Are We Listening? Making sense of classroom behaviour with pupils and parents Jackie Ravet Trentham Books (2007). Pp. 164

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Digital Storytelling in Higher Education : International Perspectives

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Human and Technological Resources Needed to Develop and Sustain A City-Wide Educational Data Observatory

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Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill

Introduction: Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. However, studies to date have focused on selected intensive care unit (ICU) populations. We sought to determine the occurrence and relation of hyperlactatemia with ICU mortality in all patients admitted to four ICUs in a large regional critical care system. Methods: All adults ([greater than or equal to] 18 years) admitted to ICUs in the Calgary Health Region (population 1.2 million) during 2003 to 2006 were included retrospectively. Lactate determinations were at the discretion of the attending service and hyperlactatemia was defined by a lactate level > 2 mmol/L. Results: A total of 13,932 ICU admissions occurred among 11,581 patients. The median age was 63 years (37% female), the mean APACHE II score was 25 ± 9 (n = 13,922). At presentation (within first day of admission), 12,246 patients had at least one lactate determination and the median peak lactate was 1.8 (IQR 1.2 to 2.9) mmol/L. The cumulative incidence of at least one documented episode of hyperlactatemia was 5578/13,932 (40%); 5058 (36%) patients had hyperlactatemia at presentation, and a further 520 (4%) developed hyperlactatemia subsequently. The incidence of hyperlactatemia varied significantly by major admitting diagnostic category (P < 0.001) and was highest among neuro/trauma patients 1053/2328 (45%), followed by medical 2047/4935 (41%), other surgical 900/2274 (40%), and cardiac surgical 1578/4395 (36%). Among a cohort of 9107 first admissions with ICU stay of at least one day, both hyperlactatemia at presentation (712/3634 (20%) vs. 289/5473 (5%); P < 0.001) and its later development (101/379 (27%) vs. 188/5094 (4%); P < 0.001) were associated with significantly increased case fatality rates as compared with patients without elevated lactate. After controlling for confounding effects in multivariable logistic regression analysis, hyperlactatemia was an independent risk factor for death. Conclusions: Hyperlactatemia is common among the critically ill and predicts risk for death.</p

The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units

Introduction: Although sodium disturbances are common in hospitalised patients, few studies have specifically investigated the epidemiology of sodium disturbances in the intensive care unit (ICU). The objectives of this study were to describe the incidence of ICU-acquired hyponatraemia and hypernatraemia and assess their effects on outcome in the ICU. Methods: We identified 8142 consecutive adults (18 years of age or older) admitted to three medical-surgical ICUs between 1 January 2000 and 31 December 2006 who were documented to have normal serum sodium levels (133 to 145 mmol/L) during the first day of ICU admission. ICU acquired hyponatraemia and hypernatraemia were respectively defined as a change in serum sodium concentration to below 133 mmol/L or above 145 mmol/L following day one in the ICU. Results: A first episode of ICU-acquired hyponatraemia developed in 917 (11%) patients and hypernatraemia in 2157 (26%) patients with an incidence density of 3.1 and 7.4 per 100 days of ICU admission, respectively, during 29,142 ICU admission days. The incidence of both ICU-acquired hyponatraemia (age, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of ICU stay, level of consciousness, serum glucose level, body temperature, serum potassium level) and ICU-acquired hypernatraemia (baseline creatinine, APACHE II score, mechanical ventilation, length of ICU stay, body temperature, serum potassium level, level of care) varied according to patients' characteristics. Compared with patients with normal serum sodium levels, hospital mortality was increased in patients with ICU-acquired hyponatraemia (16% versus 28%, p < 0.001) and ICU-acquired hypernatraemia (16% versus 34%, p < 0.001). Conclusions: ICU-acquired hyponatraemia and hypernatraemia are common in critically ill patients and are associated with increased risk of hospital mortality.</p

Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas : a mixed-methods study within a national register

ACKNOWLEDGEMENTS We are grateful to the staff of the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis register who at the time of the study were Elizabeth Ferguson-Jones, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011. FUNDING The BSRBR-AS is funded by the British Society of Rheumatology who have received funding for this, in part, from Pfizer, Abbvie and UCB. These companies receive advance copies of results but have no input in determining the topics for analysis or work involved in undertaking it. This work was conducted within the Versus Arthritis/Medical Research Council Centre for Musculoskeletal Work and Health (Grant No: 20665).Peer reviewedPublisher PD

Lessons from experiences of accessing healthcare during the pandemic for remobilising rheumatology services : a national mixed methods study

Acknowledgements We are grateful to our patient partner Inga Wood for help with designing the interview schedule and for commenting on the manuscript and Lynne Laidlaw for help with designing the questionnaire. The authors do not report any conflicts of interest. GJM conceived the idea for the study and all authors were involved in the detailed planning. LM, KS, and RH conducted the qualitative analysis with input from JP. MB and GJ undertook the questionnaire analysis. LM and RH integrated quantitative and qualitative findings, and KS, JP and GJM contributed to interpretation of findings. RH and LM drafted the manuscript and all authors contributed important intellectual content via written comments. Funding This work was supported by Versus Arthritis [Grant No: 20748] and the British Society for Rheumatology. The funding for the original studies included were from Versus Arthritis (MAmMOTH) and the British Society for Rheumatology (BSRBR-AS and BSR-PsA). LM is supported by the MRC/Versus Arthritis Centre for Musculoskeletal Health and Work [Grant No: 20665].Peer reviewedPublisher PD

Bringing the walk with ease programme to the UK: a mixed-methods study to assess the relevance, acceptability, and feasibility of implementation for people with arthritis and musculoskeletal conditions.

