“It takes a village”: A qualitative study exploring midwives’ and student midwives’ experience of the new Standards for Student Supervision and Assessment (SSSA) in practice.

Objective To explore students’ and midwives’ preparation and experiences of supervision and assessment in practice using the new Standards for Student Supervision and Assessment (SSSA). Design An exploratory qualitative study was undertaken. Student midwives and registered midwives were invited to participate using online recruitment strategies across closed groups. Participants were required to complete either an open-ended questionnaire or participate in an in-depth interview. The demographics and background data were presented in a descriptive format and qualitative data was analysed thematically. Setting and participants Twenty-two student midwives and thirteen registered midwives from across the United Kingdom that had experience using the new Standards for Student Supervision and Assessment were recruited for this study. Findings The thematic analysis identified three key themes: ‘Thrown in the deep end’ where a lack of preparation, training, time, resources, and communication were identified. ‘A double-edged sword’ in which staff and students identified the benefits of working with different professionals whilst acknowledging the significant challenges they faced without the student-midwife relationship and lack of supervisor continuity. ‘A daily struggle’ was expressed due to burnout which many students faced. Overall, one overarching theme that threaded itself through the narrative was that ‘it takes a village’ to create competent and confident midwives. Key conclusions and implications for practice This study highlights some of the benefits students and midwives experience using the new standards but they are marred with significant challenges which need to be addressed to protect the future workforce and the public. There needs to be a more collaborative effort to ensure that midwives have the right resources, training, and protected time to fulfil their roles as supervisors and assessors. The student journey across placement needs to be mapped out carefully to ensure that an element of continuity that builds a student-midwife relationship is maintained. This will alleviate the impact on student learning, confidence, and burnout

“It takes a village”: A qualitative study exploring midwives’ and student midwives’ experience of the new Standards for Student Supervision and Assessment (SSSA) in practice.

Objective To explore students’ and midwives’ preparation and experiences of supervision and assessment in practice using the new Standards for Student Supervision and Assessment (SSSA). Design An exploratory qualitative study was undertaken. Student midwives and registered midwives were invited to participate using online recruitment strategies across closed groups. Participants were required to complete either an open-ended questionnaire or participate in an in-depth interview. The demographics and background data were presented in a descriptive format and qualitative data was analysed thematically. Setting and participants Twenty-two student midwives and thirteen registered midwives from across the United Kingdom that had experience using the new Standards for Student Supervision and Assessment were recruited for this study. Findings The thematic analysis identified three key themes: ‘Thrown in the deep end’ where a lack of preparation, training, time, resources, and communication were identified. ‘A double-edged sword’ in which staff and students identified the benefits of working with different professionals whilst acknowledging the significant challenges they faced without the student-midwife relationship and lack of supervisor continuity. ‘A daily struggle’ was expressed due to burnout which many students faced. Overall, one overarching theme that threaded itself through the narrative was that ‘it takes a village’ to create competent and confident midwives. Key conclusions and implications for practice This study highlights some of the benefits students and midwives experience using the new standards but they are marred with significant challenges which need to be addressed to protect the future workforce and the public. There needs to be a more collaborative effort to ensure that midwives have the right resources, training, and protected time to fulfil their roles as supervisors and assessors. The student journey across placement needs to be mapped out carefully to ensure that an element of continuity that builds a student-midwife relationship is maintained. This will alleviate the impact on student learning, confidence, and burnout

Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis

Purpose: The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty. Methods: The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique. Results: The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9. Conclusions: This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty

Intravitreal dexamethasone to manage post endothelial keratoplasty cystoid macular oedema refractory to topical therapy

Background/Objectives To describe the visual and clinical outcomes of patients with post endothelial keratoplasty (EK) cystoid macular oedema (CMO) refractory to topical treatment with intravitreal sustained-release dexamethasone implant (Ozurdex). Subjects/Methods 131 eyes from 111 patients undergoing solitary or combined EK (52 DSAEK (40.0%) and 79 DMEK (60.0%)) at Southend University Hospital between January 2020 and February 2022 with a minimum follow-up of 6 months were evaluated. Patients suspected of having CMO underwent spectral-domain macular optical coherence tomography (SD-OCT) Patients with diabetes were not included in this series. Results CMO was identified in 5.3% (n = 7) of cases, with 2 of these patients responding to topical corticosteroid treatment. The remaining 5 patients underwent intravitreal dexamethasone implant, with 1 patient requiring repeat implant due to CMO recurrence. All presented within 2 months postoperatively. 4 out of 5 eyes treated with intravitreal dexamethasone achieved a Snellen BCVA ≤6/9.5. 1 patient had an uncontrolled rise in intraocular pressure (IOP) despite maximal medical treatment requiring an urgent PreserFlo Ab-Externo MicroShunt. Conclusions The use of intravitreal sustained-release dexamethasone implant in the management of post EK CMO refractory to topical therapy is effective and safe in most cases, but patients should be monitored and treated promptly for any secondary IOP response

