E-learning on the road: online learning and social media for continuing professional competency.

BackgroundThe impact of social media and online learning in health professions education has previously shown generally positive results in medical, nursing and pharmacy students. To date there has not been any extensive research into social media and online learning use by prehospital health care professionals such as paramedics.Aim & MethodsWe sought to identify the extent to which Irish pre-hospital practitioners make use of online learning and social media for continuous professional competency (CPC), and the means by which they do so. A cross-sectional online survey of practitioners was conducted to obtain both quantitative and qualitative data. The release of the survey was in a controlled manner to PHECC registrants via various channels. Participation was voluntary and anonymous.ResultsA total of 248 respondents completed the survey in full by closing date of 31 March 2015, representing 5.4% of all registrants (n=4,555). 77% of respondents were male, and the majority were registered as Emergency Medical Technicians (49%), followed by Advanced Paramedics (26%). Over 78% of respondents used a mobile device in the course of their clinical duties; the majority used an iOS device. Social media and online learning were considered learning tools by over 75% of respondents, and over 74% agreed they should be further incorporated into prehospital education. The most popular platforms for CPC activities were YouTube and Facebook. The majority of respondents (88%) viewed self-directed activities to constitute continuous professional development activity, but 64% felt that an activity that resulted in the awarding of a certificate was better value. Over 90% of respondents had previous experience with online learning, but only 42% indicated they had previously purchased or paid for online learning.ConclusionPrehospital practitioners in Ireland in the population studied consider online learning and social media acceptable for CPC purposes. The main social media outlets used by PHECC registrants are YouTube and Facebook. Practitioners consider online learning that awards a certificate to be better value than self-directed activities. The majority have previous experience of online learning. The results of this study can be used to ensure educational interventions are targeted at practitioners through the correct channels.

Developing Novel Prognostic Biomarkers for Multivariate Fracture Risk Prediction Algorithms

Multivariate prediction algorithms such as FRAX® and QFracture Scores provide an opportunity for new prognostic biomarkers to be developed and incorporated, potentially leading to better fracture prediction. As more research is conducted into these novel biomarkers, a number of factors need to be considered for their successful development for inclusion in these algorithms. In this review, we describe two well-known multivariate prediction algorithms for osteoporosis fracture risk applicable to the UK population, FRAX and QFracture Scores, and comment on the current prognostic tools available for fracture risk; dual X-ray assessment, quantitative ultrasonography, and genomic/biochemical markers. We also highlight the factors that need to be considered in the development of new biomarkers. These factors include the requirement for prospective data, collected in new cohort studies or using archived samples; the need for adequate stability data to be provided; and the need for appropriate storage methods to be used when retrospective data are required. Area under the receiver operating characteristic curve measures have been found to have limited utility in assessing the impact of the addition of new risk factors on the predictive performance of multivariate algorithms. New performance evaluation measures, such as net reclassification index and integrated discrimination improvement, are increasingly important in the evaluation of the impact of the addition of new markers to multivariate algorithms, and these are also discussed. © Springer Science+Business Media, LLC 2012

Raman Spectroscopic Analysis of Fingernail Clippings Can Help Differentiate between Postmenopausal Women Who Have and Have Not Suffered a Fracture

Raman spectroscopy was applied to nail clippings from 633 postmenopausal British and Irish women, from six clinical sites, of whom 42% had experienced a fragility fracture. The objective was to build a prediction algorithm for fracture using data from four sites (known as the calibration set) and test its performance using data from the other two sites (known as the validation set). Results from the validation set showed that a novel algorithm, combining spectroscopy data with clinical data, provided area under the curve (AUC) of 74% compared to an AUC of 60% from a reduced QFracture score (a clinically accepted risk calculator) and 61% from the dual-energy X-ray absorptiometry T-score, which is in current use for the diagnosis of osteoporosis. Raman spectroscopy should be investigated further as a noninvasive tool for the early detection of enhanced risk of fragility fracture

Raman Spectroscopy as a Predictive Tool for Monitoring Osteoporosis Therapy in a Rat Model of Postmenopausal Osteoporosis

Pharmacological therapy of osteoporosis reduces bone loss and risk of fracture in patients. Modulation of bone mineral density cannot explain all effects. Other aspects of bone quality affecting fragility and ways to monitor them need to be better understood. Keratinous tissue acts as surrogate marker for bone protein deterioration caused by oestrogen deficiency in rats. Ovariectomised rats were treated with alendronate (ALN), parathyroid hormone (PTH) or estrogen (E2). MicroCT assessed macro structural changes. Raman spectroscopy assessed biochemical changes. Micro CT confirmed that all treatments prevented ovariectomy-induced macro structural bone loss in rats. PTH induced macro structural changes unrelated to ovariectomy. Raman analysis revealed ALN and PTH partially protect against molecular level changes to bone collagen (80% protection) and mineral (50% protection) phases. E2 failed to prevent biochemical change. The treatments induced alterations unassociated with the ovariectomy; increased beta sheet with E2, globular alpha helices with PTH and fibrous alpha helices with both ALN and PTH. ALN is closest to maintaining physiological status of the animals, while PTH (comparable protective effect) induces side effects. E2 is unable to prevent molecular level changes associated with ovariectomy. Raman spectroscopy can act as predictive tool for monitoring pharmacological therapy of osteoporosis in rodents. Keratinous tissue is a useful surrogate marker for the protein related impact of these therapies. The results demonstrate utility of surrogates where a clear systemic causation connects the surrogate to the target tissue. It demonstrates the need to assess broader biomolecular impact of interventions to examine side effects. [Figure not available: see full text.]

