Three-day Course Research Articles

2541 Cryptosporidial Colonization of a Peptic Ulcer in a Healthy Patient—Random Occurrence or a Risk Factor?

INTRODUCTION: The incidence of Cryptosporidial enteritis (CE) has recently risen in the USA due to water and foodborne outbreaks. It has a self-limited course in healthy hosts. We describe a case of a healthy female with history of gastric bypass surgery who presented with a one-month history of voluminous watery diarrhea and vomiting. This was a rare case of CE diagnosed by endoscopic biopsies of two anastomotic peptic ulcers that were colonized by Cryptosporidium spp. CASE DESCRIPTION/METHODS: 57-year-old female with a history of GERD, iron deficiency anemia, and Roux-en-y gastric bypass complicated by jejunal strictures with revision of the gastro-jejunal anastomosis, presented with a 7-day history of vomiting and crampy epigastric abdominal pain. She recently returned from a two-week vacation to Latin America. Upon arrival, she experienced progressively worsening voluminous watery diarrhea associated with intermittent melanotic stools followed by frequent episodes of non-bilious, non-bloody vomiting along with reduced oral intake. Abdominal exam revealed hyperactive bowel sounds with tenderness to deep palpation of the epigastrium. Her hemoglobin dropped from a baseline of 11.2 g/dL to 9.1 g/dL. CT scan of the abdomen with contrast showed inflammation around the gastro-jejunostomy site. Blood and stool cultures were negative. Upper endoscopy revealed a 1 cm and 2 cm clean-based ulcers with a deep crater at the anastomotic site. Biopsy demonstrated spherical bluish-purple organisms, 2-5 µm in diameter on hematoxylin and eosin, Gomori Methanamine Silver Nitrate and Masson's trichrome stains. They were suggestive of Cryptosporidium, and the patient was diagnosed with CE. Patient's immunodeficiency workup was unremarkable. Patient's symptoms resolved with a three-day course of Nitazoxanide 500 mg twice per day. DISCUSSION: CE is a significant cause of chronic diarrhea in both healthy and immune-compromised individuals, thus stands as a key differential in those presenting with persistent voluminous diarrhea. The modified acid-fast stain carries only 50% sensitivity to this protozoan, and diagnosis is often missed on routine stool ova and parasite tests. Novel diagnostic modalities have proven useful in identifying this protozoan in stool samples. We report the first case documenting Cryptosporidium colonization of anastomotic site peptic ulcers with complete resolution of symptoms following a short course of Nitazoxanide.

Management of patent ductus arteriosus in premature infants.

Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle.

Efficacy of a pediatric procedure curriculum on resident training

BackgroundThere is growing concern that residents are not receiving the necessary experience to become proficient with medical procedures. We created a structured curriculum to improve resident comprehension, experience and confidence with pediatric procedures. MethodsA two-week procedure curriculum commenced with a three-day training course to review 26 pediatric procedures using lectures, videos, demonstrations and simulations. Residents spent the remainder of the rotation as the hospital's on-call procedure resident. Pre- and post-rotation surveys, knowledge testing and procedure logging were used to evaluate course effectiveness, along with follow up metrics a year after completing the rotation. Results were compared to a control group of residents completing their second year of residency who did not participate in the curriculum. ResultsParticipants (N = 35) averaged 67.2 procedures over the 2 weeks, compared to 41.3 procedures for controls (N = 20) during their first 2 years of residency. Participants had a higher confidence than controls (3.0 vs. 2.5 on a five-point scale) and better knowledge (65% vs. 47% correct on testing), both statistically significant. Compared to their own individual pre-rotation scores, participants showed improved knowledge (49% vs. 65%) and confidence (2.0 vs. 3.0), both statistically significant. Long-term follow up showed that these improvements were mostly sustained a year later. ConclusionsOverall, interns completing the rotation demonstrated procedure counts, knowledge levels, and confidence greater than rising third year residents. Participants were inclined to have superior confidence in procedures where higher procedure counts were achieved. Most results were sustained over the course of one year.

The impact of a short-term training program on workers' sterile processing knowledge and practices in 12 Ethiopian hospitals: A mixed methods study.

BackgroundThe need for increased attention to surgical safety in low- and middle-income countries invited organizations worldwide to support improvements in surgical care. However, little is written about issues in instrument sterilization in low- and middle-income countries including Ethiopia.ObjectiveThe study aims to identify the impact of a sterile processing course, with a training-of-trainers component and workplace mentoring on surgical instrument cleaning and sterilization practices at 12 hospitals in Ethiopia.MethodA mixed-methods research design that incorporates both qualitative and quantitative research approaches to address issues in sterile processing was used for this study. The quantitative data (test results) were validated by qualitative data (hospital assessments, including observations and participant feedback). Twelve hospitals were involved in the training, including two university teaching hospitals from two regions of Ethiopia. In each of the two regions 30 sterile processing staff were invited to participate in a three-day course including theory and skills training; 12–15 of these individuals were invited to remain for a two-day training of trainers course. The collected quantitative data were analysed using a paired t-test by SPSS software, whereas comparative analysis was employed for the qualitative data.ResultsProcess, structural, and knowledge changes were identified following program implementation. Knowledge test results indicated an increase of greater than 20% in participant sterile processing knowledge. Changes in process included improved flow of instruments from dirty to clean, greater attention to detail during the cleaning and decontamination steps, more focused inspection of instruments and careful packaging, as well as changes to how instruments were stored. Those trained to be trainers had taught over 250 additional staff.ConclusionsIncreased attention to and knowledge in sterile processing practices and care of instruments with a short, one-week course provides evidence that a small amount of resources applied to a largely under-resourced area of healthcare can result in decreased risks to patients and staff. Providing education in sterile processing and ensuring staff have the ability to disseminate their learnings to other health care providers results in decreasing risks of hospital associated infections in patients.

A National Model for Tactical Emergency Medical Support in Finland

Introduction:Tactical Emergency Medical Response (TEMS) originated in the 1990s in Finland. It is a nationally standardized joint-effort with EMS and police special units, such as SWAT.Aim:To describe a national system of TEMS in Finland.Methods:In Finland, TEMS is a national response system of specially trained paramedics and pre-hospital doctors, working normally in HEMS or a local physician staffed rapid response car. There is a two-tier selection to get accepted in the basic course. The police run background checks for all participants before they are accepted to the course. The course itself is four days and it covers the basics of police tactics, protective gear, penetrating wounds, evacuation, etc. After graduating from the basic course, the paramedic/doctor is qualified to participate in missions. Although healthcare professionals are involved, a TEMS mission is under the police command and is used as one of the police’s special teams to operate in areas where normal EMS cannot be allowed for safety reasons. TEMS does not carry any weapons. The Police provide the teams with the same protective equipment that the SWAT/CTU has. After some years, there is a three-day refresher course for active TEMS service. In this course, the main training points are working in austere environments, such as helicopters, boats, and in urban environments wearing civilian clothing. Police pay for the usage of TEMS in missions, but they do not pay for training days.Results:TEMS has good national coverage. In 2017, there were 131 TEMS activations. The normal response to a mission is a team of one or two TEMS operators.Discussion:TEMS has achieved good national coverage and is deployed often. TEMS has also channeled information and training, such as TECC, to normal EMS personnel and raised their preparedness as well.

A Design-Based Research Approach for introducing Algorithmics and Programming to Bavarian Primary Schools

Computer Science (CS) is increasingly entering the early levels of childhood education, like primary school or even kindergarten. Although Germany has not yet developed mandatory guidelines for how to deal with these new topics, Bavaria seems to consider extending the field of computer science education to the primary sector in the long term. It is therefore becoming more and more necessary to gain insight into which teaching methods and content would be suitable for students at primary level. To investigate the characteristics of effective programming courses for primary schools, we developed a three-day introductory course following the design-based research approach. This article will set focus on both the theoretical foundation resulting from this specific research approach and the didactic implementation of the theoretical framework.

Effect of intranasal oxytocin on alcohol withdrawal syndrome: A randomized placebo-controlled double-blind clinical trial

BackgroundIn a pilot study, intranasal oxytocin was demonstrated to reduce the benzodiazepine dose needed to relieve withdrawal symptoms during alcohol detoxification. The aim of the present study was to compare the effect of oxytocin and placebo during a three-day period of alcohol detoxification at an addiction treatment center in Norway. MethodsRandomized, double-blind, placebo-controlled trial with 40 patients fulfilling criteria for ICD-10 diagnosis of alcohol dependence (F10.2), admitted for alcohol detoxification and withdrawal treatment. The benzodiazepine oxazepam was given as symptom-triggered treatment based on the scores of the Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) scale. Participants were randomized to receive either intranasal oxytocin (24 IU twice daily) or placebo. Primary outcome: Oxazepam dose required to complete a three-day course of detoxification. Secondary outcomes: Scores of the CIWA-Ar, the 10-item Hopkins Symptom Check List (HSCL-10), and self-reported total number of hours of sleep. ResultsThe mean total oxazepam dose (± standard deviation) was 56.8 ± 72.8 mg in the oxytocin group and 79.0 ± 122.9 in the placebo group (p = 0.490; difference -22.3 mg; 95% confidence interval (CI) -86.9 to +42.4 mg). The findings were inconclusive as to whether a difference in the CIWA-Ar score (5.94 ± 3.86 vs. 6.48 ± 3.92; p = 0.665) or in any of the other secondary outcomes was present. No serious adverse events were reported. ConclusionCompared to placebo, intranasal oxytocin did not significantly reduce the oxazepam dose needed to complete a 3-day course of alcohol detoxification and withdrawal treatment.

Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant

The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.

Do RATs save lives? A service evaluation of an out-of-hospital cardiac arrest team in an English ambulance service.

Introduction:Out-of-hospital cardiac arrest (OHCA) is a major public health problem, leading to a substantial number of deaths in the UK. In response to this, the Yorkshire Ambulance Service NHS Trust (YAS) has introduced red arrest teams (RATs). RAT members attend a three-day training course, focusing on the technical and non-technical skills that are required to effectively team lead an OHCA and provide high quality post-resuscitation care. This evaluation aims to determine the impact of the RATs on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.Methods:All adult (≥ 18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between 1 October 2015 and 30 September 2017 were included if the patient was resuscitated and the cause of the arrest was considered to be medical in origin. Multi-variable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.Results:During the 2-year data collection period, YAS attended 15,151 cardiac arrests. After removing ineligible cases, 5868 cardiac arrests remained. RATs attended 2000/5868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, min. 1, max. 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95% CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95% CI 0.99–1.29), compared to the odds of not having a RAT present, although neither result is statistically significant.Conclusion:The presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA.

Self-Renewal and Differentiation of Adipose-Derived Stem Cells (ADSCs) Stimulated by Multi-Axial Tensile Strain in a Pneumatic Microdevice.

Adipose-derived stem cells (ADSCs) were suggested for treating degenerative osteoarthritis, suppressing inflammatory responses, and repairing damaged soft tissues. Moreover, the ADSCs have the potential to undergo self-renewal and differentiate into bone, tendon, cartilage, and ligament. Recently, investigation of the self-renewal and differentiation of the ADSCs has become an attractive area. In this work, a pneumatic microdevice has been developed to study the gene expression of the ADSCs after the stimulation of multi-axial tensile strain. The ADSCs were cultured on the microdevice and experienced multi-axial tensile strain during a three-day culture course. Self-renewal and differentiation abilities were investigated by mRNA expressions of NANOG, sex determining region Y-box 2 (SOX2), octamer-binding transcription factor 4 (OCT4), sex determining region Y-box9 (SOX9), peroxisome proliferator-activated receptor gamma (PPAR-γ), and runt-related transcription factor 2 (RUNX2). The result showed that the genes related self-renewal were significantly up-regulated after the tensile stimulation. Higher proliferation ratio of the ADSCs was also shown by cell viability assay. The microdevice provides a promising platform for cell-based study under mechanical tensile stimulation.

Empathy in vaccination counselling: a survey on the impact of a three-day residential course

ABSTRACTBackground: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known.This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients’ ratings of the level of empathy of physicians and nurses working in vaccination centers.Methods: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children.Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups.Results: Analysis of the questionnaires showed an increase of “excellent” scores and statistically significant differences between the pre- and post -course median values.Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course.Conclusions: This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents’ adherence to vaccination programs.

Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya.

BackgroundRadiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability and reliability of paediatric CXR interpretation using percent agreement and Cohen’s Kappa and the validity of field readings against expert review in a study of the impact of PCV on pneumonia.MethodsCXRs were obtained from 2716 children admitted between 2006 and 2014 to Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians and radiologists attended a three-day training course on CXR interpretation using a WHO standard. All CXRs were read once by two local primary readers. Discordant readings and 13% of concordant readings were arbitrated by a panel of three expert radiologists. To assess repeatability, a 5% median random sample was presented twice. Sensitivity and specificity of the primary readers’ interpretations was estimated against the ‘gold-standard’ of the arbitrators’ results.ResultsOf 2716 CXRs, 2 were uninterpretable and 159 were evaluated twice. The percent agreement and Kappa for RCP were 89% and 0.68 and ranged between 84–97% and 0.19–0.68, respectively, for all pathological findings. Intra-observer repeatability was similar to inter-observer reliability. Sensitivities of the primary readers to detect RCP were 69% and 73%; specificities were 96% and 95%.ConclusionIntra- and inter-observer agreements on interpretations of radiologically-confirmed pneumonia are fair to good. Reasonable sensitivity and high specificity make radiologically-confirmed pneumonia, determined in the field, a suitable measure of relative vaccine effectiveness.

Abstract 374: Direct measurements of cellular ATP levels in tumor cell lines using real-time, quantitative live-cell analysis

Abstract Metabolic reprogramming is a hallmark of tumor cells, owing to the increased energetic and biosynthetic demands associated with maintaining high rates of proliferation. Therapeutic strategies targeting unique, critical metabolic pathways of tumor cells are under investigation and in clinical trials. Standard approaches to monitoring drug induced metabolic perturbations are limited to endpoint assays that provide population-based measurements and limited kinetic information. We developed a genetically encoded ATP sensor to enable direct, automated analysis of cellular ATP levels using IncuCyte® S3. In this study, our live cell imaging approach was utilized to evaluate the effect of cancer therapeutics on ATP levels in tumor cell lines, focusing primarily on compounds that target metabolic vulnerabilities. Cell lines stably expressing a genetically encoded, fluorescent ATP sensor or a control (non-ATP binding) sensor were generated. ATP levels were monitored and analyzed using an IncuCyte® S3 equipped with a specialized filter set and data acquisition module. Cellular ATP levels were measured over the course of hours to days following compound treatment. Reductions in ATP levels could be observed within an hour of administration, highlighting the sensitivity and temporal resolution of the IncuCyte® S3 ATP sensor assay. Transient reductions in ATP followed by recovery, which would have been missed by typical endpoint assays, were noted using our live cell analysis approach. Sustained decreases in ATP were associated with enhanced antiproliferative efficacy compared to conditions under which recovery of ATP levels were observed. For example, triple-negative breast cancer (TNBC) cell lines have been shown to be more dependent on activity of glutaminase 1 (GLS1), which catalyzes the first step in utilization of glutamine to fuel mitochondrial metabolism, than their receptor-positive counterparts. Using our live cell analysis approach, we observed a rapid drop in ATP upon glutamine deprivation or inhibition of GLS1 by CB-839 in the TNBC cell line MDA-MB-231. ATP levels remained below that of vehicle-treated cells for the duration of the three-day time course. In contrast, the estrogen receptor-positive cell line MCF-7 displayed a more modest decrease in ATP and full recovery within 48 hours. Quantification of phase confluence confirmed that CB-839 had a stronger antiproliferative effect in MDA-MB-231 cells compared to MCF-7 cells. Visualization of morphology in tandem with automated ATP sensor analysis provide additional insight into the heterogeneity of cellular responses to compound addition. Overall, these data highlight the ability of IncuCyte® S3 to provide direct, kinetic measurement of ATP by live-cell analysis. Citation Format: Cicely L. Schramm, Grigory S. Filonov, Michael L. Bowe, Yong X. Chen, Laura A. Skerlos, Dyke P. McEwen, Daniel M. Appledorn. Direct measurements of cellular ATP levels in tumor cell lines using real-time, quantitative live-cell analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 374.

Development and evaluation of a standardized peer-training in the context of peer review for quality assurance in work capacity evaluation

BackgroundThe German quality assurance programme for evaluating work capacity is based on peer review that evaluates the quality of medical experts’ reports. Low reliability is thought to be due to systematic differences among peers. For this purpose, we developed a curriculum for a standardized peer-training (SPT). This study investigates, whether the SPT increases the inter-rater reliability of social medical physicians participating in a cross-institutional peer review.MethodsForty physicians from 16 regional German Pension Insurances were subjected to SPT. The three-day training course consist of nine educational objectives recorded in a training manual. The SPT is split into a basic module providing basic information about the peer review and an advanced module for small groups of up to 12 peers training peer review using medical reports. Feasibility was tested by assessing selection, comprehensibility and subjective use of contents delivered, the trainers’ delivery and design of training materials. The effectiveness of SPT was determined by evaluating peer concordance using three anonymised medical reports assessed by each peer. Percentage agreement and Fleiss’ kappa (κm) were calculated. Concordance was compared with review results from a previous unstructured, non-standardized peer-training programme (control condition) performed by 19 peers from 12 German Pension Insurances departments. The control condition focused exclusively on the application of peer review in small groups. No specifically training materials, methods and trainer instructions were used.ResultsPeer-training was shown to be feasible. The level of subjective confidence in handling the peer review instrument varied between 70 and 90%. Average percentage agreement for the main outcome criterion was 60.2%, resulting in a κm of 0.39. By comparison, the average percentage concordance was 40.2% and the κm was 0.12 for the control condition.ConclusionConcordance with the main criterion was relevant but not significant (p = 0.2) higher for SPT than for the control condition. Fleiss’ kappa coefficient showed that peer concordance was higher for SPT than randomly expected. Nevertheless, a score of 0.39 for the main criterion indicated only fair inter-rater reliability, considerably lower than the conventional standard of 0.7 for adequate reliability.

Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

Abstract People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.

Hawaii educators’ experiences in a professional development course on mindfulness

ABSTRACTMindfulness as focused attention and awareness with acceptance is increasingly being promoted and used as a professional development tool for educators to improve their own as well as students’ well-being, stress, and learning climate. Twenty-six K-12 Hawaii teachers and counselors participated in a three-day mindfulness training course as part of a professional development opportunity. Phenomenological, content analyses of educators’ reflections on personal practices revealed feelings of stress associated with classroom/student management and lack of self-care. Reflections also revealed mindfulness practices helping them to become more aware of their unskillful emotional and mental habit patterns, and how to manage stress. Their reflections on implementing three simple mindfulness lesson plans with students revealed favorable perceptions of mindfulness to improve the lives of their students, the ease as well as challenges of incorporating the practices into the classroom, and the enthusiastic adoption and uptake by the students. Research and policy recommendations as well as implications are discussed, particularly as it relates to current challenges and criticisms of secular mindfulness in education.

Accounting measurements, profit, and loss: a science fiction play in one act by Harold C. Edey

ABSTRACT This study presents a hereto-unpublished one-act play used during an annual three-day ‘residential course’ put on by the Department of Accounting at the London School of Economics and Political Science (LSE) in the late 1950s. The original author of this play, Harold C. Edey, is one of the intellectual forerunners in the development of British accounting thought. The aim of his exercise was to explore the problem of profit determination during a period of changes in specific and general prices. Reproducing this play contributes to our understanding of the development of accounting thought and teaching at the LSE in the period after the Second World War (1939–1945). To contextualise the play, the study traces the history of the LSE and of the author, as well as some of the concepts from the accounting measurement literature that would have been familiar to students attending the three-day residential course.

Applying interprofessional Team-Based Learning in patient safety: a pilot evaluation study

BackgroundInterprofessional education (IPE) interventions are not always successful in achieving learning outcomes. Team-Based Learning (TBL) would appear to be a suitable pedagogical method for IPE, as it focuses on team performance; however, little is known about interprofessional TBL as an instructional framework for patient safety. In this pilot-study, we aimed to (1) describe participants’ reactions to TBL, (2) observe their achievement with respect to interprofessional education learning objectives, and (3) document their attitudinal shifts with regard to patient safety behaviours.MethodsWe developed and implemented a three-day course for pre-qualifying, non-medical healthcare students to give instruction on non-technical skills related to ‘learning from errors’. The course consisted of three sequential modules: ‘Recognizing Errors’, ‘Analysing Errors’, and ‘Reporting Errors’. The evaluation took place within a quasi-experimental pre-test-post-test study design. Participants completed self-assessments through valid and reliable instruments such as the Mennenga’s TBL Student Assessment Instrument and the University of the West of England’s Interprofessional Questionnaire. The mean scores of the individual readiness assurance tests were compared with the scores of the group readiness assurance test in order to explore if students learned from each other during group discussions. Data was analysed using descriptive (i.e. mean, standard deviation), parametric (i.e. paired t-test), and non-parametric (i.e. Wilcoxon signed-rank test) methods.ResultsThirty-nine students from five different bachelor’s programs attended the course. The participants positively rated TBL as an instructional approach. All teams outperformed the mean score of their individual members during the readiness assurance process. We observed significant improvements in ‘communication and teamwork’ and ‘interprofessional learning’ but not in ‘interprofessional interaction’ and ‘interprofessional relationships.’ Findings on safety attitudes and behaviours were mixed.ConclusionTBL was well received by the students. Our first findings indicate that interprofessional TBL seems to be a promising pedagogical method to achieve patient safety learning objectives. It is crucial to develop relevant clinical cases that involve all professions. Further research with larger sample sizes (e.g. including medical students) and more rigorous study designs (e.g. pre-test post-test with a control group) is needed to confirm our preliminary findings.

Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar.

BackgroundThe 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization.Materials and methodsUsing a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization.ResultsAt three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant’s years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges.ConclusionUse of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

City Profile: Amsterdam

A msterdam is much more than first meets the eye. From afar, Amsterdam seems to consist of only the scandalous Red Light District and the somber Anne Frank House. But up close, this often-underestimated Dutch haven presents art and experience in spades. Arriving in this near-cartoon metropolis puts travelers in a dreamlike state: in a bustling capital where cars aren’t allowed, the tringtringing of bikes fills your ears as they whiz past multicolored pastel houses, down cobblestone streets running parallel to the canals. At first, the patternless layout of these narrow streets is disorienting, but, as you adjust to the sensory overload, you find you don’t mind; in fact, you surrender to it willingly. Literature thrives here. Secondhand bookstores line the canals in the “9 Straatjes” (Nine little streets), like the Boekie Woekie, which specializes in selfpublished and small-press books. Every Friday, Squi puts on an outside book market , where shoppers find novels, poetry, and nonfiction written in dozens of languages . Just around the corner stands the American Book Center, a four-floor library and store with wall-to-ceiling bookshelves, Beauty and the Beast style. As if that’s not enough to fill your dreamy days, every year in May, the city puts on the Amsterdam Literary Festival, which accepts submissions from all genres and proffers the world’s largest book market, with over one thousand stalls. It’s impossible not to acknowledge the ghost of Anne Frank and both the museum and statue erected in her memory. Her legacy has given birth to a rich literary scene: dozens of writing workshops meet monthly , like the Amsterdam Writers Guild, full of creatives from different backgrounds and cultures. Artists here mingle easily; most speak two or three languages. The Van Gogh Museum alone brings in hundreds of people daily from around the world. Open since 1973, it holds the largest collection of paintings and drawings by Vincent Van Gogh and his contemporaries; though Starry Night resides in the MoMA in New York City, you can still see Self-Portrait, Sunflowers, and Almond Blossoms. For those equally interested in writing as well as reading, there’s the Perdu, the center for Dutch poetry. It boasts creative workshops, exhibits, a theater, and a small publishing house. The Mezrab Storytelling School hosts a three-day introduction course to allow you to get a feel for what the professional courses might be like, should you seek a more permanent relationship with the city. The inhabitants welcome international influence, and because of this, the town has become a melting pot of perspectives, preserved by an easygoing nature and inviting aura. Amsterdam offers something for everyone, from the traveling student to the serious artist. Its door is open to all—you only have to knock. A WLT intern, Taylor Hickney has a degree in English writing from the University of Oklahoma and will begin pursuing an MFA in fiction at the New School in August. Commas are important, and she hates surprises. A big thanks to Amy Poehler for getting her this far in life. Notebook city profile Amsterdam by Taylor Hickney WHAT TO READ BY THE CANAL David Hewson The House of Dolls Pan Books Hendrik Marsman Three Dutch Poems Trans. Jacquelyn Pope WLT website Richard Milazzo “Artaud in Amsterdam” and other poems in Prayer in a Wolf’s Mouth: Poems 2013–2014 Lower Canal Books Deborah Moggach Tulip Fever Dial Press Dubravka Ugrešić The Ministry of Pain Trans. Michael Henry Heim Ecco PHOTO: KIRK FISHER/PIXABAY WORLDLIT.ORG 5 ...