The value of choice: A qualitative study

Background Providing choice in health care is part of an ongoing policy initiative Aim To explore how people understand choice in health care provision Setting South East England Design of Study A qualitative study using semi structured interviews Method Twenty two people recruited through advertising were interviewed about choice in general and choice in health care in particular. The data were analysed using template analysis. Results Participants grounded their consideration of choice in the NHS within the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. In particular, there was strong assent to the value of choice in principle and having choice was seen as positive. The provision of choice options, however, was not always associated with the possibility of meaningful choice and participants felt that the appearance rather than the substance of choice was sometimes in evidence. Making – as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP and to occasion regret. Information was seen as a necessary but not sufficient prerequisite of informed choice Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine rather than promote the doctor / patient relationship

Clinical characteristics and outcomes of pregnancy related patients admitted to the intensive care unit: a 1 year review

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed (O&G) Johannesburg January 2017Background and objectives Pregnancy can be associated with life threatening complications of pregnancy specific disease and delivery, as well as the exacerbation of preexisting comorbid disease, which requires multidisciplinary critical care. Studies have shown that advancement in medical care and access to intensive care units have been instrumental in the global decline in maternal mortality rates, particularly in developed countries. The aim of this study was to describe the admissions to ICU of all pregnant women including those with pregnancy related complications at CHBAH tertiary hospital in South Africa. Methods The study was a retrospective review of pregnant women, including pregnancy related complications, admitted to CHBAH ICU for the year of 2012. Baseline demographic data, admission diagnosis, laboratory information and acute physiological and chronic health evaluation score (APACHE II), intervention and outcomes were recorded using ICU records and general hospital records. Descriptive statistical analysis employed. Results In 2012 there were 21765 deliveries at CHBAH with 76 pregnancy related admissions to the ICU. Complete ICU data was available in 73 women. The incidence of ICU admission at the hospital was 3.5 per 1000 deliveries. The mortality rate in this group in ICU was 8.2%. The most common indication for admission was haemorrhage (43.8%) followed by medical and surgical disorders (23.3%), then sepsis (21.9%) and hypertensive disorders of pregnancy (11%). The majority of the women (98.3%) were admitted in the postpartum period. Mechanical ventilation was required in 77% of the women, inotropic support in 29% and 59% received blood transfusion products. APACHE II scoring system overestimated the possible mortality rate giving a predicted mortality rate of 15%. Conclusion Haemorrhage was the most common indication for admission to ICU. This does not concur with previous South African studies where hypertension was the most common reason for admission followed by haemorrhage. The study showed an overall mortality concurrent with some first world studies and significantly lower than cited South African studies.MT201

Fibroblast-derived HGF drives acinar lung cancer cell polarization through integrin-dependent RhoA-ROCK1 inhibition

The formation of lumens in epithelial tissues requires apical-basal polarization of cells, and the co-ordination of this individual polarity collectively around a contiguous lumen. Signals from the Extracellular Matrix (ECM) instruct epithelia as to the orientation of where basal, and thus consequently apical, surfaces should be formed. We report that this pathway is normally absent in Calu-3 human lung adenocarcinoma cells in 3-Dimensional culture, but that paracrine signals from MRC5 lung fibroblasts can induce correct orientation of polarity and acinar morphogenesis. We identify HGF, acting through the c-Met receptor, as the key polarity-inducing morphogen, which acts to activate β1-integrin-dependent adhesion. HGF and ECM-derived integrin signals co-operate via a c-Src-dependent inhibition of the RhoA-ROCK1 signalling pathway via p190A RhoGAP. This occurred via controlling localization of these signalling pathways to the ECM-abutting surface of cells in 3-Dimensional culture. Thus, stromal derived signals can influence morphogenesis in epithelial cells by controlling activation and localization of cell polarity pathways

A quasi-experiment to evaluate the effects of a blended approach of simulation learning and podcasting on caring behaviours

