An assessment of the value of simulation based learning within an aeromedical service in Johannesburg, South Africa

MSc (Nursing), Faculty of health Sciences, University of the WitwatersrandThis quasi-experimental study assesses the value of simulation based learning for a medical flight crew within an air ambulance service based in Johannesburg, South Africa. The purpose of this study was to assess the value of simulation based learning for air medical crew in performing synchronized cardioversion efficiently, effectively and safely within the air medical environment. The objectives were to determine if there is a difference between the experimental group that had been exposed to a simulation-based learning experience versus a control group that had not, in respect of performing synchronized cardioversion and scene management pertaining to this skill. This was a qausi-experimental study in which stratified random sampling was done to divide the participants into the control and experimental groups using medical qualification as homogenous subsets. The outcome of the study showed that the control group was quicker to first shock than the participants in the experimental group. However, the participants in the experimental group performed the skill more effectively, with regard to doing / following the correct steps in performing the skill of synchronized cardioversion and were safer practitioners. None of the variants within the sample groups had a significant effect on performance of the skill. The conclusion is that within this specific air ambulance service, simulation- based learning improved the performance of synchronized cardioversion in comparison to the normal orientation / training provided in the service

The Value of a Research Through Design approach to explore Healthcare Service Provision

This thesis reports on a research-through-design (RtD) PhD study. This sought to integrate Design skills and approaches as part of service provision within a healthcare team at Sheffield Childrens Hospital. Working with the chronic pain (CP) team it used a mixed-method approach to understand how design practice could be used to understand context and develop relationships with stakeholders. This supported the development of workshops to explore if demonstrating design skills and approaches to adolescents with CP could have an impact on their management behaviours. Literature suggests there is an increasing demand for design methods outside of the traditional design field. Both by designers, who find themselves working in other disciplines and non-designers, as a route to problem-solving and innovation. In particular, the complexity of health services provision and the call for increased innovation has led to increased use of design methods in healthcare to develop services and as a method to support problem solving in patients. There are complexities when conducting this type of design-led project in healthcare, where there can be conflicting worldviews on evidence and knowledge, and strict ethical procedures to contend with. This thesis follows the journey of the researcher as they navigate this whilst ultimately remaining true to a RtD approach to explore healthcare service provision. The study provides new insights on RtD in healthcare. Interviews and reflective practice suggest that design practice was successful to understand the context, build trust, visualise services, understand service complexity and navigate difficult topics. Self-report data from the workshops found that adolescents enjoyed the sessions and there was some acquisition of ‘designerly’ skills. The study adds to knowledge in the field. It acknowledges the potential value of design to support adolescents but recognises that this has a long way to go with much more work needed. Key findings are: The study argues the value of research through design in healthcare to support healthcare service provision and the future need to articulate this to a healthcare audience. In order to present some of this study approach to healthcare it argues the need of design facilitation to be a recognised design practice. And further unpacking of the specific skills that design professionals can bring to this sector. the recognition of which would encourage design involvement earlier in studies. Finally based on experiences from the study it provides recommendations for other design researchers

Development and implementation of Heart Team: a Facebook support group for cardiac patients

Improving adherence to cardiac rehabilitation programs should reduce the risk of repeat cardiac events and improve quality of life. We present the process of developing and piloting a Facebook support group, Heart Team, which other cardiac health professionals could adapt and trial at their hospital, rehabilitation or community service.Cardiovascular Disease Research Network Project Grant by the Australia Heart Foundatio

The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial

Background: The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD). Methods: Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients’ homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients’/caregivers’ coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes. Results: 517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p < .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41). Conclusions: Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports. Trial registration NCT00852852; 26 Feb 200

Variant Salmonella Genomic Island 1 Antibiotic Resistance Gene Cluster in Salmonella enterica Serovar Albany

Salmonella genomic island 1 (SGI1) contains an antibiotic resistance gene cluster and has been previously identified in multidrug-resistant Salmonella enterica serovars Typhimurium DT104, Agona, and Paratyphi B. We identified a variant SGI1 antibiotic-resistance gene cluster in a multidrug-resistant strain of S. enterica serovar Albany isolated from food fish from Thailand and imported to France. In this strain, the streptomycin resistance aadA2 gene cassette in one of the SGI1 integrons was replaced by a dfrA1 gene cassette, conferring resistance to trimethoprim and an open reading frame of unknown function. Thus, this serovar Albany strain represents the fourth S. enterica serovar in which SGI1 has been identified and the first SGI1 example where gene cassette replacement took place in one of its integron structures. The antibiotic resistance gene cluster of serovar Albany strain 7205.00 constitutes a new SGI1 variant; we propose a name of SGI1-F