A Randomised Controlled Trial of Nasal Immunisation with Live Virulence Attenuated Streptococcus pneumoniae Strains Using Human Infection Challenge

RATIONALE: Pneumococcal pneumonia remains a global health problem. Pneumococcal colonisation increases local and systemic protective immunity, suggesting nasal administration of live attenuated S. pneumoniae strains could help prevent infections. OBJECTIVES: We used a controlled human infection model to investigate whether nasopharyngeal colonisation with attenuated S. pneumoniae strains protected against re-colonisation with wild-type (WT) S. pneumoniae (Spn). METHODS: Healthy adults aged 18-50 years were randomised (1:1:1:1) for nasal administration twice (two weeks interval) with saline, WT Spn6B (BHN418) or one of two genetically modified Spn6B strains - SpnA1 (∆fhs/piaA) or SpnA3 (∆proABC/piaA) (Stage I). After 6 months, participants were challenged with SpnWT to assess protection against the homologous serotype (Stage II). MEASUREMENTS AND MAIN RESULTS: 125 participants completed both study stages as per intention to treat. No Serious Adverse Events were reported. In Stage I, colonisation rates were similar amongst groups: SpnWT 58.1% (18/31), SpnA1 60% (18/30) and SpnA3 59.4% (19/32). Anti-Spn nasal IgG levels post-colonisation were similar in all groups whilst serum IgG responses were higher in the SpnWT and SpnA1 groups than the SpnA3 group. In colonised individuals, increases in IgG responses were identified against 197 Spn protein antigens and serotype 6 capsular polysaccharide using a pangenome array. Participants given SpnWT or SpnA1 in stage 1 were partially protected against homologous challenge with SpnWT (29% and 30% recolonisation rates, respectively) at stage II, whereas those exposed to SpnA3 achieved recolonisation rate similar to control group group (50% vs 47%, respectively). CONCLUSION: Nasal colonisation with genetically modified live attenuated Spn was safe and induced protection against recolonisation, suggesting nasal adminstration of live attenuated Spn could be an effective stategy for preventing pneumococcal infections

A Randomized Controlled Clinical Trial of Nasal Immunization with Live Virulence Attenuated Streptococcus pneumoniae Strains Using Human Infection Challenge

Rationale: Pneumococcal pneumonia remains a global health problem. Pneumococcal colonization increases local and systemic protective immunity, suggesting that nasal administration of live attenuated Streptococcus pneumoniae (Spn) strains could help prevent infections. Objectives: We used a controlled human infection model to investigate whether nasopharyngeal colonization with attenuated S. pneumoniae strains protected against recolonization with wild-type (WT) Spn (SpnWT). Methods: Healthy adults aged 18-50 years were randomized (1:1:1:1) for nasal administration twice (at a 2-wk interval) with saline solution, WT Spn6B (BHN418), or one of two genetically modified Spn6B strains, SpnA1 (Δfhs/piaA) or SpnA3 (ΔproABC/piaA) (Stage I). After 6 months, participants were challenged with SpnWT to assess protection against the homologous serotype (Stage II). Measurements and Main Results: 125 participants completed both study stages per intention to treat. No serious adverse events were reported. In Stage I, colonization rates were similar among groups: SpnWT, 58.1% (18 of 31); SpnA1, 60% (18 of 30); and SpnA3, 59.4% (19 of 32). Anti-Spn nasal IgG levels after colonization were similar in all groups, whereas serum IgG responses were higher in the SpnWT and SpnA1 groups than in the SpnA3 group. In colonized individuals, increases in IgG responses were identified against 197 Spn protein antigens and serotype 6 capsular polysaccharide using a pangenome array. Participants given SpnWT or SpnA1 in Stage I were partially protected against homologous challenge with SpnWT (29% and 30% recolonization rates, respectively) at stage II, whereas those exposed to SpnA3 achieved a recolonization rate similar to that in the control group (50% vs. 47%, respectively). Conclusions: Nasal colonization with genetically modified live attenuated Spn was safe and induced protection against recolonization, suggesting that nasal administration of live attenuated Spn could be an effective strategy for preventing pneumococcal infections. Clinical trial registered with the ISRCTN registry (ISRCTN22467293)