Designing a flexible support system in dialogue with students to meet their needs

A more stringent financial climate, alongside technological and lifestyle changes, have diversified student needs and promoted the use of inclusive learning and support strategies. This paper reports on the development and evaluation of academic skills centres at an English Higher Education Institution and considers ways in which the service is able to benefit users and providers, it goes on to argue that, by fostering a dialogue with students and using a range of delivery models, the provision has been made flexible, diversified and student centred and thereby addresses issues of current significance within the institution and sector more broadly

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Preparing masters students to teach in Higher Education: a new route to enhanced employability?

This paper describes the background and development of a recently introduced innovative programme which delivers the Postgraduate Certificate of Learning and Teaching in Higher Education (PGCLTHE) to students taking taught masters courses in a range of disciplines at a UK university. Evaluation of the initiative, incorporating analysis of data from student records, interviews, and focus groups with staff, and students has provided insights into some underlying issues, particularly around employability, educational development and the potential impact the course may have for enhancing broader sector knowledge. These are discussed in the context of students choices and issues facing this institution and the HE sector, including the potential of the programme to enhance the employability of students, implications of funding increases, developmental opportunities for the sector, and delivery of the course material

The impact of Academic Skills Centres on retention, progression and attainment and improving student confidence

The Academic Skills Centres were implemented on all university campuses to provide tailored disciplinary support to students at Kingston University as part of the Learning, Teaching and Assessment Strategy (Kingston University, 2009). The intervention aimed to extend and enhance existing support by ensuring that undergraduates and postgraduates on all of the university’s campuses could access learning support that closely aligned with disciplinary criteria. In addition to providing a supportive academic resource, the intervention also aimed to improve the student experience of learning and teaching within the institution. Therefore, it incorporates a diverse and flexible range of learning and teaching strategies, to meet the increasingly diverse needs of students, in an environment of technological advances, alongside changes in expectations, approaches to learning, and learning styles. The Academic Skills Centres make a significant contribution to students’ learning experiences by engaging them to become autonomous learners in an informal environment where they receive feedback on draft assignments and from this can practise and develop a range of skills such as essay and report writing, mathematics, referencing and researching, prior to submission. Thus, the overall aim of the Academic Skills Centres is to engage students as active participants in learning, teaching and assessment processes

The impact of academic skills centres on retention, progression and attainment and improving student confidence

The Academic Skills Centres were implemented on all university campuses to provide tailored disciplinary support to students at Kingston University as part of the Learning, Teaching and Assessment Strategy (Kingston University, 2009). The intervention aimed to extend and enhance existing support by ensuring that undergraduates and postgraduates on all of the university’s campuses could access learning support that closely aligned with disciplinary criteria. In addition to providing a supportive academic resource, the intervention also aimed to improve the student experience of learning and teaching within the institution. Therefore, it incorporates a diverse and flexible range of learning and teaching strategies, to meet the increasingly diverse needs of students, in an environment of technological advances, alongside changes in expectations, approaches to learning, and learning styles. The Academic Skills Centres make a significant contribution to students’ learning experiences by engaging them to become autonomous learners in an informal environment where they receive feedback on draft assignments and from this can practise and develop a range of skills such as essay and report writing, mathematics, referencing and researching, prior to submission. Thus, the overall aim of the Academic Skills Centres is to engage students as active participants in learning, teaching and assessment processes

Providing writing and language support for students who have English as a second language – a pilot study

This paper reports on a pilot project which provided writing support for registered nurses undertaking Continuing Professional Development (CPD) and for preregistration nursing students. Both groups of students have English as a second language (ESL). The aims of the project were to extend the scope of the available writing support within the faculty for ESL students through the provision of one-to- one sessions and workshops. In addition, workshops were provided for lecturers to improve their understanding of the barriers faced by ESL students. Literature indicates that communication with tutors and the need for clear feedback are important factors for ESL students. Quantitative and qualitative data were collected from questionnaires completed by participants after teaching sessions and were analysed against pre-agreed success criteria. Findings indicate that students were very positive about the effectiveness of the sessions in helping them improve their academic writing. Additionally, three themes emerged from the student data: reasons for using the ELS support service; what they liked most about the ELS service and suggestions for improvements to the service. Data from staff show that the sessions have given staff a greater insight into the problems faced by ESL students

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc