Involving medical students in service improvement: evaluation of a student-led, extracurricular, multidisciplinary quality improvement initiative

Background: Quality improvement (QI) is considered a duty of every doctor and, as such, it is fundamental that medical schools nurture QI skills of medical students. At a London medical school, a novel initiative was designed to involve medical students in QI. Such novel aspects include its student leadership, multidisciplinary approach and extra-curricular nature. The aim of this study is to evaluate the effectiveness of the initiative, and thus add to the experiences of existing medical student QI programs, as well as provide guidance to other institutions wishing to involve medical students in QI. / Methods: The key features of the initiative’s design is described. Its effectiveness was evaluated by the collection of retrospective data on the quality of the initiative’s QI projects (QIPs), including the proportion which: 1) reached completion; 2) resulted in a significant improvement in their primary outcome; 3) had sustained results at follow-up; 4) achieved publication; and 5) contributed towards a prize or conference presentation. / Results: There were 109 students involved throughout 10 projects from 14 different undergraduate and postgraduate courses from 2015–2019. 50% of the initiative’s projects achieved a significant improvement in their primary outcome, and the proportion of projects which sustained these improvements at follow-up was 100%. Furthermore, 20% of projects were published, and 60% contributed towards a prize or conference presentation. / Conclusion: The results of this study show that the initiative was effective at involving medical students in QI. As such, other groups establishing medical student QI programs may benefit from replicating positive elements of its design and operation

Novel heart valve prosthesis with self-endothelialization potential made of modified polyhedral oligomeric silsesquioxane-nanocomposite material

In the cardiovascular system, the endothelial layer provides a natural antithrombogenic surface on the inner portion of the heart and associated vessels. For a synthetic material therefore, the ability to attract and retain endothelial or endothelial progenitor cells (EPCs), ultimately creating a single endothelial layer on its surface, is of prime importance. The authors have developed a nanocomposite polymer, based on a combination of polyhedral oligomeric silsesquioxane nanoparticles and polycarbonate urea urethane (POSS-PCU), which is biocompatible and has been used in human for the world's first synthetic trachea, tear duct, and bypass graft. In this study, the authors modified the surface of this casted nanocomposite by grafting fibronectin derived bioactive peptides [glycine-arginine-glycine-aspartic acid-glycine (GRGDG) and lauric acid conjugated GRGDG (GRGDG-LA)] to enhance the endothelialization for using heart valves leaflets from circulating EPCs. Human peripheral blood mononuclear cells were separated using Ficoll-Paque centrifugation, with harvested EPCs purified using CD34 microbead labeling and magnetic-activated cell sorting. Cells were seeded onto 96 well plates coated with POSS-PCU, GRGDG/GRGDG-LA modified POSS-PCU and PCU polymers, for a period of 21 days. Cells were studied under light, confocal, and scanning electron microscope (SEM). Fluorescence-activated cell sorting was used to analyze cell surface markers. Cell attachment and proliferation was observed in all POSS-PCU samples, significantly higher than the activity seen within the control PCU polymers (p < 0.05). Microscopic examination revealed clonal expansion and morphological changes in cells seeded on POSS-PCU. The cells expressed increasing levels of mature endothelial cell markers over time with a concurrent reduction in hematopoietic stem cell marker expression. SEM showed a mixed population of morphologically differentiated endothelial cells and EPCs. These results support the use of heart valve made with the POSS-PCU polymer and demonstrate that suitable chemical modification of this nanocomposite could increase self-endothelialization potential and reduce associated thrombotic events

Improving maternal confidence in neonatal care through a checklist intervention

Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in care of their newborn child. Based on market research, an 8-question checklist was designed, assessing maternal confidence in: feeding, jaundice, nappy care, rashes and dry skin, umbilical cord care, choking, bowel movements, and vomiting. Mothers were assessed as per the checklist, and received a score representative of their confidence in neonatal care. Mothers were followed up with a telephone call, and were assessed after a 7-day-period. Checklist scores before as compared to after the follow-up period were analysed. This process was repeated for three study cycles, with the placement of information posters on the ward prior to the second study cycle, and the stapling of the checklist to the mother's personal child health record (PCHR) prior to the third study cycle. A total of 99 mothers on the Maternity Care Unit at UCLH were enrolled in the study, and 92 were contactable after a 7-day period. During all study cycles, a significant increase in median checklist score was observed after, as compared to before, the 7-day follow up period (p < 0.001). The median difference in checklist score from baseline was greatest for the third cycle. These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care

