The Development of a Virtual World Problem-Based Learning Tutorial and Comparison With Interactive Text-Based Tutorials

Collaborative learning through case-based or problem-based learning (PBL) scenarios is an excellent way to acquire and develop workplace knowledge associated with specific competencies. At St George's, University of London we developed an interactive online form of decision-based PBL (D-PBL) for our undergraduate medical course using web-based virtual patients (VPs). This method of delivery allowed students to consider options for clinical management, to take decisions and to explore the consequences of their chosen actions. Students had identified this as a more engaging type of learning activity compared to conventional paper-based/linear PBL and demonstrated improved exam performance in controlled trials. We explored the use of Second Life (SL), a virtual world and immersive 3D environment, as a tool to provide greater realism than our interactive image and text-based D-PBL patient cases. Eighteen separate tutorial groups were provided with their own experience of the same patient scenario in separate locations within the virtual world. The study found that whilst a minority of students reported that the Second Life experience felt more realistic, most did not. Students favored the simpler interaction of the web-based VPs, which already provided them with the essential learning needed for practice. This was in part due to the time proximity to exams and the extra effort required to learn the virtual world interface. Nevertheless, this study points the way towards a scalable process for running separate PBL sessions in 3D environments

Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic. Results from the MIMIC Study (A Multi-centre cohort study evaluating the role of Inflammatory Markers in patients presenting with acute ureteric Colic)

Objectives There is conflicting data on the role of white blood cell count (WBC) and other inflammatory markers in spontaneous stone passage in patients with acute ureteric colic. The aim of the study was to assess the relationship of WBC and other routinely collected inflammatory and clinical markers including stone size, stone position and Medically Expulsive Therapy use (MET) with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic. Subjects and Methods Multi‐centre retrospective cohort study coordinated by the British Urology Researchers in Surgical Training (BURST) Research Collaborative at 71 secondary care hospitals across 4 countries (United Kingdom, Republic of Ireland, Australia and New Zealand). 4170 patients presented with acute ureteric colic and a computer tomography confirmed single ureteric stone. Our primary outcome measure was SSP as defined by the absence of need for intervention to assist stone passage. Multivariable mixed effects logistic regression was used to explore the relationship between key patient factors and SSP. Results 2518 patients were discharged with conservative management and had further follow up with a SSP rate of 74% (n = 1874/2518). Sepsis after discharge with conservative management was reported in 0.6% (n = 16/2518). On multivariable analysis neither WBC, Neutrophils or CRP were seen to predict SSP, with an adjusted OR of 0.97 [95% CI 0.91 to 1.04, p = 0.38], 1.06 [95% CI 0.99 to 1.13, p = 0.1] and 1.00 [95% CI 0.99 to 1.00, p = 0.17], respectively. Medical expulsive therapy (MET) also did not predict SSP [adjusted OR 1.11 [95% CI 0.76 to 1.61]). However, stone size and stone position were significant predictors. SSP for stones 7mm. For stones in the upper ureter the SSP rate was 52% [95% CI 48 to 56], middle ureter was 70% [95% CI 64 to 76], and lower ureter was 83% [95% CI 81 to 85]. Conclusion In contrast to the previously published literature, we found that in patients with acute ureteric colic who are discharged with initial conservative management, neither WBC, Neutrophil count or CRP help determine the likelihood of spontaneous stone passage. We also found no overall benefit from the use of MET. Stone size and position are important predictors and our findings represent the most comprehensive stone passage rates for each mm increase in stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention

The perceived value and effectiveness of Monitored Dosage System (MDS) dispensed for domiciliary use by hospital and community pharmacies.

Focal Points • To explore with pharmacy staff, patients and carers, their view of the value and effectiveness of Monitored Dosage Systems • Pharmacy staff recognised the value of MDS but lacked confidence that simpler strategies to improve adherence had not been tried before introducing MDS. • Service users and carers expressed relief that MDS reduced anxiety and saved them time in order to ensure medicines were administered correctly. • A formal assessment of adherence needs of patients and carers may enable MDS to be deployed more efficiently within the available human resource. Introduction: The CHUMS report 1 raised questions as to whether MDS was the best solution to improve adherence and safety in care homes. Dispensing errors for MDS are greater than for traditional prescriptions but there is some evidence that the administration of medicines is safer using MDS2. MDS is now widely dispensed by both community and hospital pharmacies for people living in their own homes. The aim of this study was, therefore, to find out the extent to which community and hospital staff valued MDS in domiciliary settings and also to ascertain the views of patients and carers who use MDS. Method: The study was conducted in the Midlands at a busy teaching hospital pharmacy and in a rural community pharmacy. A qualitative approach was adopted based on a phenomenological epistemological stance designed to understand and portray the ‘lived experiences’ of the participants. Eleven semi-structured interviews were audio recorded and transcribed verbatim. Reading and re-reading the transcripts led to a system of coding resulting in two overarching themes – ‘resources for dispensing’ and ‘value of MDS as an aid to improve adherence’. Participants included four pharmacists (two from the community) and three pharmacy technicians (one from the community), b) one hospital discharge nurse, two patients and one carer. The carer and patients were recruited as a convenience sample via the community pharmacy. Topic guides were used to ensure a standard approach and enabled flexibility in clarifying or probing views. The NHS Research Ethics Service confirmed that ethical approval was not required. Results: ‘Resources for dispensing’: MDS dispensing was considered to be labour intensive by both hospital and community pharmacy staff. It had an impact on other work (e.g. dispensing or medicines use reviews) in the pharmacy due to a) the complexity of dispensing and checking process, b) lack of advance notice of exact prescription (e.g. upon discharge from hospital), c) lack of staff resources and bench space. Good use of skill mix of pharmacy technicians and pharmacists enabled MDS to be managed within a busy environment. ‘Value of MDS as an aid to improve adherence’: some pharmacy staff lacked confidence that patients would benefit from MDS especially if they intentionally did not take their medicines. By contrast, carers of patients expressed relief that complex dosing had been ‘sorted’ by the pharmacy. They also considered that a small fee charged by the community pharmacy for dispensing MDS was good value. Discussion Pharmacy staff were not convinced that MDS was always of value and felt that the service increased pressure on other pharmaceutical care commitments. Service users and carers, however, greatly valued MDS because it saved time and reduced the onus upon them to organise the safe administration of medicines. These findings suggest that a formal assessment of adherence needs should be introduced in order to ensure that patients or carers are likely to benefit from MDS. Consideration should also be given as to whether MDS should be funded through the NHS rather than to assume that pharmacies will absorb the cost with or without the assistance of patients. References 1. Alldred DP, Barber N, Buckle P et al. (2009). Care Home Use of Medicines Study (CHUMS). Report to the patient safety research portfolio, Department of Health. 2. Alldred DP, Standage C,Fletcher O et al (2011). The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ Qual Saf.doi:10.1136 bmjqs.2010.04631

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Published in Bhartia Thar Registhan me Paramprik Gyan Ka Bhandar va Upayog. (Editors: Harpal Singh, Zabardan Kevia and Pratap Narayan),Central Arid Zone Research Institute, Jodhpur- (Rajasthan)Not AvailableNot Availabl