Hybrid Learning to Develop Safe Patient Handling Judgement in Occupational Therapy Students

The goal of this mixed methods pilot study was to determine the effectiveness of a hybrid pedagogy to develop safe patient handling knowledge, self-efficacy, and skills in occupational therapy students. Developing safety judgment is integral to occupational therapy education programs, which requires the deepening of knowledge associations. As evidence suggests, patient handling is taught in academic programs with traditional pedagogy. Safe patient handling requires teaching the breadth of the most relevant and contemporary theory and techniques. A growing body of evidence demonstrates the effectiveness of online education. The project author developed an evidence-based hybrid pedagogical approach that included four narrated online modules with video, photos, and asynchronous threaded discussions and a fifth hands-on lab and a case-based competency assessment module. Sixteen occupational therapy students participated in the study. Paired t-test results validated the effectiveness of the hybrid model with statistically significant pre- to post-test improvements in knowledge and self-efficacy. Content analysis of asynchronous threaded discussions and open-ended pre- and post-test responses provided evidence of improved knowledge and self-efficacy. Synthesis of the quantitative and qualitative data provided evidence to suggest improvements in judgment. The case-based competency assessment results demonstrated 75% of the students achieved the level of accomplished performance on their first attempt. Results indicated the desire for additional hands-on practice with instructor feedback to promote further skill development. Students learned safe patient handling when curriculum reflected the complexities of patient handling with adequate opportunities for problem-solving and hands-on experiences coupled with instructor feedback

Using an Accessible Room Multisensory Stimulation Environment to Reduce Dementia Associated Behaviors

Objectives: To reveal whether an accessible open floorplan Multisensory Stimulation Environment (MSSE) room design has a positive impact as a nonpharmacologic intervention for episodes of Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults living in a Memory Care Assisted Living (MCAL) facility as well as reducing the need for direct care supervision. Methods: Retrospective pre/post cohort design of 24 residents living in a Midwest MCAL facility in the United States with a diagnosis of dementia and over 65 years of age, analyzed by secondary medical chart review for 12 months to assess impact of an accessible open floorplan MSSE room design. The pre/post design analyzed secondary data over two periods of time; 6 months prior to the MSSE installation and 6 months following the MSSE installation. Results: Following the installation of an open floorplan MSSE, the number of observed BPSD episodes changed from 367 (17%) pre-test to 298 (10%) post-test over a 12-month time period. The Comparison of Proportions test determined that the difference in the proportion of BPSD episodes documented was statistically significant with clinical implications. Conclusions: The accessible open floorplan MSSE room design, located within a single-site MCAL facility, utilized as a nonpharmacological intervention for BPSD, was found in this explorative study to be effective and potentially clinically meaningful in improving behavioral episodes for older adults diagnosed with dementia in MCAL settings

Juvenile myelomonocytic leukemia displays mutations in components of the RAS pathway and the PRC2 network

International audienceJuvenile myelomonocytic leukemia (JMML) is a rare and severe myelodysplastic and myeloproliferative neoplasm of early childhood initiated by germline or somatic RAS-activating mutations. Genetic profiling and whole-exome sequencing of a large JMML cohort (118 and 30 cases, respectively) uncovered additional genetic abnormalities in 56 cases (47%). Somatic events were rare (0.38 events/Mb/case) and restricted to sporadic (49/78; 63%) or neurofibromatosis type 1 (NF1)-associated (8/8; 100%) JMML cases. Multiple concomitant genetic hits targeting the RAS pathway were identified in 13 of 78 cases (17%), disproving the concept of mutually exclusive RAS pathway mutations and defining new pathways activated in JMML involving phosphoinositide 3-kinase (PI3K) and the mTORC2 complex through RAC2 mutation. Furthermore, this study highlights PRC2 loss (26/78; 33% of sporadic JMML cases) that switches the methylation/acetylation status of lysine 27 of histone H3 in JMML cases with altered RAS and PRC2 pathways. Finally, the association between JMML outcome and mutational profile suggests a dose-dependent effect for RAS pathway activation, distinguishing very aggressive JMML rapidly progressing to acute myeloid leukemia