Analysis of Digital Media: Supporting University-Wide Online Learning via Moodle

This report aims to provide an overview of a project which explores teaching and learning within a blended mode of study. Specifically, it looks to analyse the production of digital media and online social networking with a view to enhancing the learning experience. It was the overall aim of the project to contribute to the University’s Learning and Teaching Strategy by developing media content; exploring the production process, analyse digital participation and explore the challenges and opportunities locally within schools. The project has placed emphasis on the production principles which enhance our online courses whilst providing a consistent quality of experience – recognising that our students often access course material produced by staff from across schools and colleges

Prehospital management of suspected seizures: cross-sectional study in a regional ambulance service

Introduction, Suspected convulsions and seizures are a common reason for emergency calls to ambulance services. Pre-hospital care is a key element of good quality care for these patients and it is a key determinant of downstream health service activity but there is very little research in this area. Epilepsy is an ambulatory care sensitive condition (ACSC) and the incidence of convulsions and seizures is an important indicator of failed scheduled care. The prevalence of active epilepsy in the UK is 1% and 20-30% of people with epilepsy have more than one seizure per month. Convulsions and seizures result in a large number of emergency calls to ambulance services, the majority of these patients are conveyed to emergency departments (ED), which accounts for much of the health costs of uncontrolled epilepsy. Methods, We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with suspected convulsions and seizures over a one year period (August 2011 to July 2012) extracted from a single regional ambulance service (EMAS). Our aims were firstly to generate descriptive statistics (including incidence) for patients over the age of 18 years treated by EMAS for seizures over a period of a year, and secondly to use regression analysis to identify predictors of transport to hospital in this sample. Results & Conclusion There were 6208 patients with chief complaint recorded as suspected convulsions and seizures (suspected Epileptics). There were 3218 (54.4%) male epileptics and 2697 (45.6%) female epileptics. Suspected epileptics are the sixth most common reason for emergency calls to the East Midlands Ambulance Service

Analysis of Digital Media: Supporting University-Wide Online Learning via Moodle

This report aims to provide an overview of a project which explores teaching and learning within a blended mode of study. Specifically, it looks to analyse the production of digital media and online social networking with a view to enhancing the learning experience. It was the overall aim of the project to contribute to the University’s Learning and Teaching Strategy by developing media content; exploring the production process, analyse digital participation and explore the challenges and opportunities locally within schools. The project has placed emphasis on the production principles which enhance our online courses whilst providing a consistent quality of experience – recognising that our students often access course material produced by staff from across schools and colleges

Exploratory cross-sectional study of factors associated with transport to hospital in patients with suspected convulsions presenting to ambulance services

Introduction Suspected convulsions are a common reason for emergency calls to ambulance services. Prehospital care is a key element of good quality care for these patients and is a key determinant of downstream health service activity but there has been little previous research in this area. Convulsions result in a large number of emergency calls to ambulance services; the majority of these patients are conveyed to emergency departments (ED), which accounts for most of the health service costs for this condition. Methods We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with suspected convulsions over a one year period. Our aims were firstly to generate descriptive statistics (including incidence) for patients over the age of 18 years treated by East Midlands Ambulance Service NHS Trust (EMAS) for convulsions over a period of a year, and secondly to use regression analysis to identify predictors of transport to hospital in this sample. Results & Conclusion There were 6208 patients with chief complaint recorded as suspected convulsion of which 3218 (54.4%) were men and 2697 (45.6%) women. Suspected convulsions are the sixth commonest reason for emergency calls to EMAS. Results of the regression analysis of predictors of transport are presented

Non-epileptic attack disorder: the importance of diagnosis and treatment

A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so she was referred to a tertiary centre where she underwent video EEG and was diagnosed with non-epileptic attack disorder. Her experience of the diagnosis was positive; it allowed her to understand what was happening to her and to understand the link between her seizures, adverse childhood experiences and the death of her mother. She stopped taking AEDs and she was referred to a psychologist which led to a significant improvement in her functioning and quality of life. We present this case as a good example of the benefits of accurate diagnosis, clear explanation and access to specialist car

'I just need to know what they are and if you can help me': Medicalization and the search for legitimacy in people diagnosed with non-epileptic attack disorder

This paper focuses on the struggles for legitimacy expressed by people with non-epileptic attack disorder (NEAD), one of the most common manifestations of functional neurological disorder presenting to emergency and secondary care services. Nonepileptic attacks are episodes of altered experience, awareness, and reduced self-control that superficially resemble epileptic seizures or other paroxysmal disorders but are not associated with physiological abnormalities sufficient to explain the semiological features. "Organic" or medicalized explanations are frequently sought by patients as the only legitimate explanation for symptoms, and consequently, a diagnosis of NEAD is often contested. Drawing on narrative interviews with patients from a small exploratory study and using a sociological perspective, we propose that a psychological account of NEAD does not provide a sufficiently legitimate path into a socially sanctioned sick role. This is a reflection of the dominance of biomedicine and the associated processes of medicalization. These processes are, we argue, the sole route to achieving legitimacy. The stress-based or psychologically oriented explanations offered to patients in contemporary medical models of the etiology of NEAD engender an uncertain identity and social position and fail to provide many patients with an account of the nature or origin of their symptoms that they find satisfactory or convincing. These struggles for legitimacy (shared by others with functional or somatoform conditions) are sharpened by key features of the contemporary healthcare landscape, such as the increasing framing of health through a lens of 'responsibilization'. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Who lives in a pear tree under the sea? A first look at tree reefs as a complex natural biodegradable structure to enhance biodiversity in marine systems

