Nursing Students in Clinical Placements Learning in Dyads: A Feasibility Study Using a Non-Randomized Pilot Trial

Purpose: To develop a protocol for a clinical education intervention using dyads and to assess the feasibility of implementing the approach with second year nursing students in their first clinical placement. The objectives were: 1) to evaluate and refine data collection procedures and outcome measures, 2) to evaluate the acceptability and sustainability of the intervention, and 3) to identify weaknesses of the intervention or threats to future implementation. Methods: A feasibility study was designed as a non-randomized pilot trial. The setting was the university site of a collaborative Bachelor of Science in Nursing program in Ottawa, Ontario. Three clinical groups consisting of 24 second-year students enrolled in both the French and English undergraduate programs comprised the sample. The intervention protocol was developed based on guiding principles reflective of the needs of our institution, as well as pedagogical priorities. Data were collected from clinical instructors and other stakeholders pre- and post-intervention through multiple means and analyzed descriptively. We followed the CONSORT extension to randomized pilot and feasibility trials to guide reporting of the study. Results: The intervention was deemed acceptable by the clinical instructors, as well as the managers and educators of the units. We received no negative feedback regarding the intervention, or the workload required to implement the intervention properly. For data collection instruments, the NSSES was completed more often and with greater ease than the VSI-NS. In all cases, the responses to the instruments were congruent with our expectations and student scores shifted in the anticipated direction. Clinical instructors were able to consistently observe patient care and reported having more time for teaching and mentorship. Conclusions: Using a dyad approach to clinical education appears to be a viable strategy, and our feasibility study supports the appropriateness of further research into the use of dyads for nursing clinical education. From a sustainability perspective, the intervention allowed for the safe implementation of larger group sizes without negatively affecting the learning environment or the integrity of the course objectives. Résumé Objectif : Élaborer un protocole d’intervention en formation clinique qui utilise des dyades et évaluer la faisabilité de mettre en place l’approche avec des étudiantes en sciences infirmières de deuxième année lors de leur premier stage clinique. Les objectifs étaient : 1) d’évaluer et de peaufiner les procédures de collecte de données et les mesures de résultats; 2) d’évaluer l’acceptabilité et la viabilité de l’intervention; et, 3) d’identifier les faiblesses de l’intervention ou les risques pour une future mise en place. Méthodologie : Une étude de faisabilité, a été menée sous forme d’un essai pilote non randomisé. Cette étude fut effectuée sur le site universitaire d’un programme collaboratif de baccalauréat en sciences infirmières à Ottawa, en Ontario. Les trois groupes cliniques étaient composés de 24 étudiantes de deuxième année inscrites aux programmes de premier cycle en français et en anglais. Le protocole d’intervention a été élaboré en se basant sur des principes directeurs reflétant les besoins de notre établissement et nos priorités pédagogiques. Les données ont été recueillies par plusieurs méthodes auprès des enseignantes cliniques et d’autres intervenantes avant et après l’intervention et elles ont été analysées de façon descriptive. Nous avons suivi la structure CONSORT des essais pilotes randomisés et des études de faisabilité pour guider la présentation de l’étude. Résultats : L’intervention fut jugée acceptable par les enseignantes cliniques ainsi que par les gestionnaires et les conseillères des unités. Nous n’avons reçu aucun commentaire négatif par rapport à l’intervention ou à la charge de travail requise pour la mettre en place adéquatement. Concernant les instruments de collecte de données, la NSSES (échelle d’auto-efficacité des étudiantes en sciences infirmières) a été remplie plus souvent et plus facilement que le VSI-NS (questionnaire sur les interactions verbales et sociales des étudiantes en sciences infirmières). Dans tous les cas, les réactions par rapport aux instruments correspondaient à nos attentes et les résultats des étudiantes changeaient dans la direction prévue. Les enseignantes cliniques ont pu observer systématiquement les soins aux patients et ont rapporté avoir eu plus de temps pour enseigner et faire du mentorat. Conclusions : L’utilisation d’une approche de dyade en formation clinique semble être une stratégie viable et notre étude de faisabilité appuie la pertinence de recherches plus poussées sur l’utilisation de dyades en formation clinique en sciences infirmières. Du point de vue de la viabilité, l’intervention permettait une mise en place sécuritaire de plus grands groupes sans conséquence négative sur l’environnement d’apprentissage ou l’intégrité des objectifs de cours

Temperatures leading to heat escape responses in Antarctic marine ectotherms match acute thermal limits

Thermal tolerance windows are key indicators of the range of temperatures tolerated by animals and therefore, a measure of resilience to climate change. In the ocean, where ectotherms are immersed, body temperatures are tightly coupled to environmental temperature and species have few options for thermoregulation. However, mobile species do have the ability to orientate towards optimal temperatures and move away from sub-optimal or dangerous temperatures. Escape responses are one such locomotory behavior, which typically manifests as a series of violent flicking movements that move individuals out of dangerous environments. We tested 11 species of Antarctic marine ectotherms, from one of the most stable shallow water marine environments, with an annual temperature range of -2 to +2°C, that are vulnerable to small degrees of warming. Three species, the clam Laternula elliptica, the sea cucumber Cucumaria georgianus and the brittlestar Ophionotus victoriae, showed no, or virtually no, escape response to temperature. Escape responses from a further eight species had a median response temperature of 11.2 (interquartile range, 10 to 15.7°C), which is well above current environmental temperatures but close to the range for acute lethal limits of Antarctic marine ectotherms (range, 17.2 to 26.6 °C). This highlights that both acute tolerance limits and escape responses, fall outside current environmental temperatures, but also those predicted for 100s of years in the Southern Ocean. In a warmer Southern Ocean Antarctic fauna may not have the capacity to use temperature to select optimal thermal conditions, which leaves adaptation as a primary mechanism for their persistence

