Attitudes towards, and patterns of use, of published research evidence in clinical decision making amongst intensive care clinicians.

An evidence-practice gap is defined as the difference between what we know from the best available research evidence and what actually happens in current practice. The highly respected ARDSNet low-tidal-volume ventilation trial was published in 2000, however, in 2016 an observational study conducted in over 50 countries documented that up to one third of eligible patients failed to receive the ARDSNet low-tidal-volume ventilation strategy. In this thesis, we undertook a sequence of studies to better understand research evidence use in intensive care, with the intention of developing a tool that may help close evidence-practice gaps. To better understand research evidence use, we conducted a self-administered mail-out survey of intensive care specialists in Australia and New Zealand, and a self-administered online survey of a multinational group of intensive care clinicians. Based on knowledge gained from these surveys, we developed a concise evidence summary tool designed to overcome 27 explicit barriers to the use of research evidence. To evaluate the evidence summary tool, we developed a clinical case-based scenario. Ninety-three multinational intensive care clinicians were invited to review the casebased scenario and then read the evidence summary tool. Reading the evidence summary tool led to a significant increase in the belief that the intervention described in the tool would benefit the realistic patient in our case-based scenario (mean score change 0.32, 95% CI 0.19 to 0.46, P<0.001). Interestingly, the group most influenced by the evidence summary tool were those who appeared to be less up to date. Whilst it is not known whether this success in increasing intensive care clinicians’ belief in the benefit of a treatment would translate into a change in clinical practice behaviours, these promising results clearly indicate a need for further investigation into the use of evidence summary tools as an intervention to help close evidence-practice gaps

A Case Study of a School Science Department: A Site for Workplace Learning?

This descriptive and illuminative case study of one science department in a successful, urban, secondary school in the south of England considers the science department as a site of workplace learning and the experience of beginning teachers in this context. Policy change in initial teacher training (ITT) has given schools a major role in the recruitment of trainees and emphasized the schools’ role in their training. Additionally, there continue to be significant challenges to recruit science specialist teachers despite substantial bursaries. For the purposes of this study, a community of practice of those involved with ITT and beginning teachers was defined: this included six teachers, three beginning teachers, one technician and the University tutor from the higher education institution. Interviews, focus groups, and mentor meetings, field observation notes and scrutiny of relevant documents were used to construct a rich description of the sociocultural milieu. Two interpretivist approaches were used: an inductive phenomenological study of the lived experiences and a deductive approach using a conceptual framework developed from theories of workplace learning. Findings show that there is considerable tension in the mentor’s professional life; the role and the learning needs of the mentors were poorly understood; the ‘community of practice – Beginning teachers’ was not as originally perceived because the mentors were not engaged in a joint endeavour; the perceived value of accountability measures for ITT, Ofsted and performativity measures affected the learning environment for the beginning teachers and there is a dissonance between the values and practices of the workplace learning culture. This has been explored through the lenses of balkanization (Hargreaves and Macmillan, 1992), addictive presentism (Hargreaves, 2010) and Hodkinson and Hodkinson’s model of an expansive/restrictive workplace for teachers (2005). This study may be of interest to those in teacher education and involved with recruitment and retention of science teachers

The relationship between joint hypermobility and patellar instability: A systematic review

Introduction Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility. Methods Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included. Results We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001). Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69). Conclusion Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required

Samuel Howard and the Music for the Installation of the Duke of Grafton as Chancellor of Cambridge University, 1769

Samuel Howard (?1710–1782) has long been a familiar inhabitant of the diligent footnotes of Handel biographers. A choirboy in the Chapel Royal, he was a member of Handel’s chorus and the composer of much theatre music of his own; he later became organist of both St Bride’s, Fleet Street and nearby St Clement Danes, Strand, where he was buried in 1782. His most significant and ambitious work is his fine orchestrally accompanied anthem ‘This is the day which the Lord hath made’, published posthumously in 1792 with an impressive title page detailing the performance of the work ‘at St Margaret’s Church before the governors of the Westminster Infirmary, in the Two Universities, and upon many other Publick Occasions in different parts of the Kingdom’. This article confirms for the first time that this work originated as Howard’s doctoral exercise, drawing on contemporary press reports and information in the University archives; together these make clear that the composer’s doctorate was linked to the provision of music for the Duke of Grafton’s installation as Chancellor in 1769. Surviving information about this event offers a glimpse of musical life in Cambridge on a comparable scale to the much better reported proceedings upon similar occasions in Oxford. This evidence then serves as a starting point from which to consider Howard’s later prominence as a director of high-profile public performances in London and the provinces

The life and works of William and Philip Hayes (1708-77 &amp; 1738-97)

In 3 volsSIGLEAvailable from British Library Document Supply Centre- DSC:D179178 / BLDSC - British Library Document Supply CentreGBUnited Kingdo