A Home for Life

This case study follows the progress of a cohort of Year 10 students as they engage in a collaborative project over five days inspired by the designer Roger Dean. It exemplifies the way in which different faculties - Design and Technology, Mathematics and Science - can work as one on a project where students need to combine skills from all three disciplines to solve real problems

'Ready to hit the ground running': alumni and employer accounts of a unique part-time distance learning pre-registration nurse education programme

Background This study explored the impact of The Open University’s (OU) pre-registration nursing programme on students’ employability, career progression and its contribution to developing the nursing workforce across the United Kingdom. Designed for healthcare support workers who are sponsored by their employers, the programme is the only part-time supported open/distance learning programme in the UK leading to registration as a nurse. The international literature reveals that relatively little is known about the impact of previous experience as a healthcare support worker on the experience of transition, employability skills and career progression. Objectives To identify alumni and employer views of the perceived impact of the programme on employability, career progression and workforce development. Design/Method A qualitative design using telephone interviews which were digitally recorded, transcribed verbatim prior to content analysis to identify recurrent themes. Settings Three geographical areas across the UK. Participants Alumni (n=17) and employers (n=7). Inclusion criterion for alumni was a minimum of two years post-qualifying experience. Inclusion criteria for employers were those that had responsibility for sponsoring students on the programme and employing them as newly qualified nurses. Results Four overarching themes were identified: Transition, Expectations, Learning for and in practice, and Flexibility. Conclusions Alumni and employers were of the view that the programme equipped them well to meet the competencies and expectations of being a newly qualified nurse. It provided employers with a flexible route to growing their own workforce and alumni the opportunity to achieve their ambition of becoming a qualified nurse when other more conventional routes would not have been open to them. Some of them had already demonstrated career progression. Generalising results requires caution due to the small, self-selecting sample but findings suggest that a widening participation model of pre-registration nurse education for employed healthcare support workers more than adequately prepares them for the realities of professional practice

Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention

Background Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCI). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients. Objectives We sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables. Methods Data from 706,263 PCIs performed between 7/2018-6/2019 at 1,608 sites were used to develop and validate a new full and pre-catheterization model to predict in-hospital mortality, and a simplified bedside risk score. The sample was randomly split into a development (70%, n=495,005) and validation cohort (30%, n=211,258). We created 1,000 bootstrapped samples of the development cohort and used stepwise selection logistic regression on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples and those identified a priori due to clinical relevance. Results In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (c-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged from 1.1% to 3.3% (interquartile range: 1.7%-2.1%). Conclusions The risk of mortality following PCI can be predicted in contemporary practice by incorporating variables that reflect clinical acuity. This model, which includes data previously not captured, is a valid instrument for risk stratification and for quality improvement efforts

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Practice learning and student support – The Open University experience

Pre registration nursing typically incorporates elements of work-based learning for the development of practice competencies. However for many higher educational providers, this learning is in short term units – with students moving through a placement circuit through the duration of their programme. The Open University’s provision is unique in that, not only do students develop their practice competence in one primary area; that primary area is also the student’s workplace as students learn to balance and manage the complexity of working in their prescribed roles as both student and health care assistant. This role complexity requires a significant infrastructure to be maintained to ensure that the student is able to optimise each learning opportunity and not default to the role of care assistant and worker rather than that of a learner. Often students come to the programme with little or no formal education and therefore feel very uncertain of their abilities to study, question and interrogate practice. As much of their experience is in their own workplace, students need support to see their role beyond that of a health care assistant and gain the confidence to question and challenge others, and be innovative in practice. Unlike many other higher education providers, mentors enter into this supportive relationship with students for the duration of their four year pre qualifying programme. The uniqueness of this longitudinal, rather than short term mentorship relationship in nursing mirrors more closely the original use of the concept of ‘mentor’ (Wikipedia 2009) where Mentor was left in charge of the son of Odysseus when Odysseus left for the Trojan War which historically is thought to have last for more than 150 years. It is therefore likely that Odysseus would have been away from his family and home for many years on this quest leaving the welfare and development of his son to Mentor. The Open University’s application of long term mentorship allows for significant investment to be focused on each learner. The application of mentorship as a longer term investment is not without its challenges. The primary challenge is around ensuring that the mentor has the confidence to critically and objectively provide feedback and accurate assessment of fitness for practice on their learners. In nursing, the concern re ‘failing to fail’ students led most recently to a review of the standards to support learning and assessment in practice (NMC 2008). For The Open University’s provision, the parallel relationship of the student and mentor as colleagues and co workers means that the mentorship relationship is even more complex and important to manage. For students, to benefit from learning in the work place, they must have confidence in the accuracy of the mentor’s feedback to capture precisely their levels of competence so that personal development plans can be considered appropriate to their developmental needs. Issues of familiarity must not influence the impartiality and ability of the mentor to provide critical and constructive feedback. The Open University supports both students and practitioners in their work-based learning role in the format of a programme tutor role that merges together both that of a personal tutor and clinical liaison link but additionally extends to encompass other areas of the student’s practice development. This role is seen and valued as pivotal to aid the individual’s transition from health care assistant to that of student, and ultimately to that of autonomous practitioner. Like the mentorship role, this role is set up to be longitudinal throughout the entirety of the student’s four year programme with one programme tutor assuming the responsibility for a group of ten students in their practice development. Through this time, the programme tutor will work with the student’s primary work place to fully support and develop the learning environment to ensure and enhance quality assurance processes. On a parallel, the unique teaching and learning approach of supportive distance learning through the entirety of the student’s programme, enables and requires students to apply and reflect learning directly in their workplace. Many of the course activities structured within course materials require application of principles, discussion of concepts with qualified practitioners, and development of a personal and professional portfolio in practice. Many activities are recommended for use as evidence against standards of proficiency with the student reflecting and writing these learning opportunities up for inclusion into their portfolios. As a result of this approach, The Open University’s course materials are often highly visible to practitioners in the work place and can, and are used as a basis to discuss work-based learning. These two aspects are just two examples of how The Open University has grasped work-based learning to optimise the learning for pre registration nursing students. In both these examples, partnership working between the work place and the university is critical. Ultimately the student, those who support teaching and learning and the learning and teaching strategies used impact on work-based learning and require careful management and evaluation to benefit all involved in practice-based learning. Reference: Nursing & Midwifery Council (2008) Standards to support learning and assessment in practice: NMC standards for mentors, practice teachers and teachers, London, NMC