Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

BACKGROUND: England’s extensive NHS patient survey programme has not fulfilled NHS white paper promises of improvements in patients’ experiences. Impediments to the surveys’ impact may include: surveys not being specific to departments, so staff claim “that doesn’t happen here”; clinicians not knowing how to improve; insufficient understanding of survey methods; delays in communicating survey results; and over-emphasis on data collection per se, rather than using results to improve care. METHODS: Over two years, patient surveys were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-level patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to letters, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to survey questions about nursing care were used to compute wards’ average Nursing Care Scores at each survey interval. RESULTS: 4,236 (47%) of the patients surveyed returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)). Feedback Plus meetings were effective in engaging nurses, correcting methodological misunderstandings and challenging “excuses”. Patients’ written comments stimulated interest. CONCLUSION: Merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward. The addition of ward meetings had a significant impact. Effective patient feedback can be achieved with: validated patient experience surveys; ward-specific results; information that includes a combination of numerical data and patients’ comments; and facilitated ward meetings. This study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified

It takes patience and persistence to get negative feedback from patients

Background: Patient experience surveys are increasingly used to gain information about the quality of healthcare. This paper investigates whether patients who respond early or late, and before and after reminders, to a large national survey of in-patient experience differ in systematic ways in how they evaluate the care they received. Methods: The English national in-patient survey of 2009 obtained data from just under 70,000 patients. We analyse their responses to the question “Overall, how did you rate the care you received” in relation to the time they took to respond and whether or not they had had a reminder, using statistical models designed to examine the length of time taken for an event to occur, known as “failure time regression models”. Results: 41 per cent of patients responded after the first questionnaire and 11 per cent after reminders. Those who were least positive in their evaluation of care replied on average 3.1 days later than the most positive. However, the main dividing line was between patients who responded to the initial mailing or to the reminders. Even controlling for other factors that influence the likelihood of an early response, those who respond after the initial mailing were more likely to be positive about the care they received. Conclusion: This study, using a large national dataset, shows that bias towards a positive evaluation of care could be introduced if the length of time that patients are allowed to respond is truncated or if reminders are omitted. Both patience (time) and persistence (reminders) are required to achieve unbiased results. Quality improvement efforts depend on having accurate data and negative evaluations are particularly valuable. The relevance of these findings for recent developments in patient evaluation and quality improvement are drawn out, as well as the implications for practitioners, managers and policy makers

Fossil Fuel Divestment in U.S. Higher Education: Endowment Dependence and Temporal Dynamics

Since 2012, students and others have pushed U.S. Higher Education Institutions (HEIs) to divest their endowments from fossil fuel producing industries. In the past decade, fossil fuel divestment has become the fastest growing divestment movement in history, with over 140 U.S. HEIs announcing divestment commitments. We conduct a quantitative analysis of the three phases of U.S. 4-year HEI divestment announcements (as well as rejections of divestment) to better understand the dynamics. Announcements began (2012-2017) with a number of schools divesting, followed by a second phase where new divestment announcements slowed. The current phase, which began around 2019, shows a renewed increase in divestments. Formal rejections of divestment followed a similar pattern in the early years, where rejections were slightly more common and represented more endowment value, but have declined as some schools reversed public positions. Schools that have divested from fossil fuels now represent roughly 3% of 4-year U.S. HEIs and 35% of endowment value. Roughly 85% more endowment value is now associated with U.S. schools that have divested from fossil fuels than with those that have rejected it. Our analysis points to endowment dependence (the share of operating expenses derived from the endowment) as a potentially important indicator of whether a school would divest, with early divestments from all fossil fuels coming nearly exclusively from schools with a relatively low endowment dependence. We discuss the implications of these findings in the context of different theories of change for the divestment movement. In particular, we note that over 99% of 4-year HEIs representing roughly 95% of endowment value are less dependent upon their endowment than at least one recently divested HEI, suggesting that large endowment or high dependence on endowment are no longer strict barriers to FFD for most schools

The effects of impaired cerebral circulation on Alzheimer's disease pathology: evidence from animal studies.

