Enhancing students’ confidence, competence and knowledge with Integrated Skills Challenge

Introduction/background: In today's complex healthcare environment, new nursing graduates are expected to master nursing skills in a timely manner and become critical thinkers with the capacity of solving complex healthcare problems efficiently. The increased complexity of the clinical setting requires competence-building begin in introductory courses, establishing foundational skills for critical thinking and prioritisation. In the healthcare professions, teaching and learning methods are focused on integration of clinical knowledge and skills. However, traditional teaching and learning methodologies do not always facilitate the development of a requisite level of these clinical skills. For the Master of Nursing Studies (MNSt) students whose program is shortened this means the acquisition of these skills must be achieved more rapidly. Aim/objectives: The purpose of this study is to investigate the feasibility of developing simulation scenarios (Integrated Skill Challenge [ISC]) as a supplemental teaching-learning strategy to enhance the transfer of student self-confidence and competence to the clinical nursing environment. Methods To examine potential effects of ISC on the MNSt students, a pilot study was conducted including 52 participants. Data were collected weekly over 11 week period by using pre and post-test design. Results: Analysis showed a significant increase in the confidence, competence and knowledge. Confidence, competence and knowledge scores increased when students were pre-loaded with knowledge prior to performing in the ISC. Results generally indicated that the ISC had the anticipated effects. Conclusions: This study reveals a high feasibility of developing simulation scenarios as an active learning methodology and that it should be developed further and piloted on a larger sample

Multimodal approach to predict neurological outcome after cardiac arrest: A single-center experience

Introduction: The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. Methods: Retrospective study of adult (>18 years) cardiac arrest patients who underwent multimodal monitoring; UO was defined as cerebral performance category 3-5 at 3 months. Predictors of UO were neurological pupillary index (NPi) 64 2 at 24 h; highly malignant patterns on EEG (HMp) within 48 h; bilateral absence of N20 waves on somato-sensory evoked potentials; and neuron-specific enolase (NSE) > 75 \u3bcg/L. Time-dependent decisional tree (i.e., NPi on day 1; HMp on day 1-2; absent N20 on day 2-3; highest NSE) and classification and regression tree (CART) analysis were used to assess the prediction of UO. Results: Of 137 patients, 104 (73%) had UO. Abnormal NPi, HMp on day 1 or 2, the bilateral absence of N20 or NSE >75 mcg/L had a specificity of 100% to predict UO. The presence of abnormal NPi was highly concordant with HMp and high NSE, and absence of N20 or high NSE with HMp. However, HMp had weak to moderate concordance with other predictors. The time-dependent decisional tree approach identified 73/103 patients (70%) with UO, showing a sensitivity of 71% and a specificity of 100%. Using the CART approach, HMp on EEG was the only variable significantly associated with UO. Conclusions: This study suggests that patients with UO had often at least two predictors of UO, except for HMp. A multimodal time-dependent approach may be helpful in the prediction of UO after CA. EEG should be included in all multimodal prognostic models

COVID-19 Pandemic is a renewed call for 'Speaking Up for Hand Hygiene'

As of the 31st July 2020, more than 17 million confirmed COVID-19 cases with over 668k deaths have been reported worldwide (World Health Organisation (WHO), 2020). The COVID-19 virus is genetically similar to the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS) (Schmidt, Davids, & Malinga., 2020; Zhao et al., 2020). However, initial investigations of the basic reproduction number (Ro) of COVID-19 shows higher transmissibility than SARS and MERS (Zhao et al.,2020). The mode of transmission of COVID-19 is mainly through close contacts via droplets from human to human (World Health Organisation (WHO), 2020). Whilst researchers around the world are focused on developing a vaccine for COVID-19, transmission preventative measures become the most effective means of response

Expressed sequence tag analysis of the human pathogen Paracoccidioides brasiliensis yeast phase: Identification of putative homologues of Candida albicans virulence and pathogenicity genes

Paracoccidioides brasiliensis, a thermodimorphic fungus, is the causative agent of the prevalent systemic mycosis in Latin America, paracoccidioidomycosis. We present here a survey of expressed genes in the yeast pathogenic phase of P. brasiliensis. We obtained 13,490 expressed sequence tags from both 5' and 3' ends. Clustering analysis yielded the partial sequences of 4,692 expressed genes that were functionally classified by similarity to known genes. We have identified several Candida albicans virulence and pathogenicity homologues in P. brasiliensis. Furthermore, we have analyzed the expression of some of these genes during the dimorphic yeast-mycelium-yeast transition by real-time quantitative reverse transcription-PCR. Clustering analysis of the mycelium-yeast transition revealed three groups: (i) RBT, hydrophobin, and isocitrate lyase; (ii) malate dehydrogenase, contigs Pb1067 and Pb1145, GPI, and alternative oxidase; and (iii) ubiquitin, delta-9-desaturase, HSP70, HSP82, and HSP104. the first two groups displayed high mRNA expression in the mycelial phase, whereas the third group showed higher mRNA expression in the yeast phase. Our results suggest the possible conservation of pathogenicity and virulence mechanisms among fungi, expand considerably gene identification in P. brasiliensis, and provide a broader basis for further progress in understanding its biological peculiarities.Univ São Paulo, Dept Ciencias Farmaceut, Fac Ciencias Farmaceut Ribeirao Preto, BR-14040903 Ribeirao Preto, SP, BrazilUniv São Paulo, Fac Filosofia Ciencias & Letras Ribeirao Pret, BR-14040903 Ribeirao Preto, SP, BrazilInst Pasteur, Unite Genet Mol Levures, Paris, FranceUniv Vale do Paraiba, UNIVAP, Vale Do Paraiba, BrazilUniv Mogi das Cruzes, Nucleo Integrado Biotecnol, Mogi Das Cruzes, BrazilUniversidade Federal de São Paulo, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilWeb of Scienc

Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania

<p>Abstract</p> <p>Background</p> <p>In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania.</p> <p>Methods</p> <p>Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis.</p> <p>Results</p> <p>The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support.</p> <p>Conclusions</p> <p>Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.</p

Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals : a systematic review of randomised controlled trials

BACKGROUND: The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace. We conducted a systematic review to (i) examine the effectiveness of workplace-based diet and/or physical activity interventions aimed at healthcare professionals and to (ii) identify and describe key components of effective interventions. Seven electronic databases were systematically searched. RESULTS: Thirteen randomised controlled trials met the inclusion criteria, of which seven had data available for meta-analysis. Where meta-analysis was possible, studies were grouped according to length of follow-up (<12 months and ≥12 months) and behavioural target (diet only, physical activity only or diet and physical activity), with outcome data pooled using a weighted random effects model. Nine studies reported statistically significant (between-group) differences. Four studies reported being informed by a behaviour change theory. Meta-analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight (-3.95 Kg, [95% CI -4.96 to- 2.95 Kg]) than controls up to 12 months follow up. CONCLUSIONS: Workplace diet and/or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous. To improve the evidence base, we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content.Peer reviewedFinal Published versio