Developed in the United States (US), Walk With Ease (WWE) is a popular evidence-based, 6-week community walking programme for adults with arthritis, delivered in either an instructor-led or self-directed format. While WWE has expanded into communities across the USA, it is relatively unknown in other countries across the globe. This study, in collaboration with community and patient partners, aimed to examine the relevance, acceptability and feasibility of introducing WWE into a UK context. After initial cultural adaptation, participants were recruited into the study. Eligible (≥18 years, doctor diagnosed arthritis (confirmed or self-report), self-reported joint symptoms in last 30 days, BMI ≥25 kg/m2, and <150 min/week of moderate/vigorous PA) and consented participants were randomized into two groups: WWE programme or usual care. A mixed-methods analysis approach integrated quantitative data (physical performance assessment; baseline and post-six week programme questionnaire) and qualitative data (narrative interviews exploring participants' pre- and post-WWE experiences and stakeholders' perceptions). Of 149 participants, the majority were women (70%) aged ≥60 years (76%). Among the 97 receiving the programme, 52 chose instructor-led; 45 chose self-directed. Participants found WWE relevant and acceptable—99% indicating they would recommend WWE to family/friends. Within both WWE formats, mixed differences representing improvement were observed at 6 weeks from baseline for physical performance and arthritis symptoms. Emergent themes included improved motivation, health, and social well-being. WWE is a relevant and acceptable walking programme with scope for wider implementation to support UK health and well-being policy strategies

Development of a hybrid sleep and physical activity improvement intervention for adults with osteoarthritis-related pain and sleep disturbance : a focus group study with potential users

Objective: Suboptimal sleep and physical activity are common among people living with osteoarthritis (OA) and simultaneous improvements in both may have a beneficial impact on pain. This study aimed to gather perspectives of people living with OA on important aspects to incorporate in a hybrid sleep and physical activity improvement intervention for OA pain management. Design: Qualitative study using two rounds of two focus groups. Setting and participants: Focus groups were conducted with adults living with OA-related chronic pain and sleep disturbances. Eighteen people attended focus groups in January 2020 and, of these, 16 attended subsequent focus groups in February 2020. Methods: Discussion at the first round of focus groups informed generation of prototype intervention materials that were shared, discussed and refined at the second round of focus groups. Thematic analysis was used to identify themes and sub-themes from the data. Results: Three themes, each with three sub-themes, were identified: facilitators of engagement with the intervention (sub-themes: motivational language, accountability and education); barriers to engagement (sub-themes: suboptimal interaction with healthcare practitioners, recording behaviour as burdensome/disruptive and uncertainty about technique) and characteristics of a physical activity intervention component (sub-themes: tailored, sustainable and supported). Conclusion: We have identified important aspects to incorporate into the design and delivery of a hybrid sleep and physical activity improvement intervention for OA pain management. Insights will be incorporated into intervention materials and protocols, with feasibility and acceptability assessed in a future study

The effect of COVID19 public health restrictions on the health of people with musculoskeletal conditions and symptoms : the CONTAIN study

Funding This work was supported by Versus Arthritis [Grant Number: 20748] and the British Society for Rheumatology. The funding for the original studies included were from Versus Arthritis (MAmMOTH) and the British Society for Rheumatology (BSRBR-AS and BSR-PsA). Daniel Whibley is supported by a Versus Arthritis Foundation Fellowship [Grant Number 21742] Acknowledgements We are grateful to help from staff at the National Ankylosing Spondylitis Society and specifically to patient partners Lynne Laidlaw (for help with designing questionnaire) and Susan Davis (for commenting on the manuscript). The authors do not report any conflicts of interest. GJM conceived the idea for the study and all authors were involved in the detailed planning. MH, KK, EM-B and MB were responsible for obtaining ethics and research governance approvals. MB undertook the analysis which was independently verified by GTJ. GJM, with input from MB, drafted the manuscript, and all authors contributed important intellectual content via written comments. We thank Linda Dean for comments on the manuscript. Data Availability Statement The data within the article which relate to the collection of BSR register data are owned by the BSR – access to these data are subject to application being made to the BSR: Registers (rheumatology.org.uk) . For other data in the article, application can be made for access to the data by contacting the corresponding author.Peer reviewedPublisher PD