Background: The need for quality nursing personnel in clinical practice expected nurse teachers to be able to impart instrumental and expressive aspects of caring behaviours to nursing students. Operating in a resource-limited higher educational context, nurse teachers are required to do so in a cost effective way. This study as part of a larger study evaluated the effects of a blended approach to learning of caring behaviours based on ‘modified’ medium-fidelity simulation scenarios and podcasting to repeat debriefs. Methods: This study employed a quasi-experimental, two group pre-test-post-test design. The study included 146 second year nursing students. Participants were divided into ‘intervention’ and ‘control’ groups and were asked to complete a caring behaviour inventory scale at various stages of the research study. Results: Students in the intervention group scored statistically higher, post receiving medium-fidelity simulation learning and higher post podcasting. The exposure to high fidelity simulation learning has resulted in the lower scoring in control group. Conclusions: This study highlights the value of a blended approach based on medium-fidelity simulation learning and podcasting. Successful learning of caring behaviours lies in the heart of a care-oriented teaching approach rather than the use of sophisticated technologies. This study has implications for a better practice in nursing education for developing student caring behaviours, it also has a wider implication for all vocational and non-nursing healthcare education

The association between human salivary fibroblast growth factor-2 and stress, anxiety and depression.

The global prevalence of affective and anxiety disorders is enormous, yet little is known about individual differences contributing to psychiatric vulnerability. Research has increasingly focused on biomarkers such as cortisol to improve the prediction and prevention of psychopathology. This thesis investigated whether fibroblast growth factor-2 (FGF2), a neurotrophic protein, holds potential as a psychiatric biomarker. As research has predominantly examined the association between FGF2, stress and affective outcomes in rodents, this thesis aimed to translate these findings to humans, and extend the research to investigate FGF2’s role in cognitive processes and symptoms involved in psychopathology. Study 1 investigated the effect of psychosocial stress on salivary levels of FGF2 and cortisol, and measured levels of repetitive negative thinking (RNT). FGF2 changed following stress, in a pattern that mimicked changes in cortisol. Lower FGF2 (but not cortisol) reactivity following stress was related to higher levels of RNT, and predicted future levels of RNT relating to the stressor. Study 2 examined the association between FGF2 and cortisol reactivity and depression, anxiety and stress at the time of saliva collection (i.e., Study 1), as well as at a future stressful timepoint (i.e., during COVID-19). Lower FGF2 (but not cortisol) reactivity was associated with higher levels of depression, anxiety and stress at the time of saliva collection, and depression during COVID-19. Study 3 investigated whether stressor controllability impacted changes in FGF2 and cortisol levels following the Cold Pressor Test. While stressor controllability did not differentially impact cortisol levels over time, controllable stress led to larger, and more rapid, increases in FGF2 levels, and greater FGF2 reactivity, compared to uncontrollable stress. Study 4 examined the relationship between basal and reactive levels of FGF2 and cortisol with transdiagnostic factors that have been implicated in psychopathology. No association was found between FGF2 or cortisol and substance use or sleep difficulties. While further research in humans is required to elucidate FGF2’s potential as a psychiatric biomarker, this thesis provides evidence that human salivary FGF2 is associated with psychological outcomes and cognitive processes involved in psychiatric disorders, and that this is potentially mediated by FGF2’s role in the stress response

