FIRE (facilitating implementation of research evidence) : a study protocol

Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids

A Cross-years Course Leader Collaboration to Improve Veterinary Students' Assessment and Feedback Literacy

Since 2022 course leaders (CLs) from across years 1-4 of the BVMS programme have collaborated to standardise and improve assessment and feedback practices. Given the spiral nature of the curriculum, where topics are revisited from the Foundation Phase (year 1 and 2) to Clinical Phase (year 3 and 4), it was determined that there should be greater consistency to assessment and feedback, and there were multifaceted reasons driving the need for advancement of the existing practices. From the student perspective, a recurrent theme in student feedback was the limited nature of exam feedback and lack of clarity about how they could improve their exam performance. Also, following Covid-19 and the pivot to online examinations, students were unhappy they had lost the opportunity to review their paper exam scripts. For CLs, students appeared to be starting university with poorer assessment literacy and less effective study techniques, and many students were passing at the borderline level which suggested a need for better guidance on identifying knowledge gaps. Individualised post-exam support was also being offered to failing students only, which was deemed inequitable for those who were passing, but whose performance could still improve. A collaborative approach by the CLs was deemed integral for adopting practices that were consistent, fair and sustainable, both within and between the years. The current challenges and differences across the programme were identified, and the following changes implemented: - Assessment literacy training was embedded within all years. - Standardised processes were developed for the provision of detailed individual and class assessment feedback. - Online exam script review sessions were run, which adopted a cohort-wide rather than individual student approach. To evaluate student perceptions of these changes, a mixed-methods survey study was administered in semester 2 to all students in years 2-4. Results from117 respondents, showed the majority utilised their individual (78.4%) and class (69.9%) feedback and found the level of detail provided to be useful. Just over half (61.2%) of the students agreed that the exam review sessions helped them to understand the marks they received, 59.5% thought it would help them to improve their performance in the next exam, and 66.4% said it encouraged them to identify material they needed to revise. When asked to describe what they could do as individuals to support their improved engagement or understanding of assessment feedback, themes included using feedback to target revision of past material, modifying approaches to study planning, engaging more with staff, academic support services and peers, and better utilisation of ILOs to plan revision. The survey will be administered annually to determine longitudinal changes in perceptions and behaviours. These collaborative developments have established a cohesive programme approach to ensure that students have improved assessment literacy and are developing study techniques that can be effectively applied across all years

A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation

Background The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial. Methods/Design The randomised controlled trial, with nested economic and process evaluations, recruited 2,104 inactive men and women aged 16+ with coronary heart disease (CHD) risk factors and/or mild to moderate depression, anxiety or stress. Participants were recruited from 12 local health boards in Wales and referred directly by health professionals working in a range of health care settings. Consenting participants were randomised to either a 16 week tailored exercise programme run by qualified exercise professionals at community sports centres (intervention), or received an information booklet on physical activity (control). A range of validated measures assessing physical activity, mental health, psycho-social processes and health economics were administered at 6 and 12 months, with the primary 12 month outcome measure being 7 day Physical Activity Recall. The process evaluation explored factors determining the effectiveness or otherwise of the scheme, whilst the economic evaluation determined the relative cost-effectiveness of the scheme in terms of public spending. Discussion Evaluation of such a large scale national public health intervention presents methodological challenges in terms of trial design and implementation. This study was facilitated by early collaboration with social research and policy colleagues to develop a rigorous design which included an innovative approach to patient referral and trial recruitment, a comprehensive process evaluation examining intervention delivery and an integrated economic evaluation. This will allow a unique insight into the feasibility, effectiveness and cost effectiveness of a national exercise referral scheme for participants with CHD risk factors or mild to moderate anxiety, depression, or stress and provides a potential model for future policy evaluations

Anaesthetic management of a phaeochromocytoma excision in a dog

A nine-year-old male neutered crossbreed dog was presented for adrenalectomy following diagnosis of a phaeochromocytoma, which was confirmed by urinary normetanephrine:creatinine ratio. No clinical signs were associated with the tumour. Excess release of catecholamines from the tumour can result in marked haemodynamic derangements that require careful consideration for anaesthesia. The dog was treated before surgery with phenoxybenzamine per os. During the surgery periods of marked hypertension developed and were managed with nitroprusside and increased vapouriser output. The adrenal gland was closely adhered to the kidney and a nephrectomy was also required to fully excise the mass. A moderate amount of haemorrhage occurred during the final dissection. Hypotension persisted postoperatively and required treatment with phenylephrine and fluid therapy. The dog was discharged from hospital three days following surgery