Development of a programme to facilitate interprofessional simulation-based training for final year undergraduate healthcare students

Original report can be found at: http://www.health.heacademy.ac.uk/publications/miniproject/alinier260109.pdfIntroduction: Students have few opportunities to practise alongside students from other disciplines. Simulation offers an ideal context to provide them with concrete experience in a safe and controlled environment. This project was about the development of a programme to facilitate interprofessional scenario-based simulation training for final year undergraduate healthcare students and explored whether simulation improved trainees’ knowledge of other healthcare discipline’s roles and skills. Methods: A multidisciplinary academic project team was created and trained for the development and facilitation of this project. The team worked on the development of appropriate multiprofessional scenarios and a strategy to recruit the final year students on a volunteer basis to the project. By the end of the project 95 students were involved in small groups to one of fifteen 3-hour interprofessional simulation sessions. Staff role played the relatives, doctor on call, and patient when it was more appropriate than using a patient simulator (Laerdal SimMan/SimBaby) in the simulated community setting and paediatric or adult emergency department. Each session had 3 to 4 of the following disciplines represented (Adult/Children/Learning Disability Nursing, Paramedic, Radiography, Physiotherapy) and each student observed and took part in one long and relevant high-fidelity scenario. Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (control group) and the others after (experimental group). Students were assessed on the questions relating to the disciplines represented in their session. Results: By the end of the project 95 questionnaires were collected of which 45 were control group students (Questionnaire before simulation) and 50 experimental group students (Questionnaire after simulation). Both groups were comparable in terms of gender, discipline and age representation. Participants were: Adult nurses (n=46), Children’s nurses (n=4), Learning Disability nurses (n=7), Nurses, Paramedics (n=8), Radiographers (n=20), Physiotherapists (n=8). 15 sessions were run with an average of around 7 participants and at least 3 disciplines represented. The knowledge test results about the disciplines represented was significantly different between the control and experimental groups (Control 73.80%, 95% CI 70.95-76.65; and Experimental 78.81%, 95% CI 75.76-81.87, p=0.02). In addition, there were sometimes reliable differences between the groups in their view of multidisciplinary training; confidence about working as part of a multidisciplinary team was 3.33 (SD=0.80, Control) and 3.79 (SD=0.90, Experimental), p=0.011; their anticipation that working as part of a multidisciplinary team would make them feel anxious was 2.67 (SD=1.17, Control) and 2.25 (SD=1.04, Experimental), p=0.073; their perception of their knowledge of what other healthcare professionals can or cannot do was 3.00 (SD=0.91, Control) and 3.35 (SD=0.93, Experimental), p=0.066; their view that learning with other healthcare students before qualification will improve their relationship after qualification was 3.93 (SD=1.14, Control) and 4.33 (SD=0.81, Experimental), p=0.055; their opinion about interprofessional learning helping them to become better team workers before qualification was 3.96 (SD=1.24, Control) and 4.42 (SD=0.77, Experimental), p=0.036. Conclusions: Although the difference is relatively small (~5%), the results demonstrate that students gained confidence and knowledge about the skills and role of other disciplines involved in their session. Through simulation, the positivism of students about different aspects of learning or working with other healthcare disciplines has significantly improved. Students gained knowledge of other disciplines simply by being given the opportunity to take part in a multiprofessional scenario and observe another one. The results of the test and their reported perception about multidisciplinary team working suggest that they are better prepared to enter the healthcare workforce. Discussions during the debriefings highlighted the fact that multidisciplinary training is important. The main challenges identified have been the voluntary student attendance and timetabling issues forcing us to run the session late in the day due to the number of disciplines involved in each session and their different placement rota. The aim is now to timetable formally this session within their curriculum. Introducing simulation in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals

An experiment using hypothetical patient scenarios in healthy subjects to evaluate the treatment satisfaction and medication adherence intention relationship