Persistent systemic hypoxia, a direct consequence of alterations in vascular function, can compromise the brain by increasing the risk of developing dementias such as Alzheimer’s disease (AD). Vascular contributions to cognitive impairment and AD in aged individuals are common, and several vascular risk factors for AD are linked to hypoxia. Clinical evidence confirms that structural and functional changes characteristic of AD pathology also occur following hypoxic-ischemic events such as stroke and traumatic brain injury. Studies with transgenic and non-transgenic mouse models reliably show that hypoxia increases the levels of amyloid- peptides that form the characteristic plaques in AD brains. Moreover, some studies suggest that vascular lesions also promote tau phosphorylation, modulate apolipoprotein E expression, and have more profound in effects in aged animals, but additional evidence is needed to establish these findings. Although the mechanisms underlying hypoxia-related effects remain unclear, controlled animal studies continue to reveal mechanistic aspects of the relationship between hypoxia and AD pathology that are necessary for therapeutic developments. The present review summarizes evidence from rodent studies regarding the effects of hypoxia on AD-related pathology and evaluates its impact on understanding human disease.Persistent systemic hypoxia, a direct consequence of alterations in vascular function, can compromise the brain by increasing the risk of developing dementias such as Alzheimer’s disease (AD). Vascular contributions to cognitive impairment and AD in aged individuals are common, and several vascular risk factors for AD are linked to hypoxia. Clinical evidence confirms that structural and functional changes characteristic of AD pathology also occur following hypoxic-ischemic events such as stroke and traumatic brain injury. Studies with transgenic and non-transgenic mouse models reliably show that hypoxia increases the levels of amyloid- peptides that form the characteristic plaques in AD brains. Moreover, some studies suggest that vascular lesions also promote tau phosphorylation, modulate apolipoprotein E expression, and have more profound in effects in aged animals, but additional evidence is needed to establish these findings. Although the mechanisms underlying hypoxia-related effects remain unclear, controlled animal studies continue to reveal mechanistic aspects of the relationship between hypoxia and AD pathology that are necessary for therapeutic developments. The present review summarizes evidence from rodent studies regarding the effects of hypoxia on AD-related pathology and evaluates its impact on understanding human disease

Bruton\u27s tyrosine kinase supports gut mucosal immunity and commensal microbiome recognition in autoimmune arthritis

Bruton\u27s tyrosine kinase

Latin America's 19th Century (Mostly Mexico): Formation of State, Subject and Self

This exhibit is a culmination of UT students’ collaborative effort to select, curate, and digitize original documents held in the Nettie Lee Benson Latin American Collection that reveal the region’s tumultuous and transformative 19th-century journeys towards the formation (s) of State, Subject and Self.Department of History & LLILAS Benson Latin American Studies and CollectionsLatin American Studie

A Two-Gene Signature, SKI and SLAMF1, Predicts Time-to-Treatment in Previously Untreated Patients with Chronic Lymphocytic Leukemia

We developed and validated a two-gene signature that predicts prognosis in previously-untreated chronic lymphocytic leukemia (CLL) patients. Using a 65 sample training set, from a cohort of 131 patients, we identified the best clinical models to predict time-to-treatment (TTT) and overall survival (OS). To identify individual genes or combinations in the training set with expression related to prognosis, we cross-validated univariate and multivariate models to predict TTT. We identified four gene sets (5, 6, 12, or 13 genes) to construct multivariate prognostic models. By optimizing each gene set on the training set, we constructed 11 models to predict the time from diagnosis to treatment. Each model also predicted OS and added value to the best clinical models. To determine which contributed the most value when added to clinical variables, we applied the Akaike Information Criterion. Two genes were consistently retained in the models with clinical variables: SKI (v-SKI avian sarcoma viral oncogene homolog) and SLAMF1 (signaling lymphocytic activation molecule family member 1; CD150). We optimized a two-gene model and validated it on an independent test set of 66 samples. This two-gene model predicted prognosis better on the test set than any of the known predictors, including ZAP70 and serum β2-microglobulin