Cardioprotection mediated by exosomes is impaired in the setting of type II diabetes but can be rescued by the use of non-diabetic exosomes in vitro

Many patients with ischaemic heart disease also have diabetes. As myocardial infarction is a major cause of mortality and morbidity in these patients, treatments that increase cell survival in response to ischaemia and reperfusion are needed. Exosomes-nano-sized, lipid vesicles released from cells-can protect the hearts of non-diabetic rats. We previously showed that exosomal HSP70 activates a cardioprotective signalling pathway in cardiomyocytes culminating in ERK1/2 and HSP27 phosphorylation. Here, we investigated whether the exosomal cardioprotective pathway remains intact in the setting of type II diabetes. Exosomes were isolated by differential centrifugation from non-diabetic and type II diabetic patients, from non-diabetic and Goto Kakizaki type II diabetic rats, and from normoglycaemic and hyperglycaemic endothelial cells. Exosome size and number were not significantly altered by diabetes. CD81 and HSP70 exosome markers were increased in diabetic rat exosomes. However, exosomes from diabetic rats no longer activated the ERK1/2 and HSP27 cardioprotective pathway and were no longer protective in a primary rat cardiomyocytes model of hypoxia and reoxygenation injury. Hyperglycaemic culture conditions were sufficient to impair protection by endothelial exosomes. Importantly, however, exosomes from non-diabetic rats retained the ability to protect cardiomyocytes from diabetic rats. Exosomes from diabetic plasma have lost the ability to protect cardiomyocytes, but protection can be restored with exosomes from non-diabetic plasma. These results support the concept that exosomes may be used to protect cardiomyocytes against ischaemia and reperfusion injury, even in the setting of type II diabetes

Wild interdisciplinarity: ethnography and computer science

© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Drawing on the experiences of a novel collaborative project between sociologists and computer scientists, this paper identifies a set of challenges for fieldwork that are generated by this wild interdisciplinarity. Public Access Wi-Fi Service was a project funded by an ‘in-the-wild’ research programme, involving the study of digital technologies within a marginalised community, with the goal of addressing digital exclusion. We argue that similar forms of research, in which social scientists are involved in the deployment of experimental technologies within real world settings, are becoming increasingly prevalent. The fieldwork for the project was highly problematic, with the result that few users of the system were successfully enrolled. We analyse why this was the case, identifying three sets of issues which emerge in the juxtaposition of interdisciplinary collaboration and wild setting. We conclude with a set of recommendations for projects involving technologists and social scientists.This research was supported by a research grant from the Engineering and Physical Sciences Research Council (EP/K012703/1) and by Horizon Digital Economy Research, RCUK grant (EP/G065802/1)

Comparative model analysis of two types of clamping elements in dynamic conditions

U radu se razmatra popustljivost sustava naprava-izradak. Razmatra se slučaj stezanja izratka s dva tipa elemenata za stezanje. Prvi tip elementa za stezanje je sa standardnim ravnim čelom. Drugi tip elementa za stezanje je specijalne izvedbe s čelom u obliku kružnog klina. Analiziran je slučaj stezanja malim vrijednostima sila stezanja pri čemu se deformacije u zonama kontakta između elemenata za stezanje i izratka pretežno odvijaju u zonama visine neravnina. Također je prikazana komparativna analiza, predhodno spomenuta, dva načina stezanja izradaka u uvjetima dinamičkih opterećenja. Specijalno dizajnirani element za stezanje s čelom oblika kružnog klina u odnosu na standardni element za stezanje s ravnim čelom ima izrazito veću steznu učinkovitost po pitanju tangencijalne nosivosti i popustljivosti.This paper studies the compliance of the fixture-workpiece system. Workpiece clamping case with two types of clamping elements is considered. The first type of clamping element is standard, with flat top, while the second one is specially designed, with round cutting insert. Analyzed was the case of workpiece clamping using small forces, whereby the deformations in the workpiece/clamping element interface are predominantly on the order of magnitude of roughness height. A comparative analysis of dynamic behaviour of both types of clamping elements is also presented. In comparison with its standard counterpart, the specially designed clamping element with round cutting insert has superior clamping performance regarding both tangential load capacity and compliance