Hard substrates play an important role in global marine systems as settlement surface for sessile reef-forming species such as corals, seaweeds, and shellfish. In soft-sediment systems, natural hard substrates such as stones, bedrock and driftwood are essential as they support diverse assemblages of reef-associated species. However, availability of these hard substrates has been declining in many estuaries and shallow seas worldwide due to human impacts. This is also the case in the Dutch Wadden Sea, where natural hard substrates have gradually disappeared due to burial by sand and/or active removal by humans. In addition, driftwood that was historically imported from rivers has been nullified by upstream logging and coastal damming of estuaries. To investigate the historic ecological role of wood presence in the Wadden Sea as settlement substrate and fish habitat, we constructed three meter high artificial reefs made of felled pear trees. Results demonstrate that these reefs rapidly developed into hotspots of biodiversity. Within six months, the tree-reefs were colonized by sessile hard substrate associated species, with a clear vertical zonation of the settled species. Macroalgae and barnacles were more abundant on the lower parts of the reef, while bryozoans were more dominant on the upper branches. In addition, six fish species were observed on the reefs, while only two species were caught on sandy control sites. Moreover, the abundance of fish on the reefs was five times higher. Individuals of the most commonly caught species, the five-bearded rockling Ciliata mustela, were also larger on the reef. These patterns also hold true for common prawn, Palaemon serratus, which were also larger and ten times more numerous on the reefs. Present findings indicate that the reintroduction of tree-reefs as biodegradable, structurally complex hard substrates can increase local marine biodiversity in soft-sediment systems within relatively short time scales.</p

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: vignette study

Background Home self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor. Aim To elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas. Design & setting A qualitative focus group study was conducted with a total of 21 primary care professionals. Method Participants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed. Results Themes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors. Conclusion The work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done

Which factors are associated with hospitalisation in people presenting with convulsions to ambulance services? Cross sectional study using ambulance and hospital linked data

Introduction Patients with suspected seizure result in a large number of emergency calls to ambulance services: around 3% of all calls to EMAS are due to patients with seizure which makes this the sixth highest volume single issue call to the service. Some of these patients are conveyed to the emergency department (ED) which accounts for most of the health costs. Aims We aimed to investigate which factors are associated with hospitalisation in this patient group. Method We used a cross sectional design linking ambulance dispatch and clinical data with hospital Emergency Department and inpatient data from July 2016 to June 2017. Inclusion criterion: Adults aged 16 years or over with ambulance records including the terms ‘convulsion’ or ’fitting and hospital records confirming the diagnosis of convulsion. Descriptive statistics: Ambulance service process data, ambulance response times, demographic data and clinical (physiological) findings summarised as NEWS2 (incorporating respiratory rate, oxygen saturation, systolic blood pressure, pulse rate, conscious level and temperature) and treatments. Statistical Models: We used logistic regression to construct models showing predictors of admission to hospital or intensive care unit (ICU). Findings 517 adult patients aged 16+ years had a hospital diagnosis of seizure, with 42.8% (221/517) admitted, 24 of which were to the ICU. Most patients with convulsions were therefore not hospitalised. Male patients were more likely to be admitted and older patients with greater physiological disturbance were more likely to receive intensive care. Regression model results The regression model suggests, older patients aged 65+ years were more likely to be admitted (OR 12.4, 95% CI 5.7 - 26.6, p<0.01) compared with younger patients aged 16-25 years male patients (OR 1.9, 95%CI 1.3 - 2.9, p<0.01) compared with females and those with NEWS2 of 3 vs zero (OR 2.1, 95%CI 1.2 - 3.5, p<0.01) were more likely to be admitted. Older patients aged 65 years+ (OR 10.4, 95% CI 1.8 - 60.7, P<0.01) compared with those aged 16-25 years and those with NEWS2 score 3 vs zero (OR 8.2, 95%CI 2.5 - 27.4, P<0.01) were more likely to be admitted to intensive care. Limitations Use of electronic clinical records varied at EMAS and this was a potential source of bias in the data. Prehospital datasets linked with Hospital Episode Statistics may not capture all the patients due to matching errors or duplicates, requiring visual inspection of the data. Acknowledgements We thank East Midlands Ambulance and Nottingham University Hospitals NHS Trusts for providing the data