Quantitative imaging of tissue sections using infrared scanning technology

Rona Barron - ORCID: 0000-0003-4512-9177 https://orcid.org/0000-0003-4512-9177Quantification of immunohistochemically (IHC) labelled tissue sections typically yields semi-quantitative results. Visualising infrared (IR) ‘tags’, with an appropriate scanner, provides an alternative system where the linear nature of the IR fluorophore emittance enables realistic quantitative fluorescence IHC (QFIHC). Importantly, this new technology enables entire tissue sections to be scanned, allowing accurate area and protein abundance measurements to be calculated from rapidly acquired images. Here, some of the potential benefits of using IR-based tissue imaging are examined, and the following are demonstrated. Firstly, image capture and analysis using IR-based scanning technology yields comparable area-based quantification to those obtained from a modern high-resolution digital slide scanner. Secondly, IR-based dual target visualisation and expression-based quantification is rapid and simple. Thirdly, IR-based relative protein abundance QIHC measurements are an accurate reflection of tissue sample protein abundance, as demonstrated by comparison with quantitative fluorescent Western blotting data. In summary, it is proposed that IR-based QFIHC provides an alternative method of rapid whole-tissue section low-resolution imaging for the production of reliable and accurate quantitative data.https://doi.org/10.1111/joa.12398228

Trial-and-error, Googling and talk: Engineering students taking initiative out of class

A review of the science education literature identifies the importance of outreach in raising public awareness of science while providing students with contextually relevant and meaningful science in ways that enhance their school experiences. The National Virtual School of Emerging Sciences (NVSES) provided just such an opportunity. Established throughout 2012-2014, it enabled 429 secondary students from across Australia to engage with the emerging sciences of Astrophysics and Nanotechnology. Creation of 'virtual' science classrooms allowed small groups of students to connect synchronously twice a week under the guidance of subject specialist teachers. To prepare for this context, teachers modified their face-to-face pedagogies to suit the range of technologies readily accessible in the virtual classroom. This chapter discusses how these different pedagogies were utilised by the NVSES teachers to develop lessons that created unique experiences for students within the virtual classroom environment. Data collected from pre and post student surveys, interviews with the NVSES teachers and access to digitally-recorded lessons demonstrate that while NVSES was highly successful, there were challenges for all involved

Co-evolution of genomes and plasmids within Chlamydia trachomatis and the emergence in Sweden of a new variant strain.

BACKGROUND: Chlamydia trachomatis is the most common cause of sexually transmitted infections globally and the leading cause of preventable blindness in the developing world. There are two biovariants of C. trachomatis: 'trachoma', causing ocular and genital tract infections, and the invasive 'lymphogranuloma venereum' strains. Recently, a new variant of the genital tract C. trachomatis emerged in Sweden. This variant escaped routine diagnostic tests because it carries a plasmid with a deletion. Failure to detect this strain has meant it has spread rapidly across the country provoking a worldwide alert. In addition to being a key diagnostic target, the plasmid has been linked to chlamydial virulence. Analysis of chlamydial plasmids and their cognate chromosomes was undertaken to provide insights into the evolutionary relationship between chromosome and plasmid. This is essential knowledge if the plasmid is to be continued to be relied on as a key diagnostic marker, and for an understanding of the evolution of Chlamydia trachomatis. RESULTS: The genomes of two new C. trachomatis strains were sequenced, together with plasmids from six C. trachomatis isolates, including the new variant strain from Sweden. The plasmid from the new Swedish variant has a 377 bp deletion in the first predicted coding sequence, abolishing the site used for PCR detection, resulting in negative diagnosis. In addition, the variant plasmid has a 44 bp duplication downstream of the deletion. The region containing the second predicted coding sequence is the most highly conserved region of the plasmids investigated. Phylogenetic analysis of the plasmids and chromosomes are fully congruent. Moreover this analysis also shows that ocular and genital strains diverged from a common C. trachomatis progenitor. CONCLUSION: The evolutionary pathways of the chlamydial genome and plasmid imply that inheritance of the plasmid is tightly linked with its cognate chromosome. These data suggest that the plasmid is not a highly mobile genetic element and does not transfer readily between isolates. Comparative analysis of the plasmid sequences has revealed the most conserved regions that should be used to design future plasmid based nucleic acid amplification tests, to avoid diagnostic failures