Virtual patient educational programme to teach counselling to clinical pharmacists: development and proof of concept

Pharmacist–patient counselling can benefit patients and optimise care, but appropriate training is required. A virtual patient (VP) tool to teach pharmacists non-vitamin K oral anticoagulant counselling was developed; the VP may be used for continuing professional development. The objective was to develop and show proof of concept of the VP. A cyclic development approach was adopted whereby the client, developers and a steering group informed VP design, content and aesthetic. This included formal and informal evaluation; ethical approval was not required. The VP received varied feedback. Positive feedback concerned the technology and the high-standard of animations. Negative elements concerned international VP use and differences in practice, also technological comments, regarding VP delivery and usability on various electronic devices. The VP was reported to be ‘valuable’ and realistic with high-quality animations. The steering group commented on VP’s clinical appropriateness, cultural relevance and usability. Areas highlighted for improvement were rectified during development, including the incorporation of printable feedback. European considerations concerned differences in culture and practice. The development process successfully developed the VP and the proof of the concept was demonstrated. This will inform future VP development; a large-scale VP evaluation is underway

A radio Search for high redshift HI absorption

Ground based optical observations have yielded considerable information on the statistics of damped-lyman alpha systems. In particular these systems are known to be the dominant repository of the observed neutral gas at high redshift. However, particularly at high redshift, there is the possibility that optical observations could be biased due to the exclusion of damped-lyman alpha systems that contain moderate to significant amounts of dust. Independent observational constraints on the neutral hydrogen content at high redshifts and the amount of dust in high redshift systems can be obtained from a radio search against the bright lobes of distant radio galaxies (which is less affected by the presence of dust in foreground damped-lyman alpha systems). We describe here a pilot radio survey along the line of sight to a small sample of high redshift radio galaxies, and also present some preliminary results. The survey uses a novel observing mode at the WSRT which enables one to make sensitive searches of a large redshift interval in a modest amount of telescope time.Comment: A version with figures is available at http://www.nfra.nl/~chengalu/ To appear in "Cold Gas at High Redshift", Eds. M.Bremer et al. (Kluwer, Dordrecht

Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review

Background Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences. Objectives The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists. Study selection Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes. Findings Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice. Conclusions VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives

Establishing the acceptability and usability of an animated virtual patient simulation.

Background: An animated, video-based, virtual patient (VP) has been developed to allow pharmacists to learn how, and practice how, to advise patients taking non-vitamin K oral anticoagulants, a group of high-risk medicines. VPs are well-established resources but have historically only been accessed within specific online teaching sessions or at university sites; this new VP represents a mobile design that can be accessed from anywhere. Objective: To investigate the usability and acceptability of the VP application with a focus on exploring perspectives on accessibility. Methods: The study used an exploratory sequential mixed method design consisting of a satisfaction survey and interviews. Survey data were analysed descriptively to assess satisfaction with the application and to identify interview discussion areas. Interview data were analysed using the Framework Approach to thematic analysis. Participants were hospital or community pharmacists, or pre-registration pharmacists. Results: A total of 94 survey responses were collected and 22 respondents went on to take part in an interview. Participants reported liking the concept and delivery of the VP, particularly the high-quality technology. They also reported finding it usable, and appeared to favour its mobility and accessibility, particularly as the VP can be used on any internet accessible device, including mobile phones, with no specific requirements. Amendments that were suggested included quickening the delivery of some animations and improving navigation within the application, possibly through a button to return to the previous step should a mistake be made. Conclusions: The mobile VP appeared to be functional and usable, with the majority of users reporting satisfaction with use across a range of devices. Users reported positively about the VP's remote access, but navigation around the application requires development

Impact of biodiversity-climate futures on primary production and metabolism in a model benthic estuarine system

<p>Abstract</p> <p>Background</p> <p>Understanding the effects of anthropogenically-driven changes in global temperature, atmospheric carbon dioxide and biodiversity on the functionality of marine ecosystems is crucial for predicting and managing the associated impacts. Coastal ecosystems are important sources of carbon (primary production) to shelf waters and play a vital role in global nutrient cycling. These systems are especially vulnerable to the effects of human activities and will be the first areas impacted by rising sea levels. Within these coastal ecosystems, microalgal assemblages (microphytobenthos: MPB) are vital for autochthonous carbon fixation. The level of <it>in situ </it>production by MPB mediates the net carbon cycling of transitional ecosystems between net heterotrophic or autotrophic metabolism. In this study, we examine the interactive effects of elevated atmospheric CO₂concentrations (370, 600, and 1000 ppmv), temperature (6°C, 12°C, and 18°C) and invertebrate biodiversity on MPB biomass in experimental systems. We assembled communities of three common grazing invertebrates (<it>Hydrobia ulvae, Corophium volutator </it>and <it>Hediste diversicolor) </it>in monoculture and in all possible multispecies combinations. This experimental design specifically addresses interactions between the selected climate change variables and any ecological consequences caused by changes in species composition or richness.</p> <p>Results</p> <p>The effects of elevated CO₂concentration, temperature and invertebrate diversity were not additive, rather they interacted to determine MPB biomass, and overall this effect was negative. Diversity effects were underpinned by strong species composition effects, illustrating the importance of individual species identity.</p> <p>Conclusions</p> <p>Overall, our findings suggest that in natural systems, the complex interactions between changing environmental conditions and any associated changes in invertebrate assemblage structure are likely to reduce MPB biomass. Furthermore, these effects would be sufficient to affect the net metabolic balance of the coastal ecosystem, with important implications for system ecology and sustainable exploitation.</p

