Developing a simulation safety policy for translational simulation programs in healthcare

Healthcare simulation may present risks to safety, especially when delivered ‘in situ’—in real clinical environments—when lines between simulated and real practice may be blurred. We felt compelled to develop a simulation safety policy (SSP) after reading reports of adverse events in the healthcare simulation literature, editorials highlighting these safety risks, and reflecting on our own experience as a busy translational simulation service in a large healthcare institution. The process for development of a comprehensive SSP for translational simulation programs is unclear. Personal correspondence with leaders of simulation programs like our own revealed a piecemeal approach in most institutions. In this article, we describe the process we used to develop the simulation safety policy at our health service, and crystalize principles that may provide guidance to simulation programs with similar challenges. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41077-022-00200-9

Development and evaluation of a sustainable intervention programme

This thesis is comprised of three chapters that explore the process of instituting a new service or programme. Analysis of Thinking Skills Training Programmes Among Adults With Learning Disabilities: Qualitative Review of Relevant Literature. A literature review evaluating existing literature on rehabilitation programmes for individuals with learning disabilities. The review followed the guidelines set forth by COCHRANE and PRISMA (Higgins, 2008 & Moher, Liberati, Tetzlaff & Altman, 2009). Positive Parenting Programme (Triple P) for Parents of Children with Autism Spectrum Disorder (ASD): Programme Evaluation. An evaluation of the Stepping Stones Positive Parenting Programme (Triple P), provided through an independent organization as part of its NHS autism contract. This project evaluated the effectiveness of the programme based on pre and post measures collected over four years. Thematic Analysis of Stakeholders’ Hopes, Fears and Expectations for a Peer-Mentoring Programme. The final chapter was part of a larger programme evaluation which will continue through the coming year. The project evaluates the effectiveness of a newly developed and implemented peer-mentoring programme. This section focused on the initial hopes, fears and expectations for the programme by stakeholders. This evaluation entailed conducting interviews with stakeholders and performing a qualitative evaluation using Thematic Analysis (TA)

Role of diagnostic stewardship in reducing healthcare-facility-onset Clostridioides difficile infections

We describe the implementation of an electronic medical record hard stop to decrease inappropriate Clostridioides difficile testing across a 5-hospital health system, effectively reducing the rates of healthcare-facility-onset C. difficile infection. This novel approach included expert consultation with medical director of infection prevention and control for test-order override

Sub-percent Photometry: Faint DA White Dwarf Spectophotometric Standards for Astrophysical Observatories

We have established a network of 19 faint (16.5 mag $< V <$19 mag) northern and equatorial DA white dwarfs as spectrophotometric standards for present and future wide-field observatories. Our analysis infers SED models for the stars that are tied to the three CALSPEC primary standards. Our SED models are consistent with panchromatic Hubble Space Telescope ($HST$) photometry to better than 1%. The excellent agreement between observations and models validates the use of non-local-thermodynamic-equilibrium (NLTE) DA white dwarf atmospheres extinguished by interstellar dust as accurate spectrophotometric references. Our standards are accessible from both hemispheres and suitable for ground and space-based observatories covering the ultraviolet to the near infrared. The high-precision of these faint sources make our network of standards ideally suited for any experiment that has very stringent requirements on flux calibration, such as studies of dark energy using the Large Synoptic Survey Telescope (LSST) and the Wide-Field Infrared Survey Telescope ($WFIRST$).Comment: 46 pages, 23 figures, 8 tables, accepted for publication in ApJ

Perfecting our set of spectrophotometric standard DA white dwarfs

We verified for photometric stability a set of DA white dwarfs with Hubble Space Telescope magnitudes from thenear-ultraviolet to the near-infrared and ground-based spectroscopy by using time-spaced observations from theLas Cumbres Observatory network of telescopes. The initial list of 38 stars was whittled to 32final ones, whichcomprise a high-quality set of spectrophotometric standards. These stars are homogeneously distributed around thesky and are all fainter thanr~16.5 mag. Their distribution is such that at least two of them would be available tobe observed from any observatory on the ground at any time at airmass less than 2. Light curves and differentvariability indices from the Las Cumbres Observatory data were used to determine the stability of the candidatestandards. When available, Pan-STARRS1, Zwicky Transient Facility, and TESS data were also used to confirmthe star classification. Our analysis showed that four DA white dwarfs may exhibit evidence of photometricvariability, while afifth is cooler than our established lower temperature limit, and a sixth star might be a binary. Insome instances, due to the presence of faint nearby red sources, care should be used when observing a few of thespectrophotometric standards with ground-based telescopes. Light curves andfinding charts for all the stars areprovided.This study was supportedby NASA through grant O1904 from the Space TelescopeScience Institute, which is operated by AURA, Inc., underNASA contract NAS 5-26555 and the Space Telescope ScienceInstitute. The analysis was also supported by the DDRF grantD0001.82481. E.O. was also partially supported by the NSFthrough grant AST-1815767. R.R. received funding from thepostdoctoral fellowship program Beatriu de Pinós, funded bythe Secretary of Universities and Research(Government ofCatalonia)and by the Horizon 2020 program of research andinnovation of the European Union under the Maria Skło-dowska-Curie grant agreement No. 801370. C.S. is supportedby the US DOE through award DE-SC0007881. This work hasmade use of data from the European Space Agency(ESA)mission Gaia(https://www.cosmos.esa.int/gaia), processedby the Gaia Data Processing and Analysis Consortium(DPAC;https://www.cosmos.esa.int/web/gaia/dpac/consortium).Funding for the DPAC has been provided by nationalinstitutions, in particular the institutions participating in theGaia Multilateral Agreement. This publication makes use ofVOSA, developed under the Spanish Virtual Observatoryproject supported by the Spanish MINECO through grantAyA2017-84089. VOSA has been partially updated by usingfunding from the European Union’s Horizon 2020 Research andInnovation Programme, under grant Agreement No. 776403(EXOPLANETS-A). This work includes data from the AsteroidTerrestrial-impact Last Alert System(ATLAS)project. ATLAS isprimarily funded to search for near-earth asteroids through NASAgrants NN12AR55G, 80NSSC18K0284, and 80NSSC18K1575;byproducts of the NEO search include images and catalogs fromthe survey area. The ATLAS science products have been madepossible through the contributions of the University of HawaiiInstitute for Astronomy, the Queen’s University Belfast, the SpaceTelescope Science Institute, and the South African AstronomicalObservatory. G.N. and K.M. gratefully acknowledge support fromNASA under grant 80NSSC20K0453 issued through theNNH18ZDA001N Astrophysics Data Analysis Program(ADAP).Facilities:LCO, HST(WFC3), Gaia, ATLAS, TESS,Pan-STARRS, ZTFPeer ReviewedPostprint (published version

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Background Dementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital. Objectives (1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial. Methods (1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing. Results (1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia. Limitations Given constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation. Future research To improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed. Conclusion There is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world. Trial registrations Current Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT). Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information