Faculty Perceptions of Readiness to Implement Interprofessional Education in Athletic Training

As the athletic training profession takes steps towards the next level as an allied health care profession, advocates for the profession are positioning athletic trainers as key players in the interprofessional health care team. Recently, the CAATE has pronounced a move for athletic training education to transition all entry-level education to professional master’s degree programs. CAATE is also requesting that athletic training education programs find means to align with other healthcare profession education programs within their institution and actively engage in planned and continuous interprofessional learning activities. This study explored the gap in knowledge regarding athletic training faculty perceptions on their readiness to implement IPE. Data was collected using an electronic survey administered to athletic training program faculty. The objectives of the study were to explore athletic training educators’ perceptions of knowledge, beliefs, and barriers related to IPE. The results of this study identified that differences exist in faculty perceptions of IPE based on faculty rank or role, years of teaching experience, skill level using IPE, previous experience with using IPE, and geographical location of ATEPs within the institution. Together, the findings suggest that IPE integration should include initiatives that provide administrative support, delineated leadership roles and efforts for bringing allied health disciplines in closer physical proximity on their campuses

Healthcare Students’ Abilities To Translate Interprofessional Education To Collaborative Practice

The purpose of this quantitative, correlational study was to examine the direct relationship between students learning about case-based, interprofessional education in their didactic coursework and then demonstrating a change in behavior that allows them to engage in interprofessional collaborative practice in the clinical setting. Specifically, the study determined if healthcare students from physical therapy, occupational therapy, and nursing programs demonstrated the behaviors learned during case-based, IPE training to engage in interprofessional collaborative practice in the clinical setting. The participants of the study had to have completed the case-based IPE training provided at their university during one semester and then participated in a clinical experience course in the following semester. They voluntarily completed an electronic survey that consisted of the validated Interprofessional Collaborative Competency Attainment Survey (ICCAS) and basic demographic questions. The results of the study suggested that students feel competent in IPCP skills after participating in IPE training in the classroom setting, which is a controlled environment. However, when they enter the clinical setting, an uncontrolled environment, their abilities to truly engage in IPCP is not as strong. These findings suggest the need to provide IPE training in the classroom and clinical settings. It would be beneficial for training to be scaffolded throughout the curriculum and include classroom training to provide the foundational knowledge (start of Bloom’s taxonomy), simulation to begin to introduce an uncontrolled environment (middle of Bloom’s taxonomy) and end with training in the clinical setting (high on Bloom’s taxonomy).https://dune.une.edu/pt_facpost/1005/thumbnail.jp

Faculty Perceptions of Readiness to Implement Interprofessional Education in Athletic Training

PURPOSE As the athletic training profession advances, master’s degree accreditation standards aim to position athletic trainers as key players on interprofessional healthcare teams. Interprofessional education standards were recently introduced to academic leaders as key elements in the professional healthcare education of athletic trainers. While the current standards reflect essential skills for entry-level clinicians, faculty instructing these elements may require additional development. METHODS The objective of this study was to explore athletic training educators’ perceptions of interprofessional education and to examine perceived barriers related to the implementation of IPE in athletic training curricula. An electronic survey was administered to a stratified, random sample of 1000 athletic training education program faculty from the National Athletic Trainer’s Association (NATA) member database. Participating faculty completed the Interdisciplinary Education Perception Scale (IEPS) and a set of additional Likert-scale questions regarding barriers to implementation of IPE in athletic training education. RESULTS The results indicated that differences exist in faculty readiness to implement IPE based on faculty rank or role, years of teaching experience, prior experience and skill level using IPE, and geographical location of the athletic training program within the institution. CONCLUSION The results indicated that differences exist in faculty readiness to implement IPE based on faculty rank or role, years of teaching experience, prior experience and skill level using IPE, and geographical location of the athletic training program within the institution. Together, the findings suggest that IPE integration should include initiatives that provide administrative support, delineate leadership roles, offer formal IP development, and aim to create closer physical proximity among healthcare disciplines on campuses

Patient safety incidents involving sick children in primary care in England and Wales: a mixed methods analysis

Background: The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting. Methods and Findings: We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods. Conclusions: This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality

Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports.

