scholarly journals 44 Improving Discussions Around Treatment Escalation Decisions in Patients with Subdural Haematomas on A Neurosurgical Ward

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
E Haire ◽  
G Kimpton
Keyword(s):  
Rating Scales ◽  
Free Text ◽  
Neurosurgical Department ◽  
Training And Education ◽  
High Prevalence ◽  
Patients At Risk ◽  
E Learning ◽  
Treatment Escalation ◽  
Consensus Decision ◽  
Multi Disciplinary Team

Abstract Background It is becoming increasingly accepted that discussion and documentation of patient wishes and clinical decisions regarding treatment escalation planning are an essential part of patient care. Following the Tracey judgement, it became a legal requirement, rather than a recommendation, for doctors to involve patients and their families in DNAR decisions. A previous audit in the neurosurgical department found a high prevalence of patients at risk of deterioration with little evidence of attempt to discuss or document treatment escalation decisions (TEDs). Aims Methods We conducted surveys of the multi-disciplinary team within the neurosurgical department to gain a better understanding of their opinions about the current discussion and documentation of TEDs in the department. These contained a mixture of rating scales and free text answers. Following this we engaged senior staff in plans to improve this by introducing these discussions to governance meetings and educated all members of the ward using e learning and tea trolley teaching. Results Amongst 18 healthcare professionals, 12 felt patients did not have clear TEDs. Ten felt discussions were not appropriately timed. Response themes included feeling unsupported, poor timing of conversations and low quality documentation. Following this a consensus decision from the consultant body mandated documentation of TEDs in patients presenting with chronic subdural haematomas. We have worked closely with the national ReSPECT programme and established the neurosurgical ward as a lead for the introduction of the new form. Conclusion The neurosurgery department is now at the forefront of the move to improving discussions and documentation about patient wishes in the Trust. Additionally, we have opened the conversation within the multi-disciplinary team and provided training and education about the importance of TEDs.

A Reflection and Relevance of Lectures and Organizational Performance in The Pandemic Time Covid-19

2021 ◽  
Author(s):  
Faisal Rahman Dongoran ◽  
Indra Maipita ◽  
Abdul Hamid K
Keyword(s):  
Teacher Training ◽  
Path Analysis ◽  
Organizational Performance ◽  
Study Design ◽  
Teaching Performance ◽  
Training And Education ◽  
Ex Post ◽  
Ex Post Facto ◽  
E Learning ◽  
Ex Post Facto Study

This study aims to determine the effect of lecturer competence and commitment on their teaching performance during the Covid-19 pandemic which was remotely (online) carried out through the e-learning website. The respondents were 80 permanent lecturers of the faculty of teacher training and education. A quantitative approach with ex post facto study design and path analysis with SPSS v.21 was used. The results showed that the competence variable had a higher influence of 14.5% while commitment was 7.8%. Therefore, 30.9% determined their teaching performance during the Covid-19 pandemic from the contribution of competence and commitment, while 69.1% was from other variables outside the study.

Gamified Learning

2022 ◽  
pp. 97-131
Author(s):  
Cornelia Nih Popescu ◽  
Elodie Attie ◽  
Laëtitia CHADOUTEAU
Keyword(s):  
Learning Outcomes ◽  
Control Group ◽  
Training And Education ◽  
Learning Module ◽  
Important Concern ◽  
E Learning ◽  
Current Context ◽  
Overall Performance ◽  
Gamified Learning ◽  
Experimental Group

In the context of the current COVID-19 pandemic, e-learning represents a more and more important concern of all education providers and an inevitable direction for the current context in training and education. This chapter follows the theory of gamified learning and the theory of flow to understand to which extent game characteristics improve engagement and learning outcomes, such as performance and engagement. To do this, two groups of learners (N=20) were randomly assigned: the experimental group followed a gamified learning module, and the control group followed the same content without gamification mechanisms. The game mechanisms chosen involve a game, a challenge, virtual rewards, an avatar, a final badge, and a system of points and levels. Results show that the gamified course increased the time spent on the course and the overall performance. Hence, this chapter demonstrates the relevance of using gamification to improve learning outcomes.

