Simulation for healthcare students: lessons learned from C19

Abstract. Part of the higher education (HE) experience of our healthcare students is to implement theoretical lessons learned within a practice environment – most often within the country’s National Health Service (NHS). With the emergence of the worldwide C19 pandemic, HE institutions had to reconfigure ways to support students to experience practical elements of their course online or via simulation. With the help of external funding from Health Education England (HEE), Bournemouth University piloted a variety of simulated projects across a variety of professions including: paramedicine and child and adult nursing. Students were able to access simulated skills via online and virtual reality (VR) resources, contributing to their learning experience during a worldwide pandemic. This has created a platform for further investment and educational pedagogy around simulation in healthcare provision, contributing to workforce development and future proofing educational establishment

Exercise Martian Attack!: Using VR feedback as a reflective tool for paramedic science students.

Paramedic students have had to overcome the restrictions Covid-19 with many of their clinical skills moving online, limiting opportunities to engage with clinical practice partners, a key requirement of their professional programme. Social distancing has been challenging to overcome and the paramedic teaching team’s solution was to offer a the University underground carpark to stage a simulated Casualty Clearing Point for a Major Incident Martian Attack

Perfusion by Arterial Spin Labelling following Single Dose Tadalafil in Small Vessel Disease (PASTIS): study protocol for a randomized controlled trial

Background Cerebral small vessel disease is a common cause of vascular cognitive impairment in older people, with no licensed treatment. Cerebral blood flow is reduced in small vessel disease. Tadalafil is a widely prescribed phosphodiesterase-5 inhibitor that increases blood flow in other vascular territories. The aim of this trial is to test the hypothesis that tadalafil increases cerebral blood flow in older people with small vessel disease. Methods/design Perfusion by Arterial Spin labelling following Single dose Tadalafil In Small vessel disease (PASTIS) is a phase II randomised double-blind crossover trial. In two visits, 7-30 days apart, participants undergo arterial spin labelling to measure cerebral blood flow and a battery of cognitive tests, pre- and post-dosing with oral tadalafil (20 mg) or placebo. Sample size: 54 participants are required to detect a 15% increase in cerebral blood flow in subcortical white matter (p < 0.05, 90% power). Primary outcomes are cerebral blood flow in subcortical white matter and deep grey nuclei. Secondary outcomes are cortical grey matter cerebral blood flow and performance on cognitive tests (reaction time, information processing speed, digit span forwards and backwards, semantic fluency). Discussion Recruitment started on 4th September 2015 and 36 participants have completed to date (19th April 2017). No serious adverse events have occurred. All participants have been recruited from one centre, St George’s University Hospitals NHS Foundation Trust. Trial registration European Union Clinical Trials Register: EudraCT number 2015-001235-20. Registered on 13 May 2015

AVURT: aspirin versus placebo for the treatment of venous leg ulcers a Phase II pilot randomised controlled trial

Background Venous leg ulcers (VLUs) are the most common cause of leg ulceration, affecting 1 in 100 adults. VLUs may take many months to heal (25% fail to heal). Estimated prevalence is between 1% and 3% of the elderly population. Compression is the mainstay of treatment and few additional therapies exist to improve healing. Two previous trials have indicated that low-dose aspirin, as an adjunct to standard care, may improve healing time, but these trials were insufficiently robust. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established. Objectives Primary objective – to assess the effects of 300 mg of aspirin (daily) versus placebo on the time to healing of the reference VLU. Secondary objectives – to assess the feasibility of leading into a larger pragmatic Phase III trial and the safety of aspirin in this population. Design A multicentred, pilot, Phase II randomised double-blind, parallel-group, placebo-controlled efficacy trial. Setting Community leg ulcer clinics or services, hospital outpatient clinics, leg ulcer clinics, tissue viability clinics and wound clinics in England, Wales and Scotland. Participants Patients aged ≥ 18 years with a chronic VLU (i.e. the VLU is > 6 weeks in duration or the patient has a history of VLU) and who are not regularly taking aspirin. Interventions 300 mg of daily oral aspirin versus placebo. All patients were offered care in accordance with Scottish Intercollegiate Guidelines Network (SIGN) guidance with multicomponent compression therapy aiming to deliver 40 mmHg at the ankle when possible. Randomisation Participants were allocated in a 1 : 1 (aspirin : placebo) ratio by the Research Pharmacy, St George’s University Hospitals NHS Foundation Trust, using a randomisation schedule generated in advance by the investigational medicinal product manufacturer. Randomisation was stratified according to ulcer size (≤ 5cm2 or > 5cm2). Main outcome measure The primary outcome was time to healing of the largest eligible ulcer (reference ulcer). Feasibility results – recruitment 27 patients were recruited from eight sites over a period of 8 months. The target of 100 patients was not achieved and two sites did not recruit. Barriers to recruitment included a short recruitment window and a large proportion of participants failing to meet the eligibility criteria. Results The average age of the 27 randomised participants (placebo, n = 13; aspirin, n = 14) was 62 years (standard deviation 13 years), and two-thirds were male (n = 18). Participants had their reference ulcer for a median of 15 months, and the median size of ulcer was 17.1 cm2. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis for log-ulcer area and duration (hazard ratio 0.58, 95% confidence interval 0.18 to 1.85; p = 0.357). One expected, related serious adverse event was recorded for a participant in the aspirin group. Limitations The trial under-recruited because many patients did not meet the eligibility criteria. Conclusions There was no evidence that aspirin was efficacious in hastening the healing of chronic VLUs. It can be concluded that a larger Phase III (effectiveness) trial would not be feasible. Trial registration Clinical Trials.gov NCT02333123; European Clinical Trials Database (EudraCT) 2014-003979-39. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 55. See the NIHR Journals Library website for further project information

Fusion Learning Colloquium 2022 - Proceedings

This is the proceedings of the 2022 Fusion Learning Colloquium held at Bournemouth University in the UK

Disability and Dignity-Enabling Home Environments

In Canada where long-term care is primarily oriented to elderly persons and affordable accessible housing is limited, younger disabled adults may be living in circumstances that do not meet their health needs and contribute to their social exclusion. The purpose of this study was to undertake an ethical analysis of what constitute an ‘adequate’ home environment for adults with significant mobility disabilities. An integrated design was used that combined qualitative interviews with normative ethical analysis in an iterative process. Twenty interviews with 19 participants were conducted in Ontario, Canada with two groups: younger adults (ages 18 to 55) with mobility disabilities and ‘decision-makers’ who consisted of policy makers, program administrators and discharge planners. Data were analyzed using a critical disability ethics approach and processes of reflective equilibrium. Drawing on Nora Jacobson’s taxonomy of dignity and pluralistic approaches to social justice, the concept of ‘social dignity’ provides a lens for exploring the adequacy of home environments for disabled people. Analyses suggested seven threshold conditions necessary for a dignity-enabling home: the ability to form and sustain meaningful relationships; access to community and civic life; access to control and flexibility of daily activities; access to opportunities for self-expression and identity affirmation; access to respectful relationships with attendants; access to opportunities to participate in school, work or leisure; access to physical, psychological and ontological security. The results have implications for housing, health and social care policies, and political reform. Social-dignity provides a normative ethical grounding for assessing the adequacy of home environments. The threshold elements outline specific dignity-enabling conditions that are open to further specification or elaboration in different contexts.Canadian Institutes of Health Research Catalyst Grant: Ethics (#87367

Child and Adolescent Mass Casualty Simulations Filmed in 360- Healthcare Practitioners Working Together

Objective: To provide realistic scenarios, experienced in real time and filmed using 360-degree videos, so that students feel more confident when qualifying.   Methods: First and third year paramedic students took part in mass casualty scenarios filmed at our student's union building. They worked with Critical Care Practitioners, Academics, and the National Ambulance Resilience Unit to create handover videos involving assessing casualties and providing handovers to other health care practitioners. Follow up 360 videos were created involving mental health and children’s nursing students assessing the casualties and making clinical decisions. Students could view the 360 videos using virtual reality headsets (Googlecardboard and Oculus Quest). Data was collected via online survey and focus group discussions (FGDs) and was thematically analysed (Braun and Clarke 2006). Ethical Clearance was obtained from our University committee. Results: Thirty-two students completed the survey, and eight students took part in FGDs. Eighty percent of participants thought that the learning resources will be either quite or extremely useful for student’s learning. One student commented that “it will make assessment of mental health patients a lot easier for students.” Another viewed the experience as “very useful, realistic and beneficial… It brought a lot of clarity to the previous weeks learning”. Finally, one student suggested that the video learning resources could be used as “an interacting activity followed by a discussion during the lecture…. The lecturer will be able to pause a video and focus on a selected episode of nursing care.”   Conclusions: ​Students found the simulations useful as a compliment to traditional learning approaches. These videos as an additional resource widens student access to these vital learning experiences usually limited by staffing and equipment/room capacity limitations. This research project brought together academics and practitioners from across the hospital and university. Future work should build on this collaborative approach to produce teaching aids and experiences, in particular providing opportunities for students to communicate with and help to deescalate patients experiencing mental health episodes