Our challenge was to establish and deliver a novel, rapid, multipronged approach to educating a multi-disciplinary group of health care professionals, in the face of the Covid 19 outbreak. This was ...tailored to our district general hospital where we implemented a responsive, multimodal programme of education incorporating simulation to disseminate current information approved by national bodies in order to enhance team working.The first multidisciplinary teaching team comprised anaesthetic and critical care staff. Over 48 hours, a 5 week teaching programme was developed sourcing material from a national critical care course1 incorporating lectures, practical workshops and multidisciplinary simulation aimed at all health professionals in the anaesthesia directorate. We addressed key concerns and potential service pitfalls before widening our scope to include in situ simulation in theatres and the obstetric delivery suite. We subsequently adapted our course material for non-anaesthetic health professionals, and conducted simultaneous nurse upskilling sessions to enhance critical care nursing cover.The second teaching unit led by the acute medical team and resuscitation department aimed to rapidly facilitate training in modified Advanced Life Support (ALS) practice. A new Trust policy informed by Public Health England and the World Health Organisation was instituted, before the latest Resuscitation Council Guidance was released.2 3 In situ teaching was instituted on all wards highlighting key changes and the importance of PPE. These ad hoc sessions aimed to rapidly upskill multidisciplinary team members and also offered the chance to practice systematic assessment of sick patients.Rapid feedback and peer review allowed dynamic configuration of teaching, enabling us to address questions and issues arising from the teaching via weekly hospital wide updates, disseminating the latest recommendations and peer reviewed evidence.Almost all 151 attendees to refresher sessions reported a significantly increased knowledge base post session. All 120 multidisciplinary staff attending upskilling prior to redeployment to critical care, reported increased knowledge post attendance. All 191 multidisciplinary candidates attending dedicated teaching days incorporating lectures, simulated PPE and proning practice reported an appropriate level of delivery, with all 52 multidisciplinary simulation candidates reporting 100% satisfaction. All 40 staff attending ALS simulations and sick patient assessment sessions felt training was relevant to their scope of practice, and fulfilled their needs.Staff confidence, education and team working across an organisation can be rapidly enhanced when confronted by a challenge as evidenced by our efforts, and doing so establishes strong foundations for future lear.ReferencesThe Critical CARE Course®, Troth L, Kocierz L, Burtenshaw A, Hulme J. 2020.Covid-19 Technical Specifications for Personal Protective Equipment and related IPC Supplies. World Health Organisation serial editions Feb - April 2020 (latest edition Aug 2020).COVID-19 Personal Protective Equipment (PPE). Public Health England serial editions Feb – April 2020 (latest edition Aug 2020).
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We enrolled 78 obese adults (31 male and 47 female) and randomized them to one of the three following groups for an 8‐week intervention: guided weekly health coaching with a behavior ...change curriculum (HC), utilization of a physical activity monitor and associated web tool for self‐monitoring with minimal health coaching (AM), or combination of weekly health coaching and use of a physical activity monitor and associated web tool (COMBO). The objective was to determine the relative influence of the 3 interventions on weight loss and clinical risk factors for cardiovascular disease (CVD). Percent body fat was measured by handheld Bioelectrical Impedance Analysis (BIA), and waist circumference (WC) was measured at the umbilicus. Weight reduction was significant for all groups (−4.21 ± 3.08 kg; p < 0.0001). Significant intervention effects were observed for BMI (p < 0.0001), percent body fat (p = 0.0008), WC (p < 0.0001), diastolic blood pressure (p = 0.0004), total cholesterol (p = 0.0003), triglycerides (p = 0.0001), and fasting plasma glucose (p = 0.0001). Anthropometric and clinical outcomes did not differ across treatment groups (p >; 0.05); however, trends were observed for larger effects in the COMBO group. These results indicate efficacy of both a guided intervention and a self‐monitoring device for behavior change and subsequent weight loss, with the potential for a combination of the strategies to improve results.