Comparative model analysis of two types of clamping elements in dynamic conditions

U radu se razmatra popustljivost sustava naprava-izradak. Razmatra se slučaj stezanja izratka s dva tipa elemenata za stezanje. Prvi tip elementa za stezanje je sa standardnim ravnim čelom. Drugi tip elementa za stezanje je specijalne izvedbe s čelom u obliku kružnog klina. Analiziran je slučaj stezanja malim vrijednostima sila stezanja pri čemu se deformacije u zonama kontakta između elemenata za stezanje i izratka pretežno odvijaju u zonama visine neravnina. Također je prikazana komparativna analiza, predhodno spomenuta, dva načina stezanja izradaka u uvjetima dinamičkih opterećenja. Specijalno dizajnirani element za stezanje s čelom oblika kružnog klina u odnosu na standardni element za stezanje s ravnim čelom ima izrazito veću steznu učinkovitost po pitanju tangencijalne nosivosti i popustljivosti.This paper studies the compliance of the fixture-workpiece system. Workpiece clamping case with two types of clamping elements is considered. The first type of clamping element is standard, with flat top, while the second one is specially designed, with round cutting insert. Analyzed was the case of workpiece clamping using small forces, whereby the deformations in the workpiece/clamping element interface are predominantly on the order of magnitude of roughness height. A comparative analysis of dynamic behaviour of both types of clamping elements is also presented. In comparison with its standard counterpart, the specially designed clamping element with round cutting insert has superior clamping performance regarding both tangential load capacity and compliance

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment

Curcumin and diclofenac therapeutic efficacy enhancement applying transdermal hydrogel polymer films, based on carrageenan, alginate and poloxamer

Films based on carrageenan, alginate and poloxamer 407 have been formulated with the main aim to apply prepared formulations in wound healing process. The formulated films were loaded with diclofenac, an anti-inflammatory drug, as well as diclofenac and curcumin, as multipurpose drug, in order to enhance encapsulation and achieve controlled release of these low bioavailable compounds. The obtained data demonstrated improved drugs bioavailability (encapsulation efficiency higher than 90%), with achieved high, cumulative in vitro release percentages (90.10% for diclofenac; 89.85% for curcumin and 95.61% for diclofenac in mixture-incorporated films).. The results obtained using theoretical models suggested that curcumin establish stronger, primarily dispersion interactions with carrier, in comparison with diclofenac. Curcumin and diclofenac-loaded films showed a great antibacterial activity against Gram-positive bacteria strains (Bacillus subtilis and Staphylococcus aureus, inhibition zone 16.67 mm and 13.67 mm, respectively), and in vitro and in vivo studies indicated that curcumin- and diclofenac-incorporated polymer films have a great tendency, as a new transdermal dressing, to heal wounds, because diclofenac can target the inflammatory phase and reduce pain, whereas curcumin can enhance and promote wound healing process

Impact of nutraceuticals on markers of systemic inflammation: Potential relevance to cardiovascular diseases – A position paper from the International Lipid Expert Panel (ILEP)

Inflammation is a marker of arterial disease stemming from cholesterol-dependent to -independent molecular mechanisms. In recent years, the role of inflammation in atherogenesis has been underpinned by pharmacological approaches targeting systemic inflammation that have led to a significant reduction in cardiovascular disease (CVD) risk. Although the use of nutraceuticals to prevent CVD has largely focused on lipid-lowering (e.g, red-yeast rice and omega-3 fatty acids), there is growing interest and need, especially now in the time of coronavirus pandemic, in the use of nutraceuticals to reduce inflammatory markers, and potentially the inflammatory CVD burden, however, there is still not enough evidence to confirm this. Indeed, diet is an important lifestyle determinant of health and can influence both systemic and vascular inflammation, to varying extents, according to the individual nutraceutical constituents. Thus, the aim of this Position Paper is to provide the first attempt at recommendations on the use of nutraceuticals with effective anti-inflammatory properties