PURPOSE: Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children. METHODS: This was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas. RESULTS: Of 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers. CONCLUSION: This is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children

A Target-Based High Throughput Screen Yields Trypanosoma brucei Hexokinase Small Molecule Inhibitors with Antiparasitic Activity

African sleeping sickness is a disease found in sub-Saharan Africa that is caused by the single-celled parasite Trypanosoma brucei. The drugs used widely now to treat infections are 50 years old and notable for their toxicity, emphasizing the need for development of new therapeutics. In the search for potential drug targets, researchers typically focus on enzymes or proteins that are essential to the survival of the infectious agent while being distinct enough from the host to avoid accidental targeting of the host enzyme. This work describes our research on one such trypanosome enzyme, hexokinase, which is a protein that the parasite requires to make energy. Here we describe the results of our search for inhibitors of the parasite enzyme. By screening 220,223 compounds for anti-hexokinase activity, we have identified new inhibitors of the parasite enzyme. Some of these are toxic to trypanosomes while having no effect on mammalian cells, suggesting that they may hold promise for the development of new anti-parasitic compounds

Prognostic value of pathological lymph node status and primary tumour regression grading following neoadjuvant chemotherapy – results from the MRC OE02 oesophageal cancer trial

Aims: Neoadjuvant chemotherapy (NAC) remains an important therapeutic option for advanced oesophageal cancer (OC). Pathological tumour regression grade (TRG) may offer additional information by directing adjuvant treatment and/or follow‐up but its clinical value remains unclear. We analysed the prognostic value of TRG and associated pathological factors in OC patients enrolled in the Medical Research Council (MRC) OE02 trial. Methods and results: Histopathology was reviewed in 497 resections from OE02 trial participants randomised to surgery (S group; n = 244) or NAC followed by surgery [chemotherapy plus surgery (CS) group; n = 253]. The association between TRG groups [responders (TRG1–3) versus non‐responders (TRG4–5)], pathological lymph node (LN) status and overall survival (OS) was analysed. One hundred and ninety‐five of 253 (77%) CS patients were classified as ‘non‐responders’, with a significantly higher mortality risk compared to responders [hazard ratio (HR) = 1.53, 95% confidence interval (CI) = 1.05–2.24, P = 0.026]. OS was significantly better in patients without LN metastases irrespective of TRG [non‐responders HR = 1.87, 95% CI = 1.33–2.63, P < 0.001 versus responders HR = 2.21, 95% CI = 1.11–4.10, P = 0.024]. In multivariate analyses, LN status was the only independent factor predictive of OS in CS patients (HR = 1.93, 95% CI = 1.42–2.62, P < 0.001). Exploratory subgroup analyses excluding radiotherapy‐exposed patients (n = 48) showed similar prognostic outcomes. Conclusion: Lymph node status post‐NAC is the most important prognostic factor in patients with resectable oesophageal cancer, irrespective of TRG. Potential clinical implications, e.g. adjuvant treatment or intensified follow‐up, reinforce the importance of LN dissection for staging and prognostication

Harms from discharge to primary care:mixed methods analysis of incident reports

Background Discharge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital. Aim To describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice. Design and setting A mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System. Method Detailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice. Results A total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement. Conclusion Significant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely

Spectral diversification and trans-species allelic polymorphism during the land-to-sea transition in snakes

Snakes are descended from highly visual lizards [1] , but have limited (probably dichromatic) colour vision attributed to a dim-light lifestyle of early snake ancestors [2–4]. The living species of front-fanged elapids, however, are ecologically very diverse, with ~300 terrestrial species (cobras, taipans, etc.) and ~60 fully marine sea snakes, plus eight independently marine, amphibious sea kraits [1]. Here, we investigate the evolution of spectral sensitivity in elapids by analyzing their opsin genes (which are responsible for sensitivity to UV and visible light), retinal photoreceptors, and ocular lenses. We found that sea snakes underwent rapid adaptive diversification of their visual pigments when compared with their terrestrial and amphibious relatives. The three opsins present in snakes (SWS1, LWS, RH1) have evolved under positive selection in elapids, and in sea snakes have undergone multiple shifts in spectral sensitivity towards the longer wavelengths that dominate below the sea surface. Several distantly related Hydrophis sea snakes are polymorphic for shortwave sensitive visual pigment encoded by alleles of SWS1. This spectral site polymorphism is expected to confer expanded ‘UV-Blue’ spectral sensitivity and is estimated to have persisted twice as long as the predicted survival time for selectively neutral nuclear alleles. We suggest that this polymorphism is adaptively maintained across Hydrophis species via balancing selection, similarly to the LWS polymorphism that confers allelic trichromacy in some primates. Diving sea snakes thus appear to share parallel mechanisms of color vision diversification with fruit-eating primates

Thinking about and working with archives and records: a personal reflection on theory and practice

Looking back over a career that has lasted 40 years (so far) the author reflects on developments in his own thinking and the influences involved. Not least amongst these are: the British public records tradition which predominated at UCL when he studied there; the American historical manuscripts tradition which was in the process of aligning with strands of postmodernism when he held visiting fellowships in the USA; the reconfiguration of Records Management in sub-Saharan Africa in response to public sector reform in which he was involved as an advisor; and the experience of teaching postgraduate students in Britain and overseas. The author’s publications have appeared in a wide range of journals and as monographs, some of them published overseas. Here he draws together the common strands that connect them. Finally he argues that hermeneutic techniques and the concept of fiduciarity deserve to be given serious consideration in debates about archive and records theory