Measuring the Contribution and Complexity of Nurse and Physiotherapy Consultants: A Feasibility Study

Advanced practice roles in nursing and other health professions have become integral to a range of healthcare services world-wide providing experienced practitioners with the opportunity to extend their roles and influence decision making whilst maintaining patient contact. However, there has been limited research to evaluate the impact on health services of these advanced practice roles

Effect of a 2-tier rapid response system on patient outcome and staff satisfaction

Background: Rapid response systems (RRS) have been recommended as a strategy to prevent and treat deterioration in acute care patients. Questions regarding the most effective characteristics of RRS and strategies for implementing these systems remain. Aims: The aims of this study were to (i) describe the structures and processes used to implement a 2-tier RRS, (ii) determine the comparative prevalence of deteriorating patients and incidence of unplanned intensive care unit (ICU) admission and cardiac arrest prior to and after implementation of the RRS, and (iii) determine clinician satisfaction with the RRS. Method: A quasi-experimental pre-test, post-test design was used to assess patient related outcomes and clinician satisfaction prior to and after implementation of a 2-tier RRS in a tertiary metropolitan hospital. Primary components of the RRS included an ICU Outreach Nurse and a Rapid Response Team. Prevalence of deteriorating patients was assessed through a point prevalence assessment and chart audit. Incidence of unplanned admission to ICU and cardiac arrests were accessed from routine hospital databases. Clinician satisfaction was measured through surveys. Results: Prevalence of patients who met medical emergency call criteria without current treatment reduced from 3% prior to RRS implementation to 1% after implementation; a similar reduction from 9% to 3% was identified on chart review. The number of unplanned admissions to ICU increased slightly from 17.4/month prior to RRS implementation to 18.1/month after implementation (p = 0.45) while cardiac arrests reduced slightly from 7.5/month to 5.6/month (p = 0.22) but neither of these changes were statistically significant. Staff satisfaction with the RRS was generally high. Conclusion: The 2-tier RRS was accessed by staff to assist with care of deteriorating patients in a large, tertiary hospital. High levels of satisfaction have been reported by clinical staff

A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participant-blinded randomised controlled trial.

UNLABELLED: BACKGROUND: Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced. Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk. The type of insole best suited to achieve this is unknown. This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet. METHOD: A participant-blinded randomised controlled trial recruited 119 neuropathic participants with diabetes who were randomly allocated to custom-made functional or prefabricated insoles. Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system. Primary outcomes were: peak pressure, forefoot pressure time integral, total contact area, forefoot rate of load, duration of load as a percentage of stance. Secondary outcomes were patient perceived foot health (Bristol Foot Score), quality of life (Audit of Diabetes Dependent Quality of Life). We also assessed cost of supply and fitting. Analysis was by intention-to-treat. RESULTS: There were no differences between insoles in peak pressure, or three of the other four kinetic measures. The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue (27% vs. 22%), remained more effective at six month follow-up (30% vs. 24%, p=0.001), but was more expensive (UK £656 vs. £554, p<0.001). Full compliance (minimum wear 7 hours a day 7 days per week) was reported by 40% of participants and 76% of participants reported a minimum wear of 5 hours a day 5 days per week. There was no difference in patient perception between insoles. CONCLUSION: The custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure. We recommend that where clinically appropriate, the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy. TRIAL REGISTRATION: Clinical trials.gov (NCT00999635). Note: this trial was registered on completion

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Development of Melt Spun Polymer Nanofibers

Melt spinning is an inexpensive means of producing highly oriented and crystalline fibers. Industrial production rates are typically 1000s of meters per minute. Creating “good quality” fibers becomes increasingly difficult as the diameter of the fibers is decreased to below approximately 10-15 microns. One approach to making very small fibers is to use High Island Count Islands-in-the Sea (HICINS) technology. In this approach, smaller streams of polymer called the “islands” are incorporated into a larger stream of polymer called the “sea” or confining polymer, which is then spun into a fiber. The resulting fiber can then be drawn to produce very small fibers or nanofibers (island polymer). Bi-component fiber trials were conducted to produce nanofibers having a diameter of 100 nm or less. Trials using polypropylene as the nanofibers (islands) with poly(lactic acid) or polyethylene as the confining polymer (sea) were fabricated. The nanofiber confinement diameter was controlled by varying the number and volume fraction of the islands as well as processing conditions. We will discuss the methodology for reaching 100 nm diameter fibers and the characterization of those fibers

Enabling intellectual leadership in precarious times: the contribution of the professional doctorate

This chapter explores higher education as a site of developing professional intellectual leadership. By this we mean the opportunities for professionals (e.g., law, social work, medicine, nursing, pharmacy, business) to undertake postgraduate doctoral projects. Here we focus on educational professionals who have undertaken a part-time Doctorate in Education (EdD), whereby study has been combined with full time employment. The EdD programme requires educational professionals to undertake independent primary research that is original and makes a contribution to a research field. In addition, the EdD interplays research methodology, methods and analysis with professional identities, practices and agendas, and as such it challenges educational professionals to critically reflect on their daily practices, and intellectual leadership within and beyond the organisation where they are employed. Such intellectual leadership is required to engage with the purposes of education, as well as the design of the curriculum, assessment, and pedagogical practices, and increasingly the focus is on organisational prowess within a competitive market. Undertaking doctoral work is therefore risky for educational professionals in a number of ways: first, it requires the individual to engage in learning that may challenge accepted professional strategies and tactics within the organisation; and second, such learning may make people vulnerable within performance management processes, and so their employment and livelihood could be in danger. Precarity therefore operates in two ways; it is both a productive change process through enabling the professional to think and do otherwise, but it is also deemed to be potentially inefficient because such learning interrupts the high stakes delivery agendas that educational services are required to comply with. We will therefore examine what it means for educational professionals to seek to develop intellectual leadership—at a time when it is not required to operate in the market—in two main ways: first, we will contextualise the issues through examining recent empirical research into the development of professional doctorate student identities, the impact of professional doctorates on organisational change and the imperative of critical reflexivity as a leader negotiating the roles of practitioner and researcher. Second, we will present and use a series of vignettes from our experiences as EdD graduates, where we will examine the complexity, challenges, location and practices of intellectual leadership. The analysis of these stories highlights the relational nature of intellectual leadership and the complex relationship between the roles of leader, practitioner and researcher. Our contribution by sharing these narratives is to show how doctoral study enabled us both to welcome the challenges and to embrace the risks of intellectual leadership