We present new planet candidates identified in NASA Kepler Quarter 2 public release data by volunteers engaged in the Planet Hunters citizen science project. The two candidates presented here survive ...checks for false positives, including examination of the pixel offset to constrain the possibility of a background eclipsing binary. The orbital periods of the planet candidates are 97.46 days (KIC 4552729) and 284.03 (KIC 10005758) days and the modeled planet radii are 5.3 and 3.8 R sub(+ in circle). The latter star has an additional known planet candidate with a radius of 5.05 R sub(+ in circle) and a period of 134.49 days, which was detected by the Kepler pipeline. The discovery of these candidates illustrates the value of massively distributed volunteer review of the Kepler database to recover candidates which were otherwise uncataloged.
Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first ...national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia.
A national survey of CFH nurses was conducted.
In all, 1098 CFH nurses responded to the survey. Over 60% were engaged in delivering primary prevention services from a universal platform. Overall, 82.8% reported that their service made first contact with families within 2 weeks of birth, usually in the home (80.7%). The proportion of respondents providing regular support to families decreased as the child aged. Services were primarily health centre based, although 25% reported providing services in other locations (parks, preschools).The timing and location of first contact, the frequency of ongoing services and the composition of families seen by nurses varied across Australian jurisdictions. Nurses identified time constraints as the key barrier to the delivery of comprehensive services.
CFH nurses play an important role in supporting families across Australia. The impact of differences in the CFH nursing provision across Australia requires further investigation. What is known about the topic? Countries that offer universal well child health services demonstrate better child health and developmental outcomes than countries that do not. Australian jurisdictions offer free, universal child and family health (CFH) nursing services from birth to school entry. What does this paper add? This paper provides nation-wide data on the nature of work undertaken by CFH nurses offering universal care. Across Australia, there are differences in the timing and location of first contact, the frequency of ongoing services and the range of families seen by nurses. What are the implications for practitioners? The impact for families of the variation in CFH nursing services offered across Australia is not known. Further research is required to investigate the outcomes of the service provision variations identified in the present study.
About 30% of all colorectal cancers are thought to have a genetic basis and the known predisposing genes can only account for a small fraction of cases. A previous report suggested that a colorectal ...cancer candidate gene, explaining at least 20% of colorectal cancer cases with family history, was located within a 25 cM region on chromosome 9q22.2-q31.3. We typed 16 polymorphic markers encompassing the region of putative linkage in 57 colorectal tumor families from the United Kingdom. Known Mendelian syndromes had been excluded. We found suggestive evidence of linkage, as positive parametric (HLOD = 1.23) and nonparametric (NPL = 1.21, P = 0.11) LOD scores were obtained by analysis of the whole family set. Enrichment for cases with a priori genetic etiology by analyzing families with at least one person affected at <45 years of age (n = 39 families) gave a maximum multipoint NPL score of 2.65 (P = 0.007). In this group, significant NPL scores >1.67 (P < 0.05) were found in a 6.5 cM region between D9S1851 and D9S277. With a more stringent threshold (NPL>2.4, P < 0.01), the linked region was 1.7 cM between D9S971 and D9S272/D9S173. Exclusion from the analysis of kindreds with a phenotype of multiple polyposis also found evidence of linkage in the same region (NPL = 2.47 at close to D9S277, P = 0.009). The type I transforming growth factor-beta receptor, a prime candidate gene, was excluded as a cause of disease. The results presented here further support the existence of a colorectal cancer susceptibility gene on chromosome 9q and refine its likely location.
To identify a novel susceptibility gene for colorectal cancer (CRC), we conducted a genome-wide linkage analysis of 69 pedigrees segregating colorectal neoplasia in which involvement of known loci ...had been excluded, using a high-density single nucleotide polymorphism (SNP) array containing 10 204 markers. Multipoint linkage analyses were undertaken using both non-parametric (model-free) and parametric (model-based) methods. After the removal of SNPs in strong linkage disequilibrium, we obtained a maximum non-parametric linkage statistic of 3.40 (P=0.0003) at chromosomal region 3q21–q24. The same genomic position also yielded the highest multipoint heterogeneity LOD (HLOD) score under a dominant model (HLOD=3.10, genome-wide P=0.038) with 62% of families linked to the locus. We provide evidence for a novel CRC susceptibility gene. Further studies are needed to confirm this localization and to evaluate the contribution of this locus to disease incidence.
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