absence of robust evidence. The reliance on informal sources to inform decision making and the limited role of evidence, have implications for the likelihood that RCT evidence will be created and/or adopted. To break this cycle of uncertainty we suggest focussing earlier in the research cycle to develop context-specific strategies, designed to avoid equipoise from deeming future surgical trials unfeasible and encourage evidence based surgical decision-making. This could include targeted qualitative research conducted prior to RCTs to explore drivers of surgical decision making

Social stories in mainstream schools for children with autism spectrum disorder : a feasibility randomised controlled trial

OBJECTIVES: To assess the feasibility of recruitment, retention, outcome measures and intervention training/delivery among teachers, parents and children. To calculate a sample size estimation for full trial. DESIGN: A single-centre, unblinded, cluster feasibility randomised controlled trial examining Social Stories delivered within a school environment compared with an attentional control. SETTING: 37 primary schools in York, UK. PARTICIPANTS: 50 participants were recruited and a cluster randomisation approach by school was examined. Participants were randomised into the treatment group (n=23) or a waiting list control group (n=27). OUTCOME MEASURES: Acceptability and feasibility of the trial, intervention and of measurements required to assess outcomes in a definitive trial. RESULTS: An assessment of the questionnaire completion rates indicated teachers would be most appropriate to complete the primary outcome measure. 2 outcome measures: the Social Responsiveness Scale (SRS)-2 and a goal-based measure showed both the highest levels of completion rates (above 80%) at the primary follow-up point (6 weeks postintervention) and captured relevant social and behaviour outcomes. Power calculations were based on these 2 outcome measures leading to a total proposed sample size of 180 participant groups. CONCLUSIONS: Results suggest that a future trial would be feasible to conduct and could inform the policy and practice of using Social Stories in mainstream schools. TRIAL REGISTRATION NUMBER: ISRCTN96286707; Results

Embedding qualitative research in randomised controlled trials to improve recruitment: findings from two recruitment optimisation studies of orthopaedic surgical trials

Background: Recruitment of patients is one of the main challenges when designing and conducting randomised controlled trials (RCTs). Trials of rare injuries, or those that include surgical interventions pose added challenges due to the small number of potentially eligible patients and issues with patient preferences and surgeon equipoise. We explore key issues to consider when recruiting to orthopaedic surgical trials from the perspective of staff and patients with the aim of informing the development ofstrategies to improve recruitment in future research. Design: Two qualitative process evaluations of a United Kingdom-wide orthopaedic surgical RCT (ACTIVE) and mixed methods randomised feasibility study (PRESTO). Qualitative semi-structured interviews were conducted and data was analysed thematically. Setting: NHS secondary care organisations throughout the United Kingdom. Interviewswere undertaken via telephone. Participants: 37 health professionals including UK based spinal and orthopaedic surgeons and individuals involved in recruitment to the ACTIVE and PRESTO studies (e.g. research nurses, surgeons, physiotherapists). 22 patients including patients who agreed to participate in the ACTIVE and PRESTO studies (n=15) and patients that declined participation in the ACTIVE study (n=7) were interviewed. Results: We used a mixed methods systematic review of recruiting patients to randomised controlled trials as a framework for reporting and analysing our findings. Our findings mapped onto those identified in the systematic review and highlighted the importance of equipoise, randomisation, communication, patient’s circumstances, altruism and trust in clinical and research teams. Our findings also emphasised the importance of considering how eligibility criteria are operationalised and the impact of complex patient pathways when recruiting to surgical trials. In particular, the influence of health professionals, who are not involved in trial recruitment, on patients’ treatment preferences by suggesting they would receive a certain treatment ahead of recruitment consultations should not be underestimated. Conclusions: A wealth of evidence exploring factors affecting recruitment to randomised controlled trials exists. A methodological shift is now required to ensure that this evidence is used by all those involved in recruitment and to ensure that existing knowledge is translated into methods for optimising recruitment to future trials. Trial registries: ACTIVE: (ISRCTN98152560) PRESTO: (ISRCTN12094890