BackgroundTreatment beliefs and illness consequence have been shown to impact medication adherence in patients with years of asthma experience. These relationships are unknown in patients with early experience.ObjectiveThe purpose was to test the relationship between illness consequence, treatment beliefs, treatment satisfaction and medication adherence intentions in healthy subjects exposed to an asthma scenario.MethodsA 2×2×2 factorial design experiment was conducted in 91 healthy University student subjects. Each student was randomized to receive one scenario with varying levels of illness consequence (high/low), treatment concerns (high/low) and treatment necessity (high/low). After reading the scenarios the students responded to questions about treatment satisfaction and likelihood of using the medication as directed by the physician. A multiple regression model was used to test the impact of factors on treatment satisfaction and medication adherence at the 0.05 level of significance.ResultsTreatment satisfaction was significantly predicted by treatment necessity with a moderating effect by illness consequence. Medication adherence intentions were significantly predicted by treatment satisfaction.ConclusionPatients with early diagnosis of asthma are likely to form treatment satisfaction as a result of illness consequence and treatment necessity. Patients' perceptions of illness consequence are likely to influence (moderate) the impact of treatment necessity on treatment satisfaction; and their intentions to take medication as directed are likely to be influenced by treatment satisfaction rather than treatment beliefs or illness consequence early in the patient illness experience. These results are from an experiment that should be tested in a patient population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113764/1/hex12103.pd

Analysis of plant secondary metabolism using stable isotope‐labelled precursors

Special issue of Phytochemical Analysis on NMR-based analytical techniques. open access articleIntroduction Analysis of biochemical pathways typically involves feeding a labelled precursor to an organism, and then monitoring the metabolic fate of the label. Initial studies used radioisotopes as a label and then monitored radioactivity in the metabolic products. As analytical equipment improved and became more widely available, preference shifted the use stable ‘heavy’ isotopes like deuterium (2H)‐, carbon‐13 (13C)‐ and nitrogen‐15 (15N)‐atoms as labels. Incorporation of the labels could be monitored by mass spectrometry (MS), as part of a hyphenated tool kits, e.g. Liquid chromatography (LC)–MS, gas chromatography (GC)–MS, LC–MS/MS. MS offers great sensitivity but the exact location of an isotope label in a given metabolite cannot always be unambiguously established. Nuclear magnetic resonance (NMR) can also be used to pick up signals of stable isotopes, and can give information on the precise location of incorporated label in the metabolites. However, the detection limit for NMR is quite a bit higher than that for MS. Objectives A number of experiments involving feeding stable isotope‐labelled precursors followed by NMR analysis of the metabolites is presented. The aim is to highlight the use of NMR analysis in identifying the precise fate of isotope labels after precursor feeding experiments. As more powerful NMR equipment becomes available, applications as described in this review may become more commonplace in pathway analysis. Conclusion and Prospects NMR is a widely accepted tool for chemical structure elucidation and is now increasingly used in metabolomic studies. In addition, NMR, combined with stable isotope feeding, should be considered as a tool for metabolic flux analyses

In vitro biocompatibility of a new hydrogel with Crocin, powerful antioxidant found in Crocus Sativus L. flowers

Recently, attention has been paid to the identification of natural antioxidants from the petals of Crocus S. flowers that are normally considered waste[1]. The antioxidant activities are mainly attributed to carotenoid compounds, like crocin. Scientific evidences demonstrate that this kind of compounds are among the most important natural plant sources of antioxidant activity in the human diet, protecting the body against damages caused by reactive oxygen species (ROS). This antioxidant was extracted using methanol and ethanol. In this experiment, it was used a new hydrogel consisting of three polymers - Polyvinyl pyrrolidone (PVP), Agar and Polyethylene glycol (PEG) – and Crocin, mixed, reticulated and then sterilized by gamma irradiation at 25 kGy. For the in vitro experimental protocol, it was used a primary culture of fibroblasts taken from the subcutaneous tissue of a newborn mice, seeding the cells on a little square (1cm2 area) of both kinds of hydrogel. As the ISO protocol prescribes, the experiments were repeated 3 times for each kind of hydrogel, stopping the culture at the 3rd, 7th and 14th day after the seeding. For all steps, 3 Petri dishes were used as controls without biomaterials. At fixed deadline, all Petri dishes were stained, using the Wright method for cell counting and morphological evaluations. The microscopic analysis revealed the complete biocompatibility of the hydrogel. The Petri dishes with this kind of new hydrogel has an overproduction of collagen from the fibroblasts. The presence of this natural important compound in saffron petals, now offers new possibilities for the best use of the hole flower. This study is still in progress.http://www.fupress.net/index.php/ijae/article/view/1495