Raman Spectroscopy Predicts the Link between Claw Keratin and Bone Collagen Structure in a Rodent Model of Oestrogen Deficiency

Osteoporosis is a common disease characterized by reduced bone mass and an increased risk of fragility fractures. Low bone mineral density is known to significantly increase the risk of osteoporotic fractures; however, the majority of non-traumatic fractures occur in individuals with a bone mineral density too high to be classified as osteoporotic. Therefore, there is an urgent need to investigate aspects of bone health, other than bone mass, that can predict the risk of fracture. Here, we successfully predicted association between bone collagen and nail keratin in relation to bone loss due to oestrogen deficiency using Raman spectroscopy. Raman signal signature successfully discriminated between ovariectomised rats and their sham controls with a high degree of accuracy for the bone (sensitivity 89%, specificity 91%) and claw tissue (sensitivity 89%, specificity 82%). When tested in an independent set of claw samples the classifier gave 92% sensitivity and 85% specificity. Comparison of the spectral changes occurring in the bone tissue with the changes occurring in the keratin showed a number of common features that could be attributed to common changes in the structure of bone collagen and claw keratin. This study established that systemic oestrogen deficiency mediates parallel structural changes in both the claw (primarily keratin) and bone proteins (primarily collagen). This strengthens the hypothesis that nail keratin can act as a surrogate marker of bone protein status where systemic processes induce changes

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Developing novel prognostic biomarkers for multivariate fracture risk prediction algorithms

Multivariate prediction algorithms such as FRAX® and QFractureScores provide an opportunity for new prognostic biomarkers to be developed and incorporated, potentially leading to better fracture prediction. As more research is conducted into these novel biomarkers, a number of factors need to be considered for their successful development for inclusion in these algorithms. This review paper describes two well-known multivariate prediction algorithms for osteoporosis fracture risk applicable to the UK population, FRAX and QFractureScores, and comments on the current prognostic tools available for fracture risk, dual x-ray assessment (DXA), quantitative ultrasound (QUS), genomic and biochemical markers and highlights the factors that need to be considered in the development of new biomarkers. These factors include the requirement for prospective data, collected in new cohort studies or using archived samples, the need for adequate stability data to be provided and appropriate storage methods to be used when retrospective data is required. AUC measures have been found to have limited utility in assessing the impact of the addition of new risk factors on the predictive performance multivariate algorithms. New performance evaluation measures, such as net reclassification index (NRI) and integrated discrimination improvement (IDI) are increasingly important in the evaluation of the impact of the addition of new markers to multivariate algorithms and these are also discussed

The response of pseudomonas aeruginosa biofilm to the presence of a glass polyalkenoate cement formulated from a silver containing glass

The response of pseudomonas aeruginosa biofilm to the presence of a glass polyalkenoate cement formulated from a silver containing glas

A Multi-Study Cost-Effectiveness Comparison of the QFracture and FRAX Fracture Risk Algorithms

BACKGROUND: The FRAX and QFracture risk calculators have previously been validated but their relative performance with respect to cost-effectiveness has yet to be evaluated. METHODS: The relative costs of implementing these two fracture risk calculators were assessed in two scenarios, firstly in a case-control group of 584 post-menopausal women using the National Osteoporosis Guideline Group (NOGG) guidelines, and then using the QResearch database, which contains over 8 million patient-years of prospective data. RESULTS: QFracture was more cost-effective in the first scenario while the underlying cost drivers were different for each algorithm; however, the cost per fracture prevented could not be estimated. The incremental cost-effectiveness ratio of FRAX was £516.22 per hip fracture saved compared with QFracture in the second scenario. LIMITATIONS: The comparison yielded virtually identical false negative rates for both calculators. In cases where these rates are significantly different, an all-encompassing cost comparison would be a challenge. CONCLUSIONS: FRAX was more cost-effective per fracture prevented when the same risk assessment cost was used for the two algorithms; a key factor in assessing the relative cost-effectiveness of these algorithms is the cost of the risk assessment process. QFracture considers more risk factors than FRAX and has been developed to incorporate additional risk factors in the future. This makes QFracture costly, however, this calculator may benefit from automated systems to reduce its cost of implementation