When you ask the fish: Child wellbeing through the eyes of Samoan children

Child wellbeing is the subject of substantial academic and policy interest globally and in New Zealand. Notably however, the voices of children are largely missing in much of the extended literature. In addition, and largely due to an assumption that wellbeing is a universally held construct, the influence of cultural values and beliefs on the perceptions and experiences of wellbeing of children, such as the Samoan children in this study, have not warranted in-depth attention. This study explores the influence of culture on how 8-year old Samoan children living in Wellington, NZ, conceptualise their wellbeing (Dunlop-Bennett, 2019). Part I of this article details the research approach developed for this study. Guided by Talanoa ile i’a (Faleolo, 2009) or ‘Talking to the Fish’, this study positioned children as experts on their wellbeing and through the use of talanoa and photos successfully created the reflective discussion space for 11 Samoan children to share their knowledge. The findings, outlined in Part II, show that when given the opportunity, these Samoan children offered critical and realistic insights into their experiences and aspirations. One model of wellbeing shared by these children used the analogy of a seesaw, where wellbeing was achieved when the “good bits and the bad bits” are balanced. The influence of context of wellbeing was a second key finding. These Samoan children’s experiences of wellbeing indicated a subtle interplay and balancing of their fa’asamoa (the Samoan way) and New Zealand life experiences. While this ethnic-specific study does not purport to represent the diversity of the Samoan diaspora, it presents a model that can be adapted by the Samoan diaspora living in other parts of New Zealand as well as other Pasifika and minority groups, as appropriate

The role of sentinel lymph node biopsy in cervical cancer

Lymph node dissection traditionally has been an essential component in surgical cancer staging for many different malignancies to evaluate for metastases. Lymphatic assessment plays a vital role in prognosticating and establishing the need for adjuvant therapy. Sentinel lymph node (SLN) mapping and biopsy has been proposed to identify tumour metastases while reducing the morbidity associated with systematic lymph node dissection. A SNL is the first group of lymph nodes to drain an organ before it enters the lymphatic basin. The principle that if one or more SLNs are negative for malignancy then the remaining regional nodes in the lymphatic basin will also be negative is the basis behind omission of the traditional systematic lymph node dissection which will add little value and increase morbidity.http://www.journals.co.za/content/journal/medogam2021Obstetrics and Gynaecolog

Ovarian cysts and tumours in children and adolescents

Ovarian masses are an uncommon finding in children and adolescents with an incidence of around 2.6/100000 per year excluding functional ovarian lesions of which the true incidence is unknown.1,2 While ovarian tumours account for less than 1% of all cancers in children, the likelihood of malignancy found in ovarian masses in children and adolescents ranges from 9% -11%.(1,3) The most common ovarian masses identified in this age range are listed in Table 1. Up to 64% are neoplastic of which the large majority are germ cell tumours (GCT) (60-80%). Sex cord stromal cell tumours and surface epithelial tumours account for 5% and <20% respectively unlike in adult ovarian tumours where surface epithelial tumours predominate.http://www.journals.co.za/content/journal/medogam2019Obstetrics and Gynaecolog

A quasi-experiment to evaluate the effects of a blended approach of simulation learning and podcasting on caring behaviours

Background: The need for quality nursing personnel in clinical practice expected nurse teachers to be able to impart instrumental and expressive aspects of caring behaviours to nursing students. Operating in a resource-limited higher educational context, nurse teachers are required to do so in a cost effective way. This study as part of a larger study evaluated the effects of a blended approach to learning of caring behaviours based on ‘modified’ medium-fidelity simulation scenarios and podcasting to repeat debriefs. Methods: This study employed a quasi-experimental, two group pre-test-post-test design. The study included 146 second year nursing students. Participants were divided into ‘intervention’ and ‘control’ groups and were asked to complete a caring behaviour inventory scale at various stages of the research study. Results: Students in the intervention group scored statistically higher, post receiving medium-fidelity simulation learning and higher post podcasting. The exposure to high fidelity simulation learning has resulted in the lower scoring in control group. Conclusions: This study highlights the value of a blended approach based on medium-fidelity simulation learning and podcasting. Successful learning of caring behaviours lies in the heart of a care-oriented teaching approach rather than the use of sophisticated technologies. This study has implications for a better practice in nursing education for developing student caring behaviours, it also has a wider implication for all vocational and non-nursing healthcare education

Joint Senior Recital: Sierra R. Manson, soprano and Emma V. Bryant, soprano

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Music Education. Ms. Manson studies voice with Todd Wedge. Ms. Bryant studies voice with Jana Young.https://digitalcommons.kennesaw.edu/musicprograms/2122/thumbnail.jp