Synthesis and antitrypanosomal activities of novel pyridylchalcones

Collaboration with the London School of Hygiene and Tropical Medicine. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.A library of novel pyridylchalcones were synthesised and screened against Trypanosoma brucei rhodesiense. Eight were shown to have good activity with the most potent 8 having an IC50 value of 0.29 M. Cytotoxicity testing with human KB cells showed a good selectivity profile for this compound with a selectivity index of 47. Little activity was seen when the library was tested against Leishmania donovani. In conclusion, pyridylchalcones are promising leads in the development of novel compounds for the treatment of human African trypanosomiasis (HAT)

Activity of Antioxidants from Crocus sativus L. Petals: Potential Preventive Effects towards Cardiovascular System

The petals of the saffron crocus (Crocus sativus L.) are considered a waste material in saffron production, but may be a sustainable source of natural biologically active substances of nutraceutical interest. The aim of this work was to study the cardiovascular effects of kaempferol and crocin extracted from saffron petals. The antiarrhythmic, inotropic, and chronotropic effects of saffron petal extract (SPE), kaempferol, and crocin were evaluated through in vitro biological assays. The antioxidant activity of kaempferol and crocin was investigated through the 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) assay using rat cardiomyoblast cell line H9c2. The MTT assay was applied to assess the effects of kaempferol and crocin on cell viability. SPE showed weak negative inotropic and chronotropic intrinsic activities but a significant intrinsic activity on smooth muscle with a potency on the ileum greater than on the aorta: EC50 = 0.66 mg/mL versus EC50 = 1.45 mg/mL. Kaempferol and crocin showed a selective negative inotropic activity. In addition, kaempferol decreased the contraction induced by KCl (80 mM) in guinea pig aortic and ileal strips, while crocin had no effect. Furthermore, following oxidative stress, both crocin and kaempferol decreased intracellular ROS formation and increased cell viability in a concentration-dependent manner. The results indicate that SPE, a by-product of saffron cultivation, may represent a good source of phytochemicals with a potential application in the prevention of cardiovascular diseases

Synthesis and characterization of bacterial cellulose towards osteogenic differentiation of stem cells

The extracellular matrix provides physical support and functional microenvironment in which cells exist for healthy tissue formation and maintenance. This dynamic interplay between the extracellular matrix and cells have significant effect on cellular functions like cell adhesion, cell proliferation and cell differentiation. To mimic this multimolecular three-dimension network during tissue damage, like disease, trauma or functional failure, tissue engineering introduces us to apply the principles of material science and life science for developing biocompatible materials. According to 2019 United Network for Organ Sharing report 3,180 transplants were performed with 113,839 people still on the waiting list. The sole reliance on transplantation has not only created a waiting list but also a rise in the health care cost. Current strategies involve the use of donated organs or tissues either from one patient to another or from one part of the patient’s body to another part of the body in the same patient. These practices have limitations like immunogenic rejection, risk of disease transmission, costly immunosuppression therapies and difficult and time-consuming surgical procedures. Therefore, there is a growing need for modifying factors like biomaterials that act as scaffold matrices and serve as a platform for the cells to grow and form tissues upon transplantation. In this study, we have utilized a biomimetic approach to produce a material that acts as a bioscaffold while examining its properties for its application in the field of bone tissue engineering. Bacterial cellulose is a polysaccharide material that is synthesized by specific types of bacteria like Acetobacter, Azotobacter, Gluconacetobacter, Pseudomonas, Salmonella and Sarcina ventriculi. Among them the most effective are Gluconacetobacter xylinum, Gluconacetobacter hansenii, and Gluconacetobacter pasteurianus. These bacteria polymerize glucose residues into linear ß-1,4-glucan chains that assemble and crystallize cellulose ribbons. These ribbons form a three-dimensional network of cellulose nanofibers with ideal properties like hydrophilicity, high surface area, excellent mechanical property, moldability and high purity as compared to plant cellulose. In this work, we have fermented bacterial cellulose using Gluconacetobacter Hansenii that produces a pellicle of cellulose with similar properties. Human-derived placental mesenchymal stem cells were cultured on bacterial cellulose to study its osteogenic differentiation potential to function as a cell-scaffold construct for bone regeneration. Our study found novel advances that enable bacterial cellulose to support the growth and differentiation of human-derived placental mesenchymal stem cell in vitro. Material characterization showed that bacterial cellulose has a fiber diameter of 40-60nm with twisted and interwoven cellulose fibrils caused due to the rotation of bacteria during fermentation. In its never-dried state the material is flexible and has a high stiffness while being brittle upon drying. The nanoscale feature of bacterial cellulose supported the growth of placental stem cells and showed no toxicity upon culturing for long hours. Further, the hydrophilic nature of bacterial cellulose enabled the differentiation of placental stem cells with high expression of early osteogenic marker like alkaline phosphatase and an increase in mineralized matrix by the end of 28 days. We have established the importance of hydrophilicity, nanotopography and material structure that showed improved biomineralization during osteogenic differentiation. This study provides a strong basis that material properties play a vital role in supporting the growth of the cells and its ability to deposit tissue-specific extracellular matrix. In this study, Bacterial cellulose showed as a promising biomaterial for bone tissue engineering applications

