‘The Resus doll Is dead, what now?’ end-of-life care teaching and simulation: a literature review

Background: Simulation & high-fidelity simulation involves using manikins, clinical training suites, wards, computer programs and theatres in medical teaching. These teaching formats have established themselves in medical undergraduate and postgraduate education. Rated highly among students, they have also been shown to be effective learning tools. Aims: To reduce the potential risk to patients and their proxy associated with learning ‘at the bedside’, which can pose a challenge in medical and in particular palliative settings. Education and training methods that do not expose patients to preventable communication blunders from less experienced practitioners are a priority. Simulation and high-fidelity simulation provides a way for students and doctors to train safely, before entering real-life scenarios. Methods: We provide a summary review on the current literature and evidence for simulation and high-fidelity simulation in palliative and end-of-life care settings, and discuss potential uses of technologies including virtual and augmented reality in future training. Results: The most common form of simulation in palliative medicine is often an actor-based role-play scenario with particular emphasis on communication skills. This is expensive and time-consuming to set up. Less evidence was found on the use of high-fidelity simulation in end-of-life care teaching. Conclusion: Palliative medicine has been slow to adapt to an educational method and environment that now is widely used across other areas of healthcare. There has been less emphasis on training with manikins and even less on using computer simulation and virtual reality environments to recreate challenging end-of-life care scenarios. We provide some examples of where this could benefit the curriculum

What is the evidence base for early palliative care integrated with acute oncology services in terms of oncology patient reported experience and outcomes, quality of life, and cost effectiveness? A rapid review

Many acute hospital settings include both ‘Acute Oncology Services’ (AOS) and Specialist Palliative Care (SPCT) liaison teams that contribute to the management of complex cancer patients. Acute oncology services tend to provide advice on management of cancer related issues including oncological emergencies, streamlined access to site specific oncology teams or the patient’s own oncologist, and specialist oncology services like emergency radiotherapy (National Chemo-therapy Advisory Group 2009). The role of the SPCT is broad and includes advice on management of symptoms, emotional support for patients and their families, complementary therapies, assistance with discharge planning for last days of life and for complex commu-nication. Within these roles there is sometimes crossover requiring the teams to work together closely alerting each other to patients who may benefit from the other’s specialism. There is reported evidence that meeting a specialist palliative care team early in the patient’s oncological journey can improve several outcomes including symptom severity, quality of life (Zimmermann et al. 2014) and mood (Temel et al. 2010) compared to standard oncological care (Zimmermann et al. 2014, Greer et al. 2013). The aim of this rapid review was to look at models where acute oncology and specialist palliative care teams worked together when a patient was admitted acutely to hospital to see if this combined approach improved patient outcomes. In the review itself, given the recent emergence of AOS, we didn’t find evidence for specific integration of AOS and SPCT models. There was evidence for the impact of palliative care intervention for oncology patients when admitted to acute sector

Sessile and mobile components of a benthic ecosystem display mixed trends within a temperate marine reserve

Despite recent efforts to increase the global coverage of marine protected areas (MPAs), studies investigating the effectiveness of marine protected areas within temperate waters remain scarce. Furthermore, out of the few studies published on MPAs in temperate waters, the majority focus on specific ecological or fishery components rather than investigating the ecosystem as a whole. This study therefore investigated both the dynamics of benthic communities as well as fish populations within a recently established, fully protected marine reserve in Lamlash Bay, Isle of Arran, United Kingdom, over a four year period. A combination of photo and diver surveys revealed live maerl (Phymatolithon calcareum), macroalgae, sponges, hydroids, feather stars and eyelash worms (Myxicola infundibulum) to be significantly more abundant within the marine reserve than on surrounding fishing grounds. Likewise, the overall composition of epifaunal communities in and outside the reserve was significantly different. Both results are consistent with the hypothesis that protecting areas from fishing can encourage seafloor habitats to recover. In addition, the greater abundance of complex habitats within the reserve appeared to providing nursery habitat for juvenile cod (Gadus morhua) and scallops (Pecten maximus and Aequipecten opercularis). In contrast, there was little difference in the abundance of mobile benthic fauna, such as crabs and starfish, between the reserve and outside. Similarly, the use of baited underwater video cameras revealed no difference in the abundance and size of fish between the reserve and outside. Limited recovery of these ecosystem components may be due to the relatively small size (2.67 km2) and young age of the reserve (< 5 years), both of which might have limited the extent of any benefits afforded to mobile fauna and fish communities. Overall, this study provides evidence that fully protected marine reserves can encourage seafloor habitats to recover, which in turn, can create a number of benefits that flow back to other species, including those of commercial importance