A T8.5 Brown Dwarf Member of the Xi Ursae Majoris System

The Wide-field Infrared Survey Explorer has revealed a T8.5 brown dwarf (WISE J111838.70+312537.9) that exhibits common proper motion with a solar-neighborhood (8 pc) quadruple star system - Xi Ursae Majoris. The angular separation is 8.5 arc-min, and the projected physical separation is about 4000 AU. The sub-solar metallicity and low chromospheric activity of Xi UMa A argue that the system has an age of at least 2 Gyr. The infrared luminosity and color of the brown dwarf suggests the mass of this companion ranges between 14 and 38 Jupiter masses for system ages of 2 and 8 Gyr respectively.Comment: AJ in press, 12 pages LaTeX with 6 figures. More astrometric data and a laser guide star adaptive optics image adde

Did the evidence-based intervention (EBI) programme reduce inappropriate procedures, lessen unwarranted variation or lead to spill-over effects in the National Health Service?

Background Health systems are under pressure to maintain services within limited resources. The Evidence-Based Interventions (EBI) programme published a first list of guidelines in 2019, which aimed to reduce inappropriate use of interventions within the NHS in England, reducing potential harm and optimising the use of limited resources. Seventeen procedures were selected in the first round, published in April 2019. Methods We evaluated changes in the trends for each procedure after its inclusion in the EBI’s first list of guidelines using interrupted time series analysis. We explored whether there was any evidence of spill-over effects onto related or substitute procedures, as well as exploring changes in geographical variation following the publication of national guidance. Results Most procedures were experiencing downward trends in the years prior to the launch of EBI. We found no evidence of a trend change in any of the 17 procedures following the introduction of the guidance. No evidence of spill-over increases in substitute or related procedures was found. Geographic variation in the number of procedures performed across English CCGs remained at similar levels before and after EBI. Conclusions The EBI programme had little success in its aim to further reduce the use of the 17 procedures it deemed inappropriate in all or certain circumstances. Most procedure rates were already decreasing before EBI and all continued with a similar trend afterwards. Geographical variation in the number of procedures remained at a similar level post EBI. De-adoption of inappropriate care is essential in maintaining health systems across the world. However, further research is needed to explore context specific enablers and barriers to effective identification and de-adoption of such inappropriate health care to support future de-adoption endeavours

Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: Evaluation of a CBT informed pain management programme

Randomized controlled trials and meta-analyses provide evidence for the efficacy of cognitive-behaviourally informed treatment (CBT) programmes for chronic pain. The current study aims to provide practice-based evidence for the effectiveness of CBT in routine clinical settings. Over a 10-year period 1013 pain patients were accepted into a 4 week in-patient pain management programme. Data from more than 800 patients was available at pre-treatment and at one month post-treatment and for around 600 patients at pre-treatment and at 9 months follow-up. Measures reported in this analysis were pain experience and interference, psychological distress (depression and anxiety), self-efficacy, catastrophizing, and walking. Change from pre-treatment to post-treatment and follow-up was assessed with conventional statistical tests, the computation of effect sizes and by the reliable change index (RCI) and clinically significant change (CSC) methodology. These analyses provide evidence of statistical improvement at post-treatment and follow-up and the RCI/CSC methodology suggested that between 1 in 3 and 1 in 7 (depending on the outcome measure) achieved clinically significant gains. There was also evidence that a small percentage of patients (1–2%) reliably deteriorated during the period of treatment. The limitations in the inferences that can be drawn from this study and of the methodology are discussed. A case is made for the application of benchmarking methods using data from RCTs in order to more fully evaluate practice and to generate better quality practice based evidence

Testing the resilience, physiological plasticity and mechanisms underlying upper temperature limits of Antarctic marine ecto-therms

Antarctic marine ectotherms live in the constant cold and are characterised by limited resilience to elevated temperature. Here we tested three of the central paradigms underlying this resilience. Firstly, we assessed the ability of eight species, from seven classes representing a range of functional groups, to survive, for 100 to 303 days, at temperatures 0 to 4 °C above previously calculated long-term temperature limits. Survivors were then tested for acclimation responses to acute warming and acclimatisation, in the field, was tested in the seastar Odontaster validus collected in different years, seasons and locations within Antarctica. Finally, we tested the importance of oxygen limitation in controlling upper thermal limits. We found that four of 11 species studied were able to survive for more than 245 days (245–303 days) at higher than previously recorded temperatures, between 6 and 10 °C. Only survivors of the anemone Urticinopsis antarctica did not acclimate CTmax and there was no evidence of acclimatisation in O. validus. We found species-specific effects of mild hyperoxia (30% oxygen) on survival duration, which was extended (two species), not changed (four species) or reduced (one species), re-enforcing that oxygen limitation is not universal in dictating thermal survival thresholds. Thermal sensitivity is clearly the product of multiple ecological and physiological capacities, and this diversity of response needs further investigation and interpretation to improve our ability to predict future patterns of biodiversity