Porous Inorganic Drug Delivery Systems—a Review

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Innovative methods and materials have been developed to overcome limitations associated with current drug delivery systems. Significant developments have led to the use of a variety of materials (as excipients) such as inorganic and metallic structures, marking a transition from conventional polymers. Inorganic materials, especially those possessing significant porosity, are emerging as good candidates for the delivery of a range of drugs (antibiotics, anticancer and anti-inflammatories), providing several advantages in formulation and engineering (encapsulation of drug in amorphous form, controlled delivery and improved targeting). This review focuses on key selected developments in porous drug delivery systems. The review provides a short broad overview of porous polymeric materials for drug delivery before focusing on porous inorganic materials (e.g. Santa Barbara Amorphous (SBA) and Mobil Composition of Matter (MCM)) and their utilisation in drug dosage form development. Methods for their preparation and drug loading thereafter are detailed. Several examples of porous inorganic materials, drugs used and outcomes are discussed providing the reader with an understanding of advances in the field and realistic opportunities

Pyrogallol is the main antibacterial compound in the aqueous extract of Boswellia dalzielii bark

Plants belonging to the genus Boswellia (Burseraceae) have long been appreciated for their pharmacological properties such as anti-inflammatory, antioxidative and anticancer activities1. In the Northern part of Nigeria, the bark of B. dalzielii Hutch. is an important ingredient for the treatment of infections2. To identify water-soluble antibacterial compounds, powdered bark was macerated in water for 6 to 24h at a range of temperatures. The aqueous extracts were subsequently fractionated by column chromatography, and the fractions were initially screened against wild type and methicillin resistant strains of Staphylococcus aureus. Then, minimum inhibitory concentrations of purified fractions were determined using series of concentrations from 2 mg/mL to 8 μg/mL. Results showed that longer maceration resulted in stronger antibacterial activity. With the aid of NMR and accurate mass analysis, pyrogallol was identified as the main antibacterial agent, with MIC values ranging from 24-28 μg/mL for MRSA to 34-36 μg/mL for wild-type S. aureus. Gallic acid was found to play a lesser role (MIC >200 μg/mL). Pyrogallol was found not to be a plant secondary metabolite, but a metabolic product from microbial degradation of gallic acid from the bark. Only two bacterial species could be isolated from the plant material, which were identified as Raoultella planticola and Enterobacter cloacae. Of these two micro-organisms, R. planticola was shown to be responsible for the production of pyrogallol. This is an example of bacterial allelopathy, which results in an increased efficacy of the aqueous extract