Transfer of learning and patient outcome in simulated crisis resource management : a systematic review

PURPOSE: Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. SOURCE: Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility. PRINCIPAL FINDINGS: Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality. CONCLUSIONS: Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality

Assessment of child or young person with a possible eating disorder

Assessing young people with possible eating disorders can be complex for a variety of reasons, including managing confidentiality and risk (for example, a young person not wanting their parent to be involved, or a parent presenting with concerns about their child), the young person or parent not being aware of the severity of the illness, and difficulty in knowing how questions can be sensitively phrased. This Practice Pointer will offer advice on building therapeutic relationships in consultation with a child or young person, and with their parent(s), what information to gather and how to do so sensitively, and how to discuss the role of the parent or carer in treatment. We recommend that it is read alongside the accompanying Clinical Update for detailed notes on examination, investigations, when to refer, and risk. The advice is based on expert experience. We use the female pronoun throughout as eating disorders are more prevalent in females, but it should be noted that they can and do also occur in males

Desacetyl-α-melanocyte stimulating hormone and α-melanocyte stimulating hormone are required to regulate energy balance.

OBJECTIVE: Regulation of energy balance depends on pro-opiomelanocortin (POMC)-derived peptides and melanocortin-4 receptor (MC4R). Alpha-melanocyte stimulating hormone (α-MSH) is the predicted natural POMC-derived peptide that regulates energy balance. Desacetyl-α-MSH, the precursor for α-MSH, is present in brain and blood. Desacetyl-α-MSH is considered to be unimportant for regulating energy balance despite being more potent (compared with α-MSH) at activating the appetite-regulating MC4R in vitro. Thus, the physiological role for desacetyl-α-MSH is still unclear. METHODS: We created a novel mouse model to determine whether desacetyl-α-MSH plays a role in regulating energy balance. We engineered a knock in targeted QKQR mutation in the POMC protein cleavage site that blocks the production of both desacetyl-α-MSH and α-MSH from adrenocorticotropin (ACTH1-39). RESULTS: The mutant ACTH1-39 (ACTHQKQR) functions similar to native ACTH1-39 (ACTHKKRR) at the melanocortin 2 receptor (MC2R) in vivo and MC4R in vitro. Male and female homozygous mutant ACTH1-39 (Pomctm1/tm1) mice develop the characteristic melanocortin obesity phenotype. Replacement of either desacetyl-α-MSH or α-MSH over 14 days into Pomctm1/tm1 mouse brain significantly reverses excess body weight and fat mass gained compared to wild type (WT) (Pomcwt/wt) mice. Here, we identify both desacetyl-α-MSH and α-MSH peptides as regulators of energy balance and highlight a previously unappreciated physiological role for desacetyl-α-MSH. CONCLUSIONS: Based on these data we propose that there is potential to exploit the naturally occurring POMC-derived peptides to treat obesity but this relies on first understanding the specific function(s) for desacetyl-α-MSH and α-MSH

The role of practice leadership in active support: impact of practice leaders’ presence in supported accommodation services

Objectives: Research shows practice leadership to be a factor in the successful implementation of active support. The aim of the study was to explore differences in staff practice, associated with the presence of a practice leader in a shared supported accommodation service. Methods: Quality of support and engagement for 189 service users with intellectual disability from 58 services were collected during a 2 h observation using the EMAC-R and ASM. The practice leader was present in 19 services (n = 59) and absent in 39 (n = 111). An Observed Measure of Practice Leadership was administered during a second visit to each service. Results: When the practice leader was present, levels of engagement and active support were statistically higher (p < 0.01). Although measured at a different time, observed practice leadership was also higher in services where the practice leader was present during the first observation. Conclusion: The level of observed practice leadership and presence of the practice leader appear to be associated with better quality of support. This finding provides further evidence of the importance of systems for supporting, monitoring, modelling, and improving staff practice for effective implementation of active support

Conundrums of supported living: The experiences of people with intellectual disability

Background Dissatisfaction with the inflexibility of the group home model has led to the growth of supported living that separates housing from support and is thought to have greater potential for better quality of life outcomes. Comparative studies have had mixed findings with some showing few differences, other than greater choice in supported living. By investigating service user experiences of supported living this study aimed to identify how the potential of supported living might be better realised. Method Thirty-four people with intellectual disability participated in 7 focus group interviews and 6 people in an individual interview. Data were analysed using grounded theory methods. Results Although participants experienced greater choice and control over their everyday lives, they did not feel they controlled the way support was provided and experienced restrictions on lifestyle associated with low income. Despite their use of community places and varied social connections to family, friends, and acquaintances, most experienced loneliness. Conclusions If the potential of supported living is to be realised, shortcomings of support arrangements must be addressed by, for example, greater consistency of support worker skills, consumer control over recruitment and rostering, and more skilled support to build friendships and manage difficult relationships

Nutrição mineral de hortaliças: XXIX. absorção de macronutrientes por quatro cultivares de morangueiro (Fragaria spp.)