Pregnancy in teenagers diagnosed with type 1 diabetes mellitus in childhood: a national population-based e-cohort study

The aim of this study was to describe the characteristics and outcomes of pregnancies in a national cohort of teenage (<20 years) and young adult women (≥20 years) with and without childhood-onset (<15 years) type 1 diabetes. We hypothesised that, owing to poor glycaemic control during the teenage years, pregnancy outcomes would be poorer in teenage mothers with type 1 diabetes than young adult mothers with type 1 diabetes and mothers without diabetes

Results From Wales’ 2018 Report Card on Physical Activity for Children and Youth

This is the third Active Healthy Kids Wales (AHK-Wales) Report Card following the inaugural and second report card published in 2014 and 2016 respectively.1,2 The 2018 report card (Figure 1) consolidates and translates research related to physical activity among children and young people in Wales. The report card aimed to raise the awareness of children and young people’s engagement in physical activity behaviours and influences, and advocate for children’s right to be active and healthy

A multi-disciplinary commentary on preclinical research to investigate vascular contributions to dementia

Although dementia research has been dominated by Alzheimer's disease (AD), most dementia in older people is now recognised to be due to mixed pathologies, usually combining vascular and AD brain pathology. Vascular cognitive impairment (VCI), which encompasses vascular dementia (VaD) is the second most common type of dementia. Models of VCI have been delayed by limited understanding of the underlying aetiology and pathogenesis. This review by a multidisciplinary, diverse (in terms of sex, geography and career stage), cross-institute team provides a perspective on limitations to current VCI models and recommendations for improving translation and reproducibility. We discuss reproducibility, clinical features of VCI and corresponding assessments in models, human pathology, bioinformatics approaches, and data sharing. We offer recommendations for future research, particularly focusing on small vessel disease as a main underpinning disorder

A Multi-disciplinary Commentary on Preclinical Research to investigate Vascular Contributions to Dementia

Although dementia research has been dominated by Alzheimer's disease (AD), most dementia in older people is now recognised to be due to mixed pathologies, usually combining vascular and AD brain pathology. Vascular cognitive impairment (VCI), which encompasses vascular dementia (VaD) is the second most common type of dementia. Models of VCI have been delayed by limited understanding of the underlying aetiology and pathogenesis. This review by a multidisciplinary, diverse (in terms of sex, geography and career stage), cross-institute team provides a perspective on limitations to current VCI models and recommendations for improving translation and reproducibility. We discuss reproducibility, clinical features of VCI and corresponding assessments in models, human pathology, bioinformatics approaches, and data sharing. We offer recommendations for future research, particularly focusing on small vessel disease as a main underpinning disorder.</p

State of the science: the doll is dead: simulation in palliative care education

Objectives Both simulation and high-fidelity simulation involving manikins, clinical training suites, wards, computer programs and theatres have established themselves in medical undergraduate and postgraduate education. Popular among students, they have been shown to be effective learning tools. Contrasted with this is the potential risk to patients and their proxy associated with learning ‘at the bedside’, which can pose a real challenge in medical and palliative settings. The need for education and training methods that do not expose the patient to preventable communication blunders from less experienced practitioners is a priority. Methods Here, we provide a summary review on the current literature and evidence for simulation and high-fidelity simulation in palliative and end-of-life care settings, and discuss potential uses of technologies including virtual and augmented reality in future training. Results The most common form of simulation in palliative medicine is often an actor-based role-play scenario with particular emphasis on communication skills. This is expensive and time-consuming to set up. Less evidence was found on the use of high-fidelity simulation in end-of-life care teaching. Conclusion Palliative medicine has been slow to adapt to an educational method and environment that now is widely used across other areas of healthcare. There has been less emphasis on training with manikins and even less on using computer simulation and virtual reality environments to recreate challenging end-of-life care scenarios. We provide some examples of where this could benefit the curriculum