Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention : a qualitative study

Background: Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as ‘surgical wounds healing by secondary intention’. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients’ lives. Objectives: To explore patients’ views and experiences of living with a surgical wound healing by secondary intention. Design: A qualitative, descriptive approach. Settings: Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. Participants: Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. 2 Methods: Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the ‘Framework’ approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. Findings: Alarm, shock and disbelief were frequently expressed initial reactions, particularly to “unexpected” surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients’ hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. Conclusions: Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients’ family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds

Drivers of Dyadic Cofeeding Tolerance in Pan: A Composite Measure Approach

This study aimed to construct a composite model of Dyadic Cofeeding Tolerance (DCT) in zoo-housed bonobos and chimpanzees using a validated experimental cofeeding paradigm and to investigate whether components resulting from this model differ between the two species or vary with factors such as sex, age, kinship and social bond strength. Using dimension reduction analysis on five behavioral variables from the experimental paradigm (proximity, aggression, food transfers, negative food behavior, participation), we found a two-factor model: "Tolerant Cofeeding" and "Agonistic Cofeeding". To investigate the role of social bond quality on DCT components alongside species effects, we constructed and validated a novel relationship quality model for bonobos and chimpanzees combined, resulting in two factors: Relationship Value and Incompatibility. Interestingly, bonobos and chimpanzees did not differ in DCT scores, and sex and kinship effects were identical in both species but biased by avoidance of the resource zone by male-male dyads in bonobos. Social bonds impacted DCT similarly in both species, as dyads with high Relationship Value showed more Tolerant Cofeeding, while dyads with higher Relationship Incompatibility showed more Agonistic Cofeeding. We showed that composite DCT models can be constructed that take into account both negative and positive cofeeding behavior. The resulting DCT scores were predicted by sex, kinship and social bonds in a similar fashion in both Pan species, likely reflecting their adaptability to changing socio-ecological environments. This novel operational measure to quantify cofeeding tolerance can now be applied to a wider range of species in captivity and the wild to see how variation in local socio-ecological circumstances influences fitness interdependence and cofeeding tolerance at the dyadic and group levels. This can ultimately lead to a better understanding of how local environments have shaped the evolution of tolerance in humans and other species

Student motivation in teacher learning groups

The importance of social learning for student teachers’ professional development has gained acknowledgement. One way in which teacher training institutes incorporate social learning in their curricula is by involving students in teacher learning groups (TLGs). Participation in TLGs not only enables students to develop social skills, but also prevents them from feeling isolated and losing motivation for their studies. The present study uses convergent parallel mixed-methods design to search for relationships between TLGs’ social configuration and motivation among participating students (n = 55) of four Dutch primary teacher training institutes. The analyses reveal seven key variables for student motivation in TLGs: autonomous choices regarding content; new knowledge; sharing, support, and social skills; personal goals; autonomous choices regarding collaborating partners; scaffolding; equality in an informal atmosphere. Based on the findings, we advise teacher training institutes to consider integrating homogeneous and heterogeneous TLGs in their curricula, because both are valuable for student motivation

Participation of Parents of Hospitalized Children in Medical Rounds: A Qualitative Study on Contributory Factors

Purpose: Factors that promote parents' participation during medical rounds on their hospitalized child have not been fully addressed. The aim of this study was to identify factors that promote the participation of family members during medical rounds. Design and methods: This was a descriptive qualitative study using elements of analysis from the grounded theory method. Semi-structured interviews and non-participant observations were performed from December 2015 until June 2016 and took place on a general academic pediatric ward where the age of children did not exceed 12 months. Results: In total 20 participants were interviewed: 10 pediatric nurses, 4 pediatricians and 6 parents. In addition, five medical rounds were videotaped. Five themes emerged from the analyses of the interviews and videotapes: “conditions”, “structure of medical rounds”, “cast”, “adaptive professionals” and “parents' participation as a process”. Conclusion: Contextual factors, such as the room and seating arrangement, as well as the willingness of healthcare professionals to work together with the parents are important in enabling parents' participation. To promote active participation, professionals have to communicate in layman's terms and information given by parents has to be taken seriously. Support and coaching of parents during the medical rounds and evaluating the rounds are meaningful factors. Practice implications: These findings help healthcare professionals to restructure the traditional medical rounds to enable parents' participation. The identified communication skills and attitudes can enhance the competencies of nurses and doctors as communicators and collaborators. This urge the need for more specific education for professionals to promote parents' participation

A Complement Atlas identifies interleukin 6 dependent alternative pathway dysregulation as a key druggable feature of COVID-19

To improve COVID-19 therapy, it is essential to understand the mechanisms driving critical illness. The complement system is an essential part of innate host defense that can also contribute to injury. All complement pathways have been implicated in COVID-19 pathogenesis, however the upstream drivers and downstream consequences on tissue injury remain ill-defined. Here, we demonstrate that complement activation is mediated by the alternative pathway and we provide a comprehensive atlas of the alterations in complement around the time of respiratory deterioration. Proteome and single-cell sequencing mapping across cell types and tissues reveals a division of labor between lung epithelial, stromal and myeloid cells in the production of complement, in addition to liver-derived factors. Upstream, IL-6 drives complement responses, linking complement dysregulation to approved COVID-19 therapies. In an exploratory proteomic study, C5 inhibition improves epithelial damage and markers of disease severity. Collectively, these results identify complement dysregulation as a key druggable feature of COVID-19