The aim of this work was to estimate the differences in growth (dry weight basis), nutrients uptake, fruits yield, total uptake and exportation of nutrients among several strawberry cultivars: Campinas (IAC-2712), Camanducaia (IAC-3530), Monte Alegre (IAC-3113) and SH-2. The experimental was carried out in the Escola Superior de Agricultura "Luiz de Queiroz", in field conditions, in 1975/76. The soil belongs to Terra Roxa Estruturada type, and "Luiz de Queiroz" serie. This soil has been cultivated for more than 25 years. The experimental design was that randomized blocks with four replications and analysed together following the design of split-plot. The soil of the plots were revolved to a deep of 12 cm following application of 10 kg organic matter/m². The fertilizers were applied in the groove and in the same amount for all cultivars: Ammonium sulfate (20% N), 10 g/m; triple superphosphate (20% P(2)0(5)) 10 g/m; Potassium cloride (60% K(2)0), 10 g/m. Therty days after planting, 10 g/plant of ammonium sulfate was applied. After 76 days from planting, the firsa sample was taken. Other samples were taken in equal intervals of 20 days, up to 216 days. When a decrease in fruitproduction was noted. The sample (plants) were divided in stems, leaves and fruits and chemical analysis were made for N, R, K, Ca, Mg e S. The variation on production (dry matter) nutrient uptake' and fruits yield, were obtained from data calculated by adjusted regression equation analysis. The maxima point from these equations were taken to show the total nutrient uptake. From the data obtained, the following conclusions could be drawn. Growth - The dry matter of stems, leaves and fruits were different among the cultivars. The production of dry matter by the stems and fruits were linnear for all cultivars up to 196 and 216 days. The highest productions on dry matter varied between 15 to 25 g and 12 to 20 g/plant. The maximum production of dry matter in the leaves among the cultivars varied between 20 to 30 g at 196 and 173 days respectivelly. The cultivars Campinas (IAC-2712) and Camanducaia (IAC-3530) produced more dry matter than SH-2 cultivar. Nutrient uptake -< The were differences on nutrient content in stems and leaves among cultivars (R, K, Ca, S, B) and in the fruits for N, R, K, Mg, S. The highest absorption of nutrients (days after planting) is shown in Table I. Yield - No significant difference in fruit production was observed among the cultivars. The highest yield among the cultivars showed a variation between 103 to 151 g per plant at the 207 and 207 days,Efetuou-se um estudo para avaliar a absorção e a extração dos macronutrientes nos seguintes cultivares de morangueiro: Campinas (IAC-2712); Camanducaia (IAC-3530) ; Monte Alegre (IAC-3113) e SH-2 em condições de campo. A instalação deu-se em um solo pertencente ao grande grupo Terra Roxa Estruturada, e à série "Luiz de Queiroz" cultivado intensivamente com hortaliças há mais de 25 anos, em Piracicaba-SP. A adubação aplicada foi uniforme para todos os cultivares. São apresentadas as concentrações dos macronutrientes em porcentagem nos seguintes órgãos: caules, folhas e frutos dos cultivares em função da idade (X) em dias. Constatou-se que os cultivares diferem quanto à absorção dos macronutrientes (R, K, Ca e S em relação a caules e folhas, e, N, R, K, Mg e S em relação aos frutos). Constatou-se também que os cultivares extraem totais diferentes de R, K, Ca, Mg e S sendo as extrações de R pelos cultivares menores do que as extrações de Ca e Mg, e no global as de Mg são equivalentes às de S. As quantidades máximas extraídas pelos cultivares para uma população de 150.000 plantas/ha foram : N - 192 kg; R - 24-50 kg; K - 133-244 kg; Ca - 76-116 kg; Mg - 30-34 kg; S - 13-27 kg. - A maior produção de matéria seca tanto nos órgãos como na planta inteira, ocorreu nos cultivares Campinas (IAC-2712) e Camanducaia (IAC-3530) e a menor produção verificou-se no cultivar SH-2. - Os cultivares diferem na absorção dos nutrientes: R, K, Ca, S para caules e folhas. E para frutos, N, R, K, Mg e S. - Os cultivares atingem o máximo da absorção de nutrientes nos órgãos nas seguintes épocas, em dias: - Os cultivares extraem e exportam totais diferentes de R, K, Ca e Mg. - Tanto os macronutrientes são extraídos em quantidades mais elevadas através das folhas e em menor proporção por caules e frutos. - As extrações de N, K e Ca são mais altas que aquelas dos demais macronutrientes. - As extrações de R pelos cultivares são menores que as de Ca e Mg, sendo ainda as extrações de Ca superiores às de Mg, enquanto no global as de Mg são equivalentes às de S. - A extração de macronutrientes verifica-se na ordem decrescente: K, N, Ca, Mg, S e P

The Necessity of Self-Employment Towards Retirement: Evidence from Labor Market Dynamics and Search Requirements for Unemployment Benefits

Hervorming Sociale Regelgevin