Electrocardiographic Abnormalities in Patients With Subarachnoid Hemorrhage

2002 ◽  
Vol 11 (1) ◽  
pp. 48-56 ◽  
Author(s):  
Claire E. Sommargren
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Significance ◽  
Neurological Disorder ◽  
Associated Factors ◽  
High Prevalence ◽  
Patients At Risk ◽  
Electrocardiographic Changes ◽  
Insight Into ◽  
Electrocardiographic Abnormalities ◽  
Holter Recordings

Subarachnoid hemorrhage is a serious neurological disorder that is often complicated by the occurrence of electrocardiographic abnormalities unexplained by preexisting cardiac conditions. These morphological waveform changes and arrhythmias often are unrecognized or misinterpreted, potentially placing patients at risk for inappropriate management. Many previous investigations were retrospective and relied on data collected in an unsystematic manner. More recent studies that included use of serial electrocardiograms and Holter recordings have provided new insight into the high prevalence of electrocardiographic changes in subarachnoid hemorrhage. Research on the prevalence, duration, and clinical significance of these electrocardiographic abnormalities and on associated factors and etiological theories is reviewed.

Multidimensional Assessment of Open-Ended Questions for Enhancing the Quality of Peer Assessment in E-Learning Environments

2020 ◽  
pp. 147-173
Author(s):  
Loc Phuoc Hoang ◽  
Le Anh Phuong ◽  
Somjit Arch-int ◽  
Ngamnij Arch-Int
Keyword(s):  
Learning Environments ◽  
Process Model ◽  
Peer Assessment ◽  
Student Assessment ◽  
Assessment Method ◽  
Free Text ◽  
Multidimensional Assessment ◽  
Positive Attitudes ◽  
E Learning

In online learning environments, peer assessment activities lack the observation and supervision by the teacher or instructor. Therefore, students may be lacked full effort to assess their peers. There exist the students' hesitation about criticizing their peers and scoring their peers honestly, the likelihood for peer assessment to be occasionally unreliable and unfair. The present assessment methods focus only on the single-dimensional assessment of content rather than the activities and collaborations among the students. Students also have no chance to analyze and comment on their peer answers. This study explored the multidimensional assessment method on open-ended question to foster positive attitudes and full effort among students engaging in E-learning environments. The objectives are as follows: 1) To develop a process model for multidimensional assessment (M-DA) to enable effective learning 2) To develop free-text answers assessment by using vector space model and semantic extraction model 3) To develop an algorithm for evaluating students' based on multidimensional assessment. Two groups of parallel students taking an e-course were tested on the system. The results of experiment noted that the proposed method overcomes the method just focuses on student assessment only without consideration and evaluation of the quality of the peer assessment. In light of the findings, the proposed method actively impacted on the development and improvement of learning and the quality of peer assessment among students in E-learning environments.

scholarly journals The human factor in learning design, research, policy, and practice

2015 ◽  
Vol 32 (3) ◽  
pp. 182-196 ◽  
Author(s):  
Piers MacLean ◽  
Marie Cahillane
Keyword(s):  
Cognitive Psychology ◽  
Human Factor ◽  
Research Policy ◽  
Negative Impact ◽  
Current Theory ◽  
Training Needs ◽  
Needs Analysis ◽  
Training And Education ◽  
Content Type ◽  
E Learning

Purpose – The purpose of this paper is to highlight the importance of coherent alignment of current theory from cognitive psychology with practice and policy in training and education institutions developing e-learning materials and present recommendations emphasising the human factor within processes. Design/methodology/approach – In this paper a recent empirical study which applies current theory from cognitive psychological and multimodal learning research provides the backdrop to discussion about alignment of strategic vision, through policy, to effective practice. Findings – Despite advances in cognitive psychology which can be applied to targeting effective and measurable training and education, many institutions fail to maintain updated e-learning strategy and policy resulting in a negative impact on practice and the learner experience. Practical implications – The model presented in this paper is intended to promote thoughtful discussion about the processes and framework necessary for improved collaboration and communication supported by ongoing evaluation of institutional e-learning policy such that policy becomes a dynamic process congruent with developments in the learning sciences. Social implications – The paper includes recommendations for a refined view of knowledge, skills, and attitudes and alignment of policy with practice and theory and will be of interest to training and education institutions seeking to review their policies for training needs analysis and e-learning. Originality/value – This paper offers an up-to-date view of training needs analysis and multimedia design for training discrete psychomotor skills. It will be of value to organisations and institutions providing training and education mediated by technology as well as those involved in the design of training interventions.

scholarly journals MP07: Rate of return: prevalence and correlates of revictimization among sexual and domestic assault cases presenting to the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S42-S42
Author(s):  
A. Drumm ◽  
K. Muldoon ◽  
F. Blaskovits ◽  
T. Leach ◽  
M. Heimerl ◽  
...  
Keyword(s):  
Emergency Department ◽  
Domestic Violence ◽  
Substance Use ◽  
Sexual Assault ◽  
Care Program ◽  
Sexual Assaults ◽  
Domestic Assault ◽  
Ottawa Hospital ◽  
High Prevalence ◽  
Patients At Risk

Introduction: Many survivors of sexual and domestic assault return to violent environments following post-assault care. The objective of this study was to estimate the annual prevalence of revictimization and examine factors associated with return emergency department (ED) visits following their initial encounter for sexual or domestic assault. Methods: The Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital is the only program in Ottawa offering emergency and forensic care for survivors of sexual assault and domestic violence. Information on demographics, assailant characteristics and clinical presentation were extracted from the SAPACP case registry (January 1 2015- January 31 2016). We conducted descriptive analyses to describe the study sample, and bivariable and multivariable logistic regression modelling to assess factors most strongly associated with revictimization using odds ratios (OR), adjusted OR (AOR) and 95% confidence intervals (CI). Results: Among 377 unique patients seen at the SAPACP, there were 409 encounters for sexual and domestic violence. There were 24 revictimization cases (6.4%) with the number of repeat visits ranging from 2-6. There were 343 (91.0%) female patients and 182 (48.3) under the age of 25. There were 243 (64.5%) sexual assaults, 125 (33.2%) physical assaults, and 42 (11.1%) verbal assaults. Compared to patients who presented once, revictimized patients were more likely to have experienced violence from a current or former intimate partner (AOR:3.02, 95% CI:1.24-7.34), have a substance use disorder (AOR:5.57, 95% CI:2.11-14.68), and were more likely to be taking anti-depressants (AOR:3.34, 95% CI:1.39-8.01). Conclusion: This study has identified a high prevalence of revictimization, with some clients being revictimized as many as 6 subsequent times. Key factors to help identify patients at risk of revictimization are assaults by intimate partners, having substance use problems, and being on antidepressants. Reducing revictimization and preventing further violence is a critical component of care to ensure survivors are safe following their ED encounter.

An Emerging Model for Vocational Training

2001 ◽  
Vol 15 (6) ◽  
pp. 403-408
Author(s):  
Jan Frick
Keyword(s):  
Secondary School ◽  
Vocational Training ◽  
Formal Education ◽  
Course Delivery ◽  
Research Projects ◽  
Training And Education ◽  
Innovative Method ◽  
Education Centre ◽  
Postgraduate Level ◽  
E Learning

Norway's Rogaland Kurs og Kompetansesenter (Rogaland Training and Education Centre), serving the whole of the Rogaland County region, has developed an innovative method of providing vocational training to local industry through the formal education system. The courses offered range from secondary school to postgraduate level. Provision has been enhanced through e-learning based on experiences with the Internet gathered in research projects involving schools, higher education and industry – these projects are described in the paper. The author sees great potential in the model that has been developed for providing vocational training to industry in the region. The main challenges for the future are to make this a generally applicable model, so that it can be used in other regions of Norway, and to encourage cooperation among regions in course delivery.

scholarly journals Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

2009 ◽  
Vol 161 (3) ◽  
pp. 489-493 ◽  
Author(s):  
O E Okosieme ◽  
C N Wijeyaratne ◽  
J H Lazarus ◽  
L D K E Premawardhana
Keyword(s):  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Autoimmune Thyroid ◽  
Thyroglobulin Antibody ◽  
High Prevalence ◽  
Patients At Risk ◽  
Healthy Control ◽  
A Prospective Study ◽  
Design And Methods

ObjectivesFollowing iodisation in Sri Lanka we observed a high prevalence of thyroglobulin antibodies (TgAbs) in type 1 diabetic (T1DM) patients. The clinical significance of these TgAbs is uncertain. We sought to obtain a detailed epitope analysis of TgAbs in T1DM patients recruited from diabetes clinics and to compare these with TgAb epitope specificities in patients with autoimmune thyroid disease (AITD) and healthy individuals in that country.Design and methodsWe used a panel of 10 Tg-MAbs in competitive ELISA reactions in a prospective study of subjects recruited from Colombo, to determine the epitopes recognised by TgAb-positive patients with T1DM (n=58, 34F:24M, median age 16 years), AITD patients (n=42, 33F:9M, median age 37 years) and healthy subjects (n=50, 39F:11M, median age 27 years). The outcomes were a comparison of reactivity with six Tg clusters (I–VI) in these subjects, and the relation of epitope specificity patterns with free thyroxine and TSH.ResultsPatients with T1DM and AITD but not healthy control subjects preferentially recognised the immunodominant clusters, I, III and IV. Patients with these narrow epitope specificities had higher median TSH levels (1.60 vs 1.06;P=0.01), and were more frequently positive for antibodies to thyroid peroxidase than those with broad specificities (52.3 vs 7.1%;P=0.004).ConclusionsThe TgAb epitope specificities in euthyroid Sri Lankans with T1DM are similar to AITD patients. TgAb epitope studies may potentially identify T1DM patients at risk of thyroid dysfunction.

Wolff–Parkinson–White syndrome: lessons learnt and lessons remaining

2017 ◽  
Vol 27 (S1) ◽  
pp. S62-S67 ◽  
Author(s):  
D. Woodrow Benson ◽  
Mitchell I. Cohen
Keyword(s):  
Atrial Fibrillation ◽  
Sudden Death ◽  
Accessory Pathway ◽  
Minimal Risk ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
High Negative Predictive Value ◽  
Patients At Risk ◽  
Accessory Atrioventricular Pathway

AbstractThe Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff–Parkinson–White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.

Prevalence and clinical consequences of cytomegalovirus DNA in the aqueous humour and corneal transplants

2018 ◽  
Vol 103 (5) ◽  
pp. 666-671 ◽  
Author(s):  
Ching-Hsi Hsiao ◽  
Yih-Shiou Hwang ◽  
Wen-Yu Chuang ◽  
David H K Ma ◽  
Lung-Kun Yeh ◽  
...  
Keyword(s):  
Medical Records ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Diagnostic Value ◽  
Pcr Analysis ◽  
High Prevalence ◽  
Corneal Transplants ◽  
Clinical Consequences ◽  
Patients At Risk

AimTo determine the prevalence and clinical consequences of cytomegalovirus (CMV) DNA in the aqueous and corneal tissues obtained at the time of corneal transplantation to evaluate the diagnostic value of PCR analysis in identifying patients at risk of postkeratoplasty CMV endotheliitis.MethodsThirty patients who underwent corneal transplantation were included in 2011. The aqueous, excised recipient corneas and donor corneoscleral rims were analysed by PCR for the presence of CMV DNA. The medical records of the patients were retrospectively reviewed and linked with PCR results.ResultsCMV DNA was detected in three (10%) aqueous, eight (26.7%) recipient corneas and six (20.0%) donor corneas obtained during keratoplasty from the 30 patients. Postoperatively, four patients, who had CMV DNA in either aqueous (3) or recipient cornea (1), were diagnosed with CMV endotheliitis based on clinical features and repeat aqueous tapping for real-time PCR analysis. At the median 60.5 months follow-up, 8 (72.7%), including 4 with postkeratoplasty CMV endotheliitis, of the 11 patients with CMV positivity in any one sample had graft failure, while 9 (47.3%) of the 19 patients without evidence of CMV DNA experienced graft failure.ConclusionsWe found a relatively high prevalence of CMV DNA in the aqueous and corneas obtained during keratoplasty. All the patients who had CMV positivity in aqueous developed CMV endotheliitis postoperatively and experienced graft failure eventually. Aqueous tapping at the time of corneal transplantation for PCR analysis may help to improve the diagnosis and follow-up management of postkeratoplasty CMV endotheliitis.

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