Development of a programme to facilitate interprofessional simulation-based training for final year undergraduate healthcare students

Original report can be found at: http://www.health.heacademy.ac.uk/publications/miniproject/alinier260109.pdfIntroduction: Students have few opportunities to practise alongside students from other disciplines. Simulation offers an ideal context to provide them with concrete experience in a safe and controlled environment. This project was about the development of a programme to facilitate interprofessional scenario-based simulation training for final year undergraduate healthcare students and explored whether simulation improved trainees’ knowledge of other healthcare discipline’s roles and skills. Methods: A multidisciplinary academic project team was created and trained for the development and facilitation of this project. The team worked on the development of appropriate multiprofessional scenarios and a strategy to recruit the final year students on a volunteer basis to the project. By the end of the project 95 students were involved in small groups to one of fifteen 3-hour interprofessional simulation sessions. Staff role played the relatives, doctor on call, and patient when it was more appropriate than using a patient simulator (Laerdal SimMan/SimBaby) in the simulated community setting and paediatric or adult emergency department. Each session had 3 to 4 of the following disciplines represented (Adult/Children/Learning Disability Nursing, Paramedic, Radiography, Physiotherapy) and each student observed and took part in one long and relevant high-fidelity scenario. Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (control group) and the others after (experimental group). Students were assessed on the questions relating to the disciplines represented in their session. Results: By the end of the project 95 questionnaires were collected of which 45 were control group students (Questionnaire before simulation) and 50 experimental group students (Questionnaire after simulation). Both groups were comparable in terms of gender, discipline and age representation. Participants were: Adult nurses (n=46), Children’s nurses (n=4), Learning Disability nurses (n=7), Nurses, Paramedics (n=8), Radiographers (n=20), Physiotherapists (n=8). 15 sessions were run with an average of around 7 participants and at least 3 disciplines represented. The knowledge test results about the disciplines represented was significantly different between the control and experimental groups (Control 73.80%, 95% CI 70.95-76.65; and Experimental 78.81%, 95% CI 75.76-81.87, p=0.02). In addition, there were sometimes reliable differences between the groups in their view of multidisciplinary training; confidence about working as part of a multidisciplinary team was 3.33 (SD=0.80, Control) and 3.79 (SD=0.90, Experimental), p=0.011; their anticipation that working as part of a multidisciplinary team would make them feel anxious was 2.67 (SD=1.17, Control) and 2.25 (SD=1.04, Experimental), p=0.073; their perception of their knowledge of what other healthcare professionals can or cannot do was 3.00 (SD=0.91, Control) and 3.35 (SD=0.93, Experimental), p=0.066; their view that learning with other healthcare students before qualification will improve their relationship after qualification was 3.93 (SD=1.14, Control) and 4.33 (SD=0.81, Experimental), p=0.055; their opinion about interprofessional learning helping them to become better team workers before qualification was 3.96 (SD=1.24, Control) and 4.42 (SD=0.77, Experimental), p=0.036. Conclusions: Although the difference is relatively small (~5%), the results demonstrate that students gained confidence and knowledge about the skills and role of other disciplines involved in their session. Through simulation, the positivism of students about different aspects of learning or working with other healthcare disciplines has significantly improved. Students gained knowledge of other disciplines simply by being given the opportunity to take part in a multiprofessional scenario and observe another one. The results of the test and their reported perception about multidisciplinary team working suggest that they are better prepared to enter the healthcare workforce. Discussions during the debriefings highlighted the fact that multidisciplinary training is important. The main challenges identified have been the voluntary student attendance and timetabling issues forcing us to run the session late in the day due to the number of disciplines involved in each session and their different placement rota. The aim is now to timetable formally this session within their curriculum. Introducing simulation in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals

Oscillation-free method for semilinear diffusion equations under noisy initial conditions

Noise in initial conditions from measurement errors can create unwanted oscillations which propagate in numerical solutions. We present a technique of prohibiting such oscillation errors when solving initial-boundary-value problems of semilinear diffusion equations. Symmetric Strang splitting is applied to the equation for solving the linear diffusion and nonlinear remainder separately. An oscillation-free scheme is developed for overcoming any oscillatory behavior when numerically solving the linear diffusion portion. To demonstrate the ills of stable oscillations, we compare our method using a weighted implicit Euler scheme to the Crank-Nicolson method. The oscillation-free feature and stability of our method are analyzed through a local linearization. The accuracy of our oscillation-free method is proved and its usefulness is further verified through solving a Fisher-type equation where oscillation-free solutions are successfully produced in spite of random errors in the initial conditions.Comment: 19 pages, 9 figure

Confirmatory factor analysis of the Test of Performance Strategies (TOPS) among adolescent athletes

The aim of the present study was to examine the factorial validity of the Test of Performance Strategies (TOPS; Thomas et al., 1999) among adolescent athletes using confirmatory factor analysis. The TOPS was designed to assess eight psychological strategies used in competition (i.e. activation, automaticity, emotional control, goal-setting, imagery, negative thinking, relaxation and self-talk,) and eight used in practice (the same strategies except negative thinking is replaced by attentional control). National-level athletes (n = 584) completed the 64-item TOPS during training camps. Fit indices provided partial support for the overall measurement model for the competition items (robust comparative fit index = 0.92, Tucker-Lewis index = 0.88, root mean square error of approximation = 0.05) but minimal support for the training items (robust comparative fit index = 0.86, Tucker-Lewis index = 0.81, root mean square error of approximation = 0.06). For the competition items, the automaticity, goal-setting, relaxation and self-talk scales showed good fit, whereas the activation, emotional control, imagery and negative thinking scales did not. For the practice items, the attentional control, emotional control, goal-setting, imagery and self-talk scales showed good fit, whereas the activation, automaticity and relaxation scales did not. Overall, it appears that the factorial validity of the TOPS for use with adolescents is questionable at present and further development is required

Geology of the Lower Paleozoic Rocks in the Boundary Mountain Anticlinorium

Guidebook for field trips in the Rangeley Lakes - Dead River Basin region, western Maine: 62nd annual meeting October 2, 3, and 4, 1970: Trip A-

EOS MLS observations of dehydration in the 2004-2005 polar winters

We prove various estimates for the first eigenvalue of the magnetic Dirichlet Laplacian on a bounded domain in two dimensions. When the magnetic field is constant, we give lower and upper bounds in terms of geometric quantities of the domain. We furthermore prove a lower bound for the first magnetic Neumann eigenvalue in the case of constant field.Comment: 19 page

What do young athletes implicitly understand about psychological skills?

One reason sport psychologists teach psychological skills is to enhance performance in sport; but the value of psychological skills for young athletes is questionable because of the qualitative and quantitative differences between children and adults in their understanding of abstract concepts such as mental skills. To teach these skills effectively to young athletes, sport psychologists need to appreciate what young athletes implicitly understand about such skills because maturational (e.g., cognitive, social) and environmental (e.g., coaches) factors can influence the progressive development of children and youth. In the present qualitative study, we explored young athletes’ (aged 10–15 years) understanding of four basic psychological skills: goal setting, mental imagery, self-talk, and relaxation. Young athletes (n = 118: 75 males and 43 females) completed an open-ended questionnaire to report their understanding of these four basic psychological skills. Compared with the older youth athletes, the younger youth athletes were less able to explain the meaning of each psychological skill. Goal setting and mental imagery were better understood than self-talk and relaxation. Based on these findings, sport psychologists should consider adapting interventions and psychoeducational programs to match young athletes’ age and developmental level

Post-translocational folding of secretory proteins in Gram-positive bacteria

AbstractThe transport of proteins from their site of synthesis in the cytoplasm to their functional location is an essential characteristic of all living cells. In Gram-positive bacteria the majority of proteins that are translocated across the cytoplasmic membrane are delivered to the membrane–cell wall interface in an essentially unfolded form. They must then be folded into their native configuration in an environment that is dominated by a high density of immobilised negative charge—in essence an ion exchange resin. It is essential to the viability of the cell that these proteins do not block the translocation machinery in the membrane, form illegitimate interactions with the cell wall or, through intermolecular interactions, form insoluble aggregates. Native Gram-positive proteins therefore have intrinsic folding characteristics that facilitate their rapid folding, and this is assisted by a variety of folding factors, including enzymes, peptides and metal ions. Despite these intrinsic and extrinsic factors, secretory proteins do misfold, particularly if the cell is subjected to certain types of stress. Consequently, Gram-positive bacteria such as Bacillus subtilis encode membrane- and cell wall-associated proteases that act as a quality control machine, clearing misfolded or otherwise aberrant proteins from the translocase and the cell wall

Medication decision-making and adherence in lupus: patient–physician discordance and the impact of previous ‘adverse medical experiences’

OBJECTIVES: Medication adherence is critical in the successful management of lupus. There is very limited existing literature on reasons why non-adherence is not reported. This study explores the impact of current and previous medical experiences on patient satisfaction, adherence and reporting of non-adherence. METHODS: Mixed methodology involved thematic analysis of in-depth interviews (N = 23) to further explore the statistically analysed quantitative survey findings (N = 186). RESULTS: This study identified five themes: 1) physician-patient discordance and a 'hierarchy of evidence' in medication decisions, 2) the association of adherence with satisfaction with care, 3) the persisting impact of past Adverse Medical Experiences (AMEs), 4) the dynamic balance of patient-physician control, and 5) holistic care - beyond a purely medication- based focus. Improving quality of life (43% of participants) and a supportive medical relationship (24%) were the main reasons for adherence. Patient-priorities and self-reported symptoms were perceived as less important to physicians than organ-protection and blood results. Non-reporters of non-adherence, non-adherers and those with past AMEs (e.g. psychosomatic misdiagnoses) had statistically significant lower satisfaction with care. The importance of listening to patients was a key component of every theme, and associated with patient satisfaction and adherence. The mean rating for rheumatologist's listening skills was 2.88 for non-adherers compared to 3.53 for other participants (mean difference 0.65, P = 0.003). CONCLUSION: Patients would like more weight and discussion given to self-reported symptoms and quality of life in medication decisions. Greater understanding and interventions are required to alleviate the persisting impact of past AMEs on some patients' wellbeing, behaviour and current medical relationships