UK research priority setting for childhood neurological conditions

Aim: To identify research priorities regarding the effectiveness of interventions for children and young people (CYP) with childhood neurological conditions (CNCs). These include common conditions such as epilepsies and cerebral palsy, as well as many rare conditions. Method: The National Institute for Health and Care Research (NIHR) and the James Lind Alliance (JLA) champion and facilitate priority setting partnerships (PSPs) between patients, caregivers, and clinicians (stakeholders) to identify the most important unanswered questions for research (uncertainties). A NIHR–JLA and British Paediatric Neurology Association collaboration used the JLA PSP methodology. This consisted of two surveys to stakeholders: survey 1 (to identify uncertainties) and survey 2 (a prioritization survey). The final top 10 priorities were agreed by consensus in a stakeholder workshop. Results: One hundred and thirty‐two charities and partner organizations were invited to participate. In survey 1, 701 participants (70% non‐clinicians, including CYP and parent and caregivers) submitted 1800 uncertainties from which 44 uncertainties were identified for prioritization in survey 2; from these, 1451 participants (83% non‐clinicians) selected their top 10 priorities. An unweighted amalgamated score across participant roles was used to select 26. In the final workshop, 14 health care professionals, 11 parent and caregivers, and two CYP ranked the 26 questions to finalize the top 10 priorities. Ten top priority questions were identified regarding interventions to treat CYP with CNCs and their associated comorbidities, for example, sleep, emotional well‐being, and distressing symptoms. Interpretation: The results of this study will inform research into the effectiveness of interventions for children with neurological conditions

Ageing-associated changes in transcriptional elongation influence longevity

Physiological homeostasis becomes compromised during ageing, as a result of impairment of cellular processes, including transcription and RNA splicing1-4. However, the molecular mechanisms leading to the loss of transcriptional fidelity are so far elusive, as are ways of preventing it. Here we profiled and analysed genome-wide, ageing-related changes in transcriptional processes across different organisms: nematodes, fruitflies, mice, rats and humans. The average transcriptional elongation speed (RNA polymerase II speed) increased with age in all five species. Along with these changes in elongation speed, we observed changes in splicing, including a reduction of unspliced transcripts and the formation of more circular RNAs. Two lifespan-extending interventions, dietary restriction and lowered insulin-IGF signalling, both reversed most of these ageing-related changes. Genetic variants in RNA polymerase II that reduced its speed in worms5 and flies6 increased their lifespan. Similarly, reducing the speed of RNA polymerase II by overexpressing histone components, to counter age-associated changes in nucleosome positioning, also extended lifespan in flies and the division potential of human cells. Our findings uncover fundamental molecular mechanisms underlying animal ageing and lifespan-extending interventions, and point to possible preventive measures

Airway Epithelial Cell Migration Dynamics: Mmp-9 Role in Cell–Extracellular Matrix Remodeling

Cell spreading and migration associated with the expression of the 92-kD gelatinase (matrix metalloproteinase 9 or MMP-9) are important mechanisms involved in the repair of the respiratory epithelium. We investigated the location of MMP-9 and its potential role in migrating human bronchial epithelial cells (HBEC). In vivo and in vitro, MMP-9 accumulated in migrating HBEC located at the leading edge of a wound and MMP-9 expression paralleled cell migration speed. MMP-9 accumulated through an actin-dependent pathway in the advancing lamellipodia of migrating cells and was subsequently found active in the extracellular matrix (ECM). Lamellipodia became anchored through primordial contacts established with type IV collagen. MMP-9 became amassed behind collagen IV where there were fewer cell–ECM contacts. Both collagen IV and MMP-9 were involved in cell migration because when cell–collagen IV interaction was blocked, cells spread slightly but did not migrate; and when MMP-9 activation was prevented, cells remained fixed on primordial contacts and did not advance at all. These observations suggest that MMP-9 controls the migration of repairing HBEC by remodeling the provisional ECM implicated in primordial contacts