Measurement of chest wall forces on coughing with the use of human cadavers

Letter commenting on an article by Magovern et al.peer-reviewe

Bromus cathatrticus Vahl (Fam. Poaceae) : a new record for the Maltese Islands

The discoveries of the first 4 known populations of the alien Bromus catharticus from the Maltese Islands are reported. Notes on the species’ distribution range, local habitat and invasive potential are also given.peer-reviewe

Transforming the NHS through transforming ourselves

Abstract Background: Leadership development impacts on quality of care and workplace cultures for staff. Clinical Leadership embracing transformational and other collective leadership approaches are key enablers to developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal, inter-professional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had previously been unsuccessful in engaging medical doctors. Aims and Objectives: This paper shares how a dedicated practice development based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become both transformational and collective leaders and facilitators with the skills to begin to develop and sustain effective workplace cultures, that are person centred, safe and effective. Methods: Practice development methodology with its collaborative, inclusive and participative approach for developing person centred cultures combined with clinical leadership strategies, formed the basis of the programme which emphasised the use of active and action learning drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and co-creation of insights about clinical leadership together with collaborative analysis of evaluation data led to the syntheses of insights through the use of reflection and action planning. Findings/Results: Findings are presented at two levels: 1) Five individual authentic reflections by authors to illustrate their leadership journeys which also demonstrate how a range of tools were used and their impact from reflections. Insights and learning include recognition of the benefits of peer support and networking; development of a disciplined approach to learning and self-management; 2) A collaborative reflection and critique that embraced the feeling of a sense of team ethos and community cohesion, for the first time in a safe environment; as well as, a sense of collective shared purpose and values. Conclusions: We conclude that the programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled a journey of self-transformation for medical clinical leaders to commence. Practical implications arising from our learning: • An internal model grows clinical leadership capacity across the organisation through peer support and networking and collective leadership. • Investing in a safe confidential space for clinical leads and other staff groups is a strategy for leadership development practice. • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates potential for enabling transformative and collective leadership for achieving person-centred cultures in the workplace. Keywords: Clinical leadership, collective leadership, critical companionship, micro-systems, transformational leadership, workplace cultur

A concurrent engineering approach to develop BioMEMS employed in a deep brain stimulator integrated with a drug delivery system

This paper presents an Integrated Product Development (IPD) based model to specifically develop bio-medical micro-electro-mechanical-systems (BioMEMS). The concurrent engineering model is based on the IPD model phases, which are presented and formulated by the Integration DEFinition (IDEF) model- ling language. To evaluate the IPD model, a case study concerning the development of a BioMEMS device for a deep brain stimulation (DBS) system was investigated. By following the relevant mechanisms and controls in the model, a design concept of a wireless head-mounted DBS implant integrated with a drug delivery system (DDS) was conceived. The contribution of this paper is the IDEF model, which provides a road map to the product development team members in order to take a concurrent engineering approach to develop Bio-MEMS. The qualitative feedback received from the identified stakeholders, together with the quality of the case study employed, namely, an integrated DBS and DDS solution, indicate a degree of evidence that the model provides a sound basis in this direction.peer-reviewe

Rediscovery of Ornithogalum divergens Boreau (Hyacinthaceae) in Malta (Central Mediterranean)

Ornithogalum diver gens had not been reported from the Maltese islands since 1927 and was presumed to be extinct here. Recently the species was rediscovered at the Buskett woodland and a new population was recorded at Girgenti.peer-reviewe

Reply to Jutley et al.

Reply to a letter by Jutley et al.peer-reviewe

Reply to Losanoff et al.

Replying to a letter by Losanoff et al.peer-reviewe

Rapid fabrication of annuloplasty rings by electron beam melting

Electron Beam Melting (EBM) is an Additive Manufacturing (AM) technology capable of producing intricate parts by melting powder metal with the aid of an electron beam gun. EBM has facilitated the production of standard and customisable implants. Customizable implants such as orthopaedic implants, cranial implants and dental implants have already been developed and implanted successfully after being fabricated by AM technology. Other medical devices can also benefit from the possibilities offered by AM. An example of such a medical device would be the annuloplasty ring. Standard annuloplasty rings are implanted whenever a patient is diagnosed with mitral valve regurgitation. This problem arises when the mitral valve does not close properly, causing back leakage through the closed valve resulting in blood flowing to the atrium instead of the aorta during systole. The latest designs of annuloplasty rings allow restoration of the mitral annulus configuration to a saddle-shaped shape.peer-reviewe

Rediscovery of Ornithagalum divergens Boreau (Hyacinthaceae) in Malta (Supplement)

Due to a fortuitous omission, the last few references in the article "Rediscovery of Ornithogalum divergens Boreau (Hyacinthaceae) in Malta" (CMN, Volume 4 Part 3, pp 205-206) were not included. The same references are hereby included as a supplement:peer-reviewe

Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. Conclusion: Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours. © 2017, © The Author(s) 2017