A multi-discpilnary training programme for end-of-life care: a sequential simulation

Sequential Simulation,1 a longitudinal form of simulation, was identified as an effective training approach for multi-disciplinary teams in identifying and caring for patients in their last year of life in a hospital setting. Sequential Simulation is a physical simulation of a pathway of care rather than isolated components of the trajectory. End-of-life care for patients in hospital has been reported as inadequate in the UK.2 The need for this training was identified through the literature and an in-house training needs analysis in conjunction with patients and their families

How to design a Sequential Simulation (SqS) for a variety of objectives

Sequential Simulation (SqS) is the physical re-enactment of longitudinal elements of care, rather than single episodes, as is currently the main format of most healthcare simulations. It takes a patient's perspective of their care pathway journey through the system rather than the healthcare professionals perspectives alone. It has been used for a variety of applications including training multi-disciplinary teams on end-of-life care, initiating integrated care, quality improvement projects, designing new models of care, evaluating new interventions, and improving care of the deteriorating patient, to name but a few.1,2 Its applications are wide, and therefore the design process can be complex. This workshop draws on an empirically and theoretically driven model, to guide participants in designing Sequential Simulations for a variety of clinical objectives

Sequential simulation: a new approach to sharing challenges, opportunities and learning in maternity service delivery

A recent CQC inspection identified disparities in care quality across maternity services in several London1 districts, revealing a need to identify challenges and solutions and to share learning across sites. Sequential Simulation2 (SqS) uses physical simulation to portray selected snapshots from a pathway of care, for pedagogical and engagement activities. In representing the lived experience of service users, SqS provides a platform for facilitated discussion among a diverse range of multidisciplinary participants. SqS workshops at six maternity sites in London aimed to explore service delivery challenges with front-line staff, in order to identify possible solutions, establish whether findings could inform learning outcomes for an educational intervention, and identify unanticipated outcomes of facilitated discussions

Enteric Neurospheres Are Not Specific to Neural Crest Cultures: Implications for Neural Stem Cell Therapies

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Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049