Salford postgraduate annual research conference (SPARC) 2012 proceedings

These proceedings bring together a selection of papers from the 2012 Salford Postgraduate Annual Research Conference (SPARC). They reflect the breadth and diversity of research interests showcased at the conference, at which over 130 researchers from Salford, the North West and other UK universities presented their work. 21 papers are collated here from the humanities, arts, social sciences, health, engineering, environment and life sciences, built environment and business

Study protocol: evaluation of a parenting and stress management programme: a randomised controlled trial of Triple P discussion groups and stress control

&lt;br&gt;Background: Children displaying psychosocial problems are at an increased risk of negative developmental outcomes. Parenting practices are closely linked with child development and behaviour, and parenting programmes have been recommended in the treatment of child psychosocial problems. However, parental mental health also needs to be addressed when delivering parenting programmes as it is linked with parenting practices, child outcomes, and treatment outcomes of parenting programmes. This paper describes the protocol of a study examining the effects of a combined intervention of a parenting programme and a cognitive behavioural intervention for mental health problems.&lt;/br&gt; &lt;br&gt;Methods: The effects of a combined intervention of Triple P Discussion Groups and Stress Control will be examined using a randomised controlled trial design. Parents with a child aged 3?8?years will be recruited to take part in the study. After obtaining informed consent and pre-intervention measures, participants will be randomly assigned to either an intervention or a waitlist condition. The two primary outcomes for this study are change in dysfunctional/ineffective parenting practices and change in symptoms of depression, anxiety, and stress. Secondary outcomes are child behaviour problems, parenting experiences, parental self-efficacy, family relationships, and positive parental mental health. Demographic information, participant satisfaction with the intervention, and treatment fidelity data will also be collected. Data will be collected at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up.&lt;/br&gt; &lt;br&gt;Discussion: The aim of this paper is to describe the study protocol of a randomised controlled trial evaluating the effects of a combined intervention of Triple P Discussion Groups and Stress Control in comparison to a waitlist condition. This study is important because it will provide evidence about the effects of this combined intervention for parents with 3?8?year old children. The results of the study could be used to inform policy about parenting support and support for parents with mental health problems. Trial registration ClinicalTrial.gov: NCT01777724, UTN: U1111-1137-1053.&lt;/br&gt

Detection of a novel insect specific flavivirus across ecologically diverse populations of <i>Aedes aegypti</i> on the Caribbean Island of Saint Lucia

ABSTRACTOutbreaks of mosquito-borne arboviral diseases including dengue virus (DENV), Zika virus (ZIKV), yellow fever virus (YFV) and chikungunya virus (CHIKV) have recently occurred in the Caribbean. The geographical range of the principle vectors responsible for transmission, Aedes (Ae.) aegypti and Ae. albopictus is increasing and greater mosquito surveillance is needed in the Caribbean given international tourism is so prominent. The island of Saint Lucia has seen outbreaks of DENV and CHIKV in the past five years but vector surveillance has been limited with the last studies dating back to the late 1970s. Natural disasters have changed the landscape of Saint Lucia and the island has gone through significant urbanisation. In this study, we conducted an entomological survey of Ae. aegypti and Ae. albopictus distribution across the island and analysed environmental parameters associated with the presence of these species. Although we collected Ae. aegypti across a range of sites across the island, no Ae. albopictus were collected despite traps being placed in diverse ecological settings. The number of Ae. aegypti collected was significantly associated with higher elevation and semi-urban settings yielded female mosquito counts per trap-day that were 5-fold lower than urban settings. Screening for arboviruses revealed a high prevalence of a novel insect-specific flavivirus closely related to cell fusing agent virus (CFAV). We discuss the implications that natural disasters, water storage and lack of mosquito surveillance have on arboviral outbreaks in Saint Lucia and implications for insect only flaviviruses on surveillance and detection of pathogenic flaviviruses.</jats:p

The prognostic significance of tumour-stroma ratio in oestrogen receptor-positive breast cancer

BACKGROUND: A high percentage of stroma predicts poor survival in triple-negative breast cancers but is diminished in studies of unselected cases. We determined the prognostic significance of tumour-stroma ratio (TSR) in oestrogen receptor (ER)-positive male and female breast carcinomas. METHODS: TSR was measured in haematoxylin and eosin-stained tissue sections (118 female and 62 male). Relationship of TSR (cutoff 49%) to overall survival (OS) and relapse-free survival (RFS) was analysed. RESULTS: Tumours with ≥49% stroma were associated with better survival in female (OS P=0.008, HR=0.2-0.7; RFS P=0.006, HR=0.1-0.6) and male breast cancer (OS P=0.005, HR=0.05-0.6; RFS P=0.01, HR=0.87-5.6), confirmed in multivariate analysis. CONCLUSIONS: High stromal content was related to better survival in ER-positive breast cancers across both genders, contrasting data in triple-negative breast cancer and highlighting the importance of considering ER status when interpreting the prognostic value of TSR