Additional Educational Support Research Articles

Protective and risk factors at school level during the COVID‐19 pandemic: Perspective of primary school students with LD and ADHD from Croatia, Slovenia and Serbia

Protective and risk factors at school level during the <scp>COVID</scp>‐19 pandemic: Perspective of primary school students with <scp>LD</scp> and <scp>ADHD</scp> from Croatia, Slovenia and Serbia

Health-Related Quality of Life of Omani Adult Patients with Sickle Cell Disease at the Sultan Qaboos University Hospital

Objectives: The quality of life of Omani adults with sickle cell disease (SCD) is not yet known. This study aimed to determine the health-related quality of life (HRQoL) of adult Omani patients with SCD attending a single tertiary center. Methods: A cross-sectional study was conducted among patients with SCD from June to October 2022 at the Sultan Qaboos University Hospital. A validated Arabic version of the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL over eight domains. Results: A total of 235 patients with SCD participated in the study, of which the majority were female (74.9%) and 18–35 years of age (64.6%). The lowest HRQoL was reported for the domain of role limitations due to physical health (median score: 25.0; interquartile range [IQR]: 35.0), while the highest was seen for role limitations due to emotional problems (median score: 66.7, IQR: 100.0). Frequent SCD-related emergency department visits/hospital admissions and the adverse effect of SCD on patients’ social lives had a significant negative impact on SF-36 scores for all eight HRQoL domains (p ≤0.05). In addition, the impact of SCD on academic performance and a history of having been bullied due to SCD had a significant negative impact on SF-36 scores for several domains (p ≤0.05). Conclusion: Omani adult patients with SCD reported relatively poor HRQoL in several domains, with various factors found to have significant associations with poorer HRQoL. Healthcare providers and policy-makers should consider offering additional clinical, educational, and financial support to patients to enhance their HRQoL.&#x0D; Keywords: Sickle Cell Disease; Health-Related Quality of Life; Adults; Oman

Digital Game Based Learning in the institutional-academic study of history: theory and practice of learning modality of video game cybertexts

Introduction. The universal and state importance of history is dissonant with the inertial methods of its institutional and academic study, which are often inadequate to modern media culture. This requires updating educational historical practices, integrating popular media texts that can increase interest in historical knowledge and offer new rhetorical modalities. The purpose of the article is a comprehensive, comparative-oriented analytics of the use of Digital Game Based Learning in history education. Materials and Methods. Theoretically and methodologically, the work draws on the concepts of "procedural rhetoric", "cybertext," and "rhetoric of simulations," as well as the method of narrative research of cultural artifacts, comparative analysis, and classification approach. The practical part utilizes the methodological principles of Digital Game Based Learning strategy formulated by M. Prensky, the qualitative-case study approach of R. Stacke and the media-phenomenological educational principle of S. Freitas. Freitas. A set of quantitative and qualitative methods are also applied to investigate the level of motivation in learning and to compare academic performance. Results. The conducted research revealed that within the framework of DGBL practices video games, their narrative and gameplay content, represent a special interactive cybertext that transmits new knowledge and procedurally forms multiple competencies. According to the type of realization of historical information in video games, they are divided into three main types: conceptual, narrative and aesthetic. The dynamics of the obtained results indicate that the use of DGBL methodology increased on average by 36% the degree of interest in the study of history. The vast majority of students (83-86%) found history classes using the DGBL methodology useful for them. At the same time, a rather high (about 50%) degree of distrust in using the DGBL method was found among teachers and parents of students. Conclusion. Based on the results of the study, it was determined that video games can be legitimized as educational cybertexts with innovative mediarrhythmic tools. Our experiment demonstrated that the use of narratively relevant video games in the system of institutional-academic study of history markedly increases students' motivation and allows them to better understand and explore the essence of historical development as a multifactorial and multimodal process. However, taking into account the identified difficulties and problems in the implementation of DGBL, it is concluded that this method should be extended, first of all, to optional educational practices and the sphere of independent work of students. At the same time, in order to achieve a positive educational effect, it is important that familiarization with a particular video game should have additional educational and methodological support.

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study.

Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

'It is a life changing experience': The experiences of living kidney donors who live in rural Australia.

A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.

Preschool Teachers’ Professional Training in the Field of Inclusive Education in The North of Kosovo and Metohija

The issue of inclusive education is focused on providing the high quality education for all learners through the process of introducing the changes concerning the educational approach and the modification of educational content depending on the learners’ individual needs for additional support. The analyses of inclusive policies and inclusive practice in Europe indicate that the characteristics of social context significantly impact the development of inclusive practice. Self-assessment for professional training is a vital condition for enhancing competences through continuous learning and reflexive practice with the aim of achieving the final learning outcomes of all pupils. The aim of the research was also to determine the dominance of certain ways of training within the regular professional training, in regard to the quality and availability of education and support for work that can be provided by the preschool institution where these teachers are employed. The sample comprises of 130 preschool teachers of the following preschool institutions in the north of Kosovo and Metohija. Taking into account the results of the conducted research, the respondents outlined as the most useful findings and skills that are necessary for working with children with disabilities the following ones: the identification of characteristics of certain difficulties among children, the adjustment of methods, ways of teaching, materials and space to working with children who need additional educational support, the creation of individual educational plan for a child who needs additional educational support and communication skills for working with parents.

Neurosurgical management of proton beam therapy-induced moyamoya syndrome.

Proton beam therapy (PBT) is an increasingly used treatment modality for pediatric patients with brain tumors. Moyamoya syndrome (MMS) is well recognized as a complication of traditional photon radiotherapy, however its association with PBT is less well described. The authors discuss their initial experience with the neurosurgical management of MMS secondary to PBT in a large-volume pediatric neurovascular service. The authors performed a retrospective case review of consecutive children referred for neurosurgical management of MMS after PBT between 2009 and 2022. Patient demographic characteristics, oncological history and treatment, interval between PBT and MMS diagnosis, and MMS management were recorded. Clinical outcome at last review was classified as good if the modified Rankin Scale (mRS) score was ≤ 2 and/or the patient attended mainstream education without additional assistance. Poor outcome was defined as mRS score ≥ 3 and/or the patient received additional educational support. The recorded radiological outcomes included angiographic analysis of stenosis, evidence of brain ischemia/infarction on MRI, and postsurgical angiographic revascularization. Ten patients were identified. Oncological diagnosis included craniopharyngioma (n = 6), optic pathway glioma (1), ependymoma (1), Ewing sarcoma (1), and rhabdosarcoma (1). The median (interquartile range [IQR]) age at PBT was 5.1 (2.7-7.9) years. The median (IQR) age at MMS diagnosis was 7.8 (5.7-9.3) years. The median time between PBT and diagnosis of MMS was 20 (15-41) months. Six patients had poor functional status after initial oncological treatment and prior to diagnosis of MMS. All 10 patients had endocrine dysfunction, 8 had visual impairment, and 4 had behavioral issues prior to MMS diagnosis. Four patients had a perioperative ischemic event: 2 after tumor surgery, 1 after MMS surgical revascularization, and 1 after receiving a general anesthetic for an MRI scan during oncological surveillance. Seven children were treated with surgical revascularization, whereas 3 were managed medically. The incidence of ischemic events per cerebral hemisphere was reduced after surgical revascularization: only 1 patient of 7 had an ischemic event during the follow-up period after surgery. No children moved from good to poor functional status after MMS diagnosis. MMS can occur after PBT. Magnetic resonance angiography sequences should be included in surveillance MRI scans to screen for MMS, and families should be counseled about this complication. Management at a high-volume pediatric neurovascular center, including selective use of revascularization surgery, appears to maintain functional status in these children.

Does intellectual disability in children impact access to preventive dental services and oral health?

The aim of this study was to determine the access to preventive dental care and oral health among children with additional educational support needs as compared to normal children in primary education years. This was a population-based record-linkage study, where the data was retrieved from six different nationaldatabases. Children born in Scotland between years 2011 and 2014 and entered elementary school education in years 2016-19 were included and the corresponding information about their additional educational support needs (ASNs) was determined using a Pupil Census database. These children with intellectual disabilities were categorised as:intellectual disabilities, Autism spectrum, social learning-disabilities and other learning-disabilities. The data about their oral health, including caries experience and extractions under GA, and the data about their access to preventive dental care, including professional brushing instructions, fluoride varnish (FV) applications etc. was retrieved from other national databases. The caries experience and access to dental care was compared for these special children with that of normal children without any ASNs. Among primary outcomes, significantly higher caries experience was recorded among children with 'social'(aRR = 1.42, CI = 1.38-1.46) and 'other'(aRR = 1.17, CI = 1.13-1.21) ASNs, while higher risk of extractions under GA was found in ID (aRR = 1.67, CI = 1.16-2.37), social (aRR = 1.24, CI = 1.08-1.42) groups while autism group showed nonsignificant higher risk (aRR = 1.12, CI = 0.79-1.53). Among secondary outcomes, significantly less attendance at general/public dental practice was recorded for all the intellectual disabilities' groups, with least attendance by children with social ASNs (aRR = 0.51 CI = 0.49-0.54). Least exposure to professional advice was received by autism group (aRR = 0.93, CI = 0.87-0.99). Further, all the groups showed less participation in nursery toothbrushing (NTB) and FV program at school; while least exposure to these preventive programs was depicted by children with social ASNs (NTB: aRR = 0.89, CI = 0.86-0.92, FV aRR = 0.95, CI = 0.92-0.98). Children with intellectual disabilities have poor access to preventive dental care and also exhibit higher incidence of caries experience and extractions.

Allied health professionals' contribution to care at end of life in aged care settings.

The Australian population is aging, and the proportion of older Australians will continue to grow over the coming decades. However, there is a lack of research published on the specific roles and responsibilities of allied health professionals (AHPs) providing palliative care within an aged care context. Understanding the roles and needs of AHPs providing care during the last months of life in the community and aged care facilities could contribute to workforce planning, targeted information and improved care. In total, 108 eSurveys were collected between November 2019 to May 2020 from three allied health professions working in government-funded aged care; the majority of these being in residential aged care. Descriptive data are reported on the provision of care in key palliative care domains, care settings and practice activity. Nearly all respondents reported they had worked with older Australians who had palliative care needs. However, over one-third of respondents reported low levels of confidence in supporting clients or residents with palliative care needs. The majority indicated they would benefit from additional education and training and support in palliative care. This study investigated the role of the allied health workforce in contributing to the care of older Australians at the end of life. It has also demonstrated that there are gaps in practice activity and work role that must be addressed to ensure this workforce can support older people with palliative care needs in receipt of aged care services.

Municipal Forest Program Management in the United States of America: A Systematic Review

Municipalities across the United States have varied available resources to manage urban forests, resulting in substantial differences in urban forestry services and outcomes. This article reviews 32 survey-based studies that characterize U.S. municipal urban forest management program dimensions, including program components; needs and barriers; knowledge of and attitudes toward urban forests; and plans and priorities for future management. Such information is critical for agencies that support local urban forest management efforts but has not previously been systematically gathered and condensed. Based on the limited national, regional, and state-level data published in peer-reviewed journals, we find that the number of municipal urban forestry programs appears to be increasing, many communities have at least one tree ordinance, and larger communities are more likely to have an official program. However, evidence suggests that few municipalities have an urban forest inventory or management plan, and most require additional financial, political, public, or educational support. More research on urban forestry program status, needed support, and local knowledge is needed as knowledge gaps remain regarding the influence of metropolitan areas and resident demographics on the presence and extent of municipal urban forestry programs. Additionally, few studies have investigated future municipal urban forestry-related intentions and priorities.

Speech and Language outcomes in Auditory Neuropathy Spectrum Disorder (ANSD) children managed with amplification

ObjectiveTo evaluate speech and language outcomes in children with Auditory Neuropathy Spectrum Disorder (ANSD) without significant comorbidities who received hearing rehabilitation in the form of hearing aids and/or cochlear implantation. MethodsRetrospective chart review of pediatric ANSD patients at a large academic tertiary care institution from 2010 to 2019. Patients were included if they received a diagnosis of bilateral ANSD, had minimal to no comorbidities, and had speech and language testing (SLT) on at least two occasions. Results51 patients were reviewed and 7 met inclusion criteria. Average age at ANSD diagnosis was 1 year and 11 months, and average age of hearing aid fitting was 3 years and 3 months. Hearing loss ranged from mild to profound, with four of the children wearing behind (BTE) hearing aids and three eventually receiving cochlear implants. Four of five patients who received hearing aids prior to their first speech and language evaluation demonstrated a delay at their initial evaluation, and all five patients continued to demonstrate a delay at their most recent evaluation, despite appropriate audiologic management and speech and language therapy. There were two patients who were unaided at the time of their initial and latest evaluations; one patient showed a delay at both timepoints, and one patient showed no speech delay at either timepoint. ConclusionsPediatric ANSD patients, who are otherwise typically developing and received hearing rehabilitation and speech and language therapy, continue to show a speech and language delay (SLD). This outcome underscores the importance of close monitoring of speech and language development, providing early amplification and/or cochlear implantation, and promoting additional education and psychosocial support.

PMON312 A De Novo Heterozygous Nonsense Variant In The SEC31A Gene Associated With Pituitary Hormone Deficiency And Disorders Of Sex Development.

Abstract Introduction XYdisorders of sex development (DSD) result from variants in many different human genes but frequently have no detectable molecular cause. In approximately 25% of cases of XY DSD, the index case may have associated malformations. Genetic disorders of endoplasmic reticulum (ER) function are increasingly being recognised but have not been associated with DSD or pituitary disorders. Clinical case Three siblings (with unaffected non-consanguineous parents) were reviewed at the tertiary endocrine clinic. Child I was noted at birth to have cliteromegaly. Imaging and examination under anaesthetic revealed a normal vagina and uterus but gonads of indeterminate origin. She was 46,XY and basal endocrine investigations at the age of 4 years showed a low AMH for male but otherwise normal gonadal and thyroid function and normal IGF-1. She had a laparoscopic bilateral gonadectomy aged 5 years. Pathology demonstrated bilateral testicular tissue, with substantial fibrotic atrophic change and occasional placental alkaline phosphatase (PLAP) positive cells, suggestive of germ cell tumours. Aged 8 years she developed obesity and later hypertension. Child II was reviewed due to short stature and diagnosed with GH deficiency aged 2 years. She has normal adrenal and thyroid function and gonadotrophins. MRI demonstrated an ectopic posterior pituitary. Child III presented with perineal hypospadias, a small phallus, bilateral undescended testes and craniofacial abnormalities. Endocrine investigations revealed hypogonadotrophic hypogonadism, with no testosterone response to hCG stimulation, a low normal AMH and no response of LH or FSH on LHRH stimulation. He has panhypopituitarism with an ectopic posterior pituitary gland on MRI and is currently on treatment with GH, hydrocortisone and levothyroxine. His BP is on the 98th centile for age and height. Child I and Child III have mild developmental delay but are in mainstream school with additional educational support. High-throughput DNA sequencing revealed, in all three siblings, a heterozygous truncating variant in the SEC31A gene that encodes a component of the COPII-complex that coats the vesicles mediating ER to Golgi transport. CRISPR-Cas9 targeted knockout of the corresponding Sec31a region resulted in embryonic lethality in homozygous mice. mRNA phenotyping of ER-related genes demonstrated increased mRNA expression of ATF4 and CHOP in the affected children, genes encoding key ER stress-related proteins, associated with defective protein transport. Conclusions Dysregulation ofanterograde and retrograde COPII-coated-vesicle ER-Golgi transport is increasingly recognised to underlie human developmental disorders, including Craniolenticulosutural dysplasia (OMIM 607812) and Saul-Wilson syndrome (OMIM 618150). The de novo SEC31A nonsense variant in all three affected siblings, the ER stress response, plus reported developmental syndromes with dysfunction of this transport mechanism and evidence from the preclinical mouse model suggest that SEC31A might underlie a previously unrecognised clinical syndrome comprising DSD, endocrine abnormalities, dysmorphic features and developmental delay. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Community Health Nurses' Perspective on the Introduced Rational Drug Use Policy in Primary Care Settings in Thailand: A Descriptive Qualitative Study.

Background: To address the problems related to drug resistance and medication safety, the rational drug use (RDU) policy has been implemented in Thailand since 2014. Theoretically, the policy was supposed to bring drastic changes to the way clinicians prescribe medications and its impacts on clinical practice, however, it has not yet been investigated. The study aimed to describe the experience of community health nurses with regard to the impact of RDU policy implementation on their practices. Methods: Focus group interviews and in-depth interviews with community nurses were conducted. Thematic analysis was performed. Results: Five themes emerged from the analysis, namely, (1) a welcome opportunity, (2) RDU as the quality of healthcare, (3) multidisciplinary collaboration, (4) reinventing productive interactions between nurses and patients, and (5) challenges over control of medications prescribed or purchased elsewhere. Conclusions: Implementing RDU in primary care provides opportunities for protecting individual patients and public health as well as safeguarding against professional prescription error. This can be made possible by adopting a systemic approach to changes. Additional educational and organizational support will optimize health professionals’ contribution to the implementation and hence optimal outcomes of this important policy.

Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study.

Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.

Survey of the American Society of Neuroradiology Membership on the Use and Value of Intracranial Vessel Wall MRI.

Intracranial vessel wall MR imaging is an emerging technique for intracranial vasculopathy assessment. Our aim was to investigate intracranial vessel wall MR imaging use by the American Society of Neuroradiology (ASNR) members at their home institutions, including indications and barriers to implementation. The ASNR Vessel Wall Imaging Study Group survey on vessel wall MR imaging use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using vessel wall MR imaging, ordering-provider interest, and impact on clinical care, was distributed to the ASNR membership between April 2 and August 30, 2019. There were 532 responses; 79 were excluded due to nonresponse and 42 due to redundant institutional responses, leaving 411 responses. Fifty-two percent indicated that their institution performs vessel wall MR imaging, with 71.5% performed at least 1-2 times/month, most frequently on 3T MR imaging, and 87.7% using 3D sequences. Protocols most commonly included were T1-weighted pre- and postcontrast and TOF-MRA; 60.6% had limited contributions from vendors or were still in protocol development. Vasculopathy differentiation (94.4%), cryptogenic stroke (41.3%), aneurysm (38.0%), and atherosclerosis (37.6%) evaluation were the most common indications. For those not performing vessel wall MR imaging, interpretation (53.1%) or technical (46.4%) expertise, knowledge of applications (50.5%), or limitations of clinician (56.7%) or radiologist (49.0%) interest were the most common reasons. If technical/expertise obstacles were overcome, 56.4% of those not performing vessel wall MR imaging indicated that they would perform it. Ordering providers most frequently inquiring about vessel wall MR imaging were from stroke neurology (56.5%) and neurosurgery (25.1%), while 34.3% indicated that no providers had inquired. More than 50% of neuroradiology groups use vessel wall MR imaging for intracranial vasculopathy characterization and differentiation, emphasizing the need for additional technical and educational support, especially as clinical vessel wall MR imaging implementation continues to grow.

School Outcomes Among Children Following Death of a Parent

To better support children with the experience of parental death, it is crucial to understand whether parental death increases the risk of adverse school outcomes. To examine whether parental death is associated with poorer school outcomes independent of factors unique to the family, and whether children of certain ages are particularly vulnerable to parental death. This population-based sibling cohort study used Swedish national register-based longitudinal data with linkage between family members. Register data were collected from January 1, 1990, to December 31, 2016. Data analyses were performed on July 14, 2021. The participants were all children born between 1991 and 2000 who lived in Sweden before turning age 17 years (N = 908 064). Parental death before finishing compulsory school. Mean school grades (year-specific z scores) and ineligibility for upper secondary education on finishing compulsory school at age 15 to 16 years. Population-based cohort analyses were conducted to examine the association between parental death and school outcomes using conventional linear and Poisson regression models, after adjustment for demographic and parental socioeconomic and health indicators measured before childbirth. Second, using fixed-effect linear and Poisson regression models, children who experienced parental death before finishing compulsory school were compared with their siblings who experienced the death after. Third, the study explored the age-specific associations between parental death and school outcomes. In the conventional population-based analyses, bereaved children (N = 22 634; 11 553 boys [51.0%]; 11 081 girls [49.0%]; mean [SD] age, 21.0 [2.8] years) had lower mean school grade z scores (adjusted β coefficient, -0.19; 95% CI, -0.21 to -0.18; P < .001) and a higher risk of ineligibility for upper secondary education than the nonbereaved children (adjusted risk ratio, 1.36; 95% CI, 1.32-1.41; P < .001). Within-sibling comparisons using fixed-effects models showed that experiencing parental death before finishing compulsory school was associated with lower mean school grade z scores (-0.06; 95% CI, -0.10 to -0.01; P = .02) but not with ineligibility for upper secondary education (adjusted risk ratio, 1.07; 95% CI, 0.93-1.23; P = .34). Independent of birth order, losing a parent at a younger age was associated with lower grades within a family. In this cohort study, childhood parental death was associated with lower school grades after adjustment for familial confounders shared between siblings. Children who lost a parent may benefit from additional educational support that could reduce the risk of adverse socioeconomic trajectories later in life.

Academic Integrity: Putting Policy into Practice

On first reading of the University of Dundee’s Policy on Academic Misconduct seems eminently sensible, fair and clear. The Policy classifies plagiarism cases as 1 (very minor), 2 (minor) and 3 (serious), giving examples of each to inform the academic community. There is guidance on how all three should be handled, ranging from additional educational support through written warning through a hearing from a formal academic misconduct panel. As Associate Dean Quality Assurance and Standards at our Medical School I oversee how this policy is both enacted and data collected across the school. This paper outlines how we have operationalised the policy for a distance learning course with a thousand students and over 50 markers, based both within the Centre and globally. The programme is a masters in medical education, with about a third of the students based overseas, about 90% medical doctors, the others being allied health professionals, dentists, nurses and vets. The studies are all online at a distance, and assignments are in the main written. They are submitted, marked ad moderated via Turnitin, and students are encouraged to engage with the similarity report before finalising their submissions. I summarise the policy and identify various issues and how the Centre has sought to solve these. I present the process we have developed so far, our rationale behind each decision made and how going forward we are evaluating this process. I discuss our assessment strategy, including our underpinning pedagogical philosophy and how these have informed the decisions we have taken. I give an overview of both our student and our marker induction and faculty development for our core staff, who as module leads moderate the process. I present some initial statistics on student uptake of the various elements. I describe the development of an efficient and effective reporting process, codeveloped between academics and professional services, and the next stages of this development as we move to the piloting stage. I finish with some current questions we have on how we can support the students further as they navigate through the academic discourse around misconduct, learning and enacting the language, not least the challenges of collaboration versus corroboration and self-plagiarism in a course ending with a capstone assessment.

Patient Interactions With an Automated Conversational Agent Delivering Pretest Genetics Education: Descriptive Study.

BackgroundCancer genetic testing to assess an individual’s cancer risk and to enable genomics-informed cancer treatment has grown exponentially in the past decade. Because of this continued growth and a shortage of health care workers, there is a need for automated strategies that provide high-quality genetics services to patients to reduce the clinical demand for genetics providers. Conversational agents have shown promise in managing mental health, pain, and other chronic conditions and are increasingly being used in cancer genetic services. However, research on how patients interact with these agents to satisfy their information needs is limited.ObjectiveOur primary aim is to assess user interactions with a conversational agent for pretest genetics education.MethodsWe conducted a feasibility study of user interactions with a conversational agent who delivers pretest genetics education to primary care patients without cancer who are eligible for cancer genetic evaluation. The conversational agent provided scripted content similar to that delivered in a pretest genetic counseling visit for cancer genetic testing. Outside of a core set of information delivered to all patients, users were able to navigate within the chat to request additional content in their areas of interest. An artificial intelligence–based preprogrammed library was also established to allow users to ask open-ended questions to the conversational agent. Transcripts of the interactions were recorded. Here, we describe the information selected, time spent to complete the chat, and use of the open-ended question feature. Descriptive statistics were used for quantitative measures, and thematic analyses were used for qualitative responses.ResultsWe invited 103 patients to participate, of which 88.3% (91/103) were offered access to the conversational agent, 39% (36/91) started the chat, and 32% (30/91) completed the chat. Most users who completed the chat indicated that they wanted to continue with genetic testing (21/30, 70%), few were unsure (9/30, 30%), and no patient declined to move forward with testing. Those who decided to test spent an average of 10 (SD 2.57) minutes on the chat, selected an average of 1.87 (SD 1.2) additional pieces of information, and generally did not ask open-ended questions. Those who were unsure spent 4 more minutes on average (mean 14.1, SD 7.41; P=.03) on the chat, selected an average of 3.67 (SD 2.9) additional pieces of information, and asked at least one open-ended question.ConclusionsThe pretest chat provided enough information for most patients to decide on cancer genetic testing, as indicated by the small number of open-ended questions. A subset of participants were still unsure about receiving genetic testing and may require additional education or interpersonal support before making a testing decision. Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers.

Social and Educational Outcomes in Patients With Biliary Atresia: A Systematic Review.

To systematically review the social outcomes of patients with biliary atresia (BA), including educational, employment and family outcomes. We conducted a systematic review of Medline, EMBASE, Global Health, Maternity and Infant Care Database, supplemented by reference searching. National Heart, Lung and Blood Institute scoring was conducted for quality assessment. The PROSPERO registration ID was CRD42020178846. Fifty-one studies were included (41 cohort, 10 cross-sectional), including 4631 participants across 16 countries. Cohorts were BA post-liver transplant (LT) (18 studies), native liver survivors (NLS) (16 studies), mixed (13 studies) and four other cohorts. Outcomes covered; education (n = 35), employment (n = 16), family outcomes (n = 22), and social functioning (n = 22). BA patients had lower school functioning scores than controls, with no difference between NLS versus post-LT. Between 2% and 48% of children required additional educational support. Between 60% and 100% of adult patients with BA were employed. Pregnancies were described in 17 studies, with small samples, and some noted complications. Social functioning scores were similar to healthy controls in 8 of 11 comparisons. Despite BA being the primary indication for liver transplantation in childhood, social outcomes for children and adolescents are predominantly reported in non-controlled, single-centre survey-based studies. School functioning is lower compared to peer groups, with no evidence of a difference for those having a liver transplant. We recommend routine psychosocial assessment of these patients during follow-up, alongside multi-centre collaborations, to maximise the quality of evidence for future patients.

Implementing a New EMR. How Should We Train the Staff?

Background Information Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. Objectives of Project • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Process of Implementation Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Statement of Successful Practice Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Implication for Advancing the Practice of Perianesthesia Nursing Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition. Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition.