OSCE best practice guidelines—applicability for nursing simulations

Background: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. Methods: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.Results: Few changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. Discussion: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. Conclusions: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role

OSCE Best Practice Guidelines – applicability for nursing simulations

Background: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. Methods: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.Results: Few changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. Discussion: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. Conclusions: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role

Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review which identified cancer survivors’ needs, including barriers and facilitators to intervention success. Review evidence (N=49 papers) informed the intervention’s Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N=96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N=31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions

Year-to-year variation in larval fish assemblages of the Southern North Sea

In order to test the temporal stability within and the reproducibility of larval fish assemblages between years, the larval fish assemblage at Helgoland Roads, North Sea (NE Atlantic) was quantitatively sampled almost daily from January 2003 to December 2005. The survey resulted in a total of 462 samples containing 50,632 larval fish of at least 42 taxa. In winter the larval fish assemblage was mainly dominated by larvae emerging from demersal eggs. This changed gradually to larvae hatching from pelagic eggs. Larvae from pelagic eggs dominated the ichthyoplankton assemblage in summer. A remarkably stable seasonality in terms of dominance patterns with recurring, season-specific fish assemblages was observed over the three years, despite substantial variation in environmental conditions such as a temperature difference of almost 20°C between summer and winter. The lesser sandeel (Ammodytes marinus), was the only species which showed significant fluctuations in abundance between the years. After removal of this species from the analysis, the dominance patterns of the remaining fish species were almost identical between years

Bisphosphonate Derivatives of 2’-C-Methyl-, and 3’-C-Methyl-Adenosine as Ligands at P2Y1 and P2Y2 Receptors

The P2 purinergic receptors are a major class of receptors in the human body activated by nucleotides, such as ATP, ADP, UTP or UDP. They are subdivided into G protein-coupled or metabotropic P2 receptors (GPCRs), designated P2Y, and ligand-gated ion channels or ionotropic receptors, termed P2X. Both families constitute important drug targets due to their involvement in the modulation of various functions in many tissues and organs under both normal and pathophysiological conditions. The P2Y receptors are expressed in most human tissues including the heart, placenta, vascular endothelia, prostate, ovary, platelets and brain (1). Until recently, the only P2Y receptor ligands in pharmaceutical use are the antithrombotic P2Y12 receptor antagonists Clopidogrel, Ticagrelor, Ticlopidine and Prasugrel. Therefore, there is a growing effort to identify new agents to act at the P2Y receptors for pharmaceutical development. Recently, we have synthesized the 2’- and 3’-C-methyl derivatives of ADP and evaluated their capacity to promote hP2Y1 and hP2Y2 receptor-mediated activation of phospholipase C (PLC) at recombinant human receptors expressed in atrocytoma cells. From the functional assay 2’-C-methyl-ADP resulted a full agonist at P2Y1 receptor, while 3’-C-methyl-ADP acted as partial agonist at P2Y2 receptor. The interesting biological activity of these compounds is limited by the presence of the pyrophosphate bridge in the structure, which is highly sensitive to both enzymatic and chemical hydrolysis. It is thus of outmost interest to prepare stable analogues of these nucleotides. Hence, bisphosphonate derivatives of 2’-C-methyl- and 3’-C-methyl-adenosine were synthesized and tested at hP2Y1 and hP2Y2 receptors. The results of the functional assay will be discussed

ADP- and ATP-mimetics derived from 2'(3')-C-methyladenosine as human P2Y1 and P2Y2 receptor ligands

Nucleotides and their hydrolytic products act through specific nucleotide receptors which are divided in: ionotropic P2X and metabotropic P2Y receptors coupled to G proteins. The P2Y receptor family consists of at least eight human subtypes (P2Y1,2,4,6,11-14), that are activated by either or both adenine and uracil nucleotides [1]. Activation of P2Y receptors generally results in the stimulation of phospholipase C (PLC), which generates inositol phosphates and diacylglycerol from phosphatidyl inositol(4,5)bisphosphate, leading to the rise in intracellular calcium and activation of protein kinase C. According to a dendrogram relating sequence homology, the P2Y1, P2Y2, P2Y4, P2Y6, and P2Y11 receptors form a cluster of preferentially Gq-coupled receptors, and the P2Y12, P2Y13, and P2Y14 form a cluster of preferentially Gi-coupled receptors. The P2Y1 and P2Y2 receptors are expressed in most human tissues, including brain, heart, placenta, lungs, liver, skeletal muscle, kidneys, pancreas and variuos blood cells. P2Y1 receptor is activated by ADP, while P2Y2 is activated equipotently by both ATP and UTP. Several ADP and ATP analogues have been investigated to explore structure-activity relationships for P2Y1 and P2Y2 receptors. It was reported that constraining the riboselike ring as methanocarba analogues of ADP and ATP, the Northern (N, 2'-exo) conformation was associated with increased agonist potency at recombinant human P2Y1 and P2Y2 receptors, while the Southern (S, 2'-endo) conformer was less potent. A similar conformational preference of the ribose moiety in binding to uridine nucleotide-activated hP2Y2 receptor was detected with the methanocarba analogues of UTP [2]. In order to further investigate the influence of conformation of ribose-modified ADP and ATP analogues on affinity and efficacy at hP2Y1 and hP2Y2 receptors, we have synthesized the 2'- and 3'-C-methyl derivatives of ADP and ATP. These nucleotides were evaluated for their capacity to promote hP2Y1 and hP2Y2 receptor-mediated activation of phospholipase C at recombinant human receptors expressed in astrocytoma cells. The results of the functional assay will be discussed. [1] Abbracchio MP et al. International Union of Pharmacology LVIII: Update on the P2Y G Protein-Coupled Nucleotide Receptors: From Molecular Mechanisms and Pathophysiology to Therapy. Pharmacol Rev. 2006, 58: 281-341. [2] Kim, H. S.; Ravi, R. G.; Marquez, V. E.; Maddileti, S.; Wihlborg, A.-K.; Erlinge, D.; Malmsjö, M.; Boyer, J. L.; Harden, K.; Jacobson, K. A. Methanocarba Modification of Uracil and Adenine Nucleotides: High Potency of Northern Ring Conformation at P2Y1, P2Y2, P2Y4 and P2Y11 but not P2Y6 Receptors. J. Med. Chem. 2002, 45: 208-18

High dose Losartan and ACE gene polymorphism in IgA nephritis

Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 ± 0.8 gm/day compared to 1.7 ± 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min−1year−1 for high dose ARB compared to 3.2–3.5 ml min−1year−1 for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P < 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P < 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival