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Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods
The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results
The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion
The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.
Natural smectites bind aflatoxins from water effectively, but the complex chemical environment in the guts of mammals and other animals can limit binding of aflatoxins. Many efforts have been made to enhance the adsorption capacity and affinity of smectites for aflatoxins in the presence of biological compounds. The main objective of the present study was to modify smectite structures by pillaring and cation exchange to enhance aflatoxin B1 adsorption capacity and selectivity. Smectite was pillared with Al and Al-Fe polycations or saturated with Ca, Mg, Zn, or Li. Structural changes in smectites with or without heat treatment were determined using X-ray diffraction and Fourier-transform infrared spectroscopy. Equilibrium aflatoxin B1 adsorption to the smectites was measured in aqueous solution and in simulated gastric fluid. Pillaring with the polycations expanded smectites in the z-direction to 18.6 Å and the expansion was stable after heating at 500°C. Changes in the Al–OH–Al infrared bands in the stretching region supported the formation of pillared clays. Migration of Mg, Zn, and Li into the octahedral sites of the smectite was observed as Mg and Zn saturation yielded a d spacing of 15 Å at 200°C which collapsed to 9.6 Å at 400°C. The 14.6 Å peak of the Li-saturated smectite collapsed to 9.6 Å at 200°C while the 15 Å Ca-saturated smectite peak was stable up to 400°C. The unheated Al- and AlFe-pillared smectites adsorbed significantly more aflatoxin B1 from an aqueous suspension than did unpillared clay. In both water and simulated gastric fluid, heat treatment decreased aflatoxin B1 adsorption to pillared smectites, but heat treatment increased aflatoxin B1 adsorption to unpillared smectites. Without heat treatment, smectites saturated with divalent cations (Ca, Mg, Zn) adsorbed more aflatoxin B1 from an aqueous suspension than the smectite saturated with a monovalent cation (Li). Ca-saturated smectite showed the greatest aflatoxin B1 adsorption, 114 g kg–1, from aqueous suspension after 400°C heat treatment. The Zn-, Mg-, and Li-saturated smectites showed maximum aflatoxin adsorption of 107, 93, and 90 g kg–1, respectively, after 200°C heat treatment. From simulated gastric fluid with pepsin, the 200°C heated, Zn-saturated smectite had maximum aflatoxin B1 adsorption of 68 g kg–1. Pillared smectites effectively adsorbed aflatoxin B1 from aqueous suspension, but Ca- and Zn-saturated smectites after heat treatment might improve the selectivity of smectites for aflatoxin B1 over pepsin and enhance the efficacy of smectite as a feed additive.
Horizon scanning for health technology appraisal (HTA) in England involves topic notification to the National Institute for Health and Care Excellence (NICE) via technology briefings. This activity is undertaken by the Innovation Observatory with submission timelines designed to ensure that HTA decisions align with regulatory approval time. In this paper, we aimed to track and assess the progression and current status of the topics notified for HTA and provide a descriptive analysis of these topics.
Methods
Technology briefings were mapped from submission to NICE technology appraisal/highly specialized technologies recommendations from April 2017 until October 2021. This was done using a combination of searches on Google and NICE website, searching a downloadable spreadsheet containing NICE topic selection decisions, and querying NICE Topic Selection team. Analysis was undertaken regarding type of indications and interventions of submitted topics and published guidance.
Results
Six-hundred and ninety-three topics entered the NICE scoping process, of which 94 percent were prioritized. As of November 2021, approximately 39 percent of prioritized topics were in scoping/in progress, 31 percent were proposed/completed, 20 percent were suspended/terminated, and 4 percent were referred back to Innovation Observatory (IO) for further monitoring.
Conclusions
Our work demonstrates that horizon scanning for HTA is a complex and time-intensive process. Timelines and progress through HTA is challenging due to the growing number of innovative medicines, significant uncertainties, and limited transparency in clinical development and regulatory pathways. A better understanding of clinical trials and regulatory requirements may help eliminate some of this uncertainty and improve timely HTA.
After the introduction of proposal regarding cannabidiol for the treatment of some psychiatric disorders including anxiety, there is confusion if cannabidiol use is associated with the provocation of anxiety symptoms or it can be safely used for the treatment. In nonmedical terms, (Cannabidiol) Cannabis is referred to as Marijuana and has been considered a potential substance of abuse for ages, that raises few questions for its use as a treating agent. It is an interesting area to be explored.
Objectives
Our aim is to find out the implications of Cannabidiol use. We look forward to knowing the mechanism behind cannabidiol being a potential treatment strategy for anxiety.
Methods
A literature search was conducted using the search terms [anxiety] OR [cannabis] OR[ Marijuana] OR [cannabidiol] OR [tetrahydrocannabinol] OR [phytocannabinoids] OR [panic] OR [generalized anxiety] OR [social anxiety] OR [psycholgic distress] OR[psychosis] OR [depression]. The overall search produced 230 results. We included 30 studies relevant to the subject in this review.
Results
Results revealed that anxiety is highly prevalent in individuals with a history of cannabidiol use in comparison to non-users. Symptoms of stress are more pronounced with more frequent cannabidiol use. Chronic users present with more severe symptoms like palpitations and the constant restlessness that are difficult to be managed. The potential role of Cannabinoids in reducing the conditioning of fear can be considered one of the reasons for investigations being done on it. Cannabidiol (Cb1) receptor plays a potential role in producing anxiolytic effects. The side effects of first-line drugs like distorted body shape due to weight gain, sexual health concerns and resistance along with frequent relapses, available for managing anxiety disorders are one of the reasons to consider alternative substances. Though, human testings are still underway, animal models are used currently for experimentation purposes and show positive anxiolytic effects of cannabidiol.
Conclusions
There is increased need to investigate necessary chemical and physiologic changes that are produced within the body in response to cannabidiol use. More investigations should be done on human subjects along with animal studies. Proper guidelines should be shared with practicing physicians so that new and pretested ways are open for the treatment of resistant cases with proper implications of knowledge in clinical settings so that there is minimal chance of abuse of potentially addictive chemicals.
Epilepsy is a neurologic condition characterized by spontaneous jerky body movements. It is a chronic morbid condition mostly diagnosed during childhood. Patients are maintained on long-term medications to prevent recurrent seizures that can damage the brain. Medications used for the management of epilepsy have several side effects and require proper monitoring. Patients with epilepsy are at increased risk of psychiatric comorbidities.
Objectives
Our aim is to find factors responsible for causing suicidality in patients with epilepsy.
Methods
A review was conducted using Pubmed database with the search terms [epilepsy] OR [neurological conditions] OR [suicide] OR [suidical attempt] OR [suicidal ideation] OR [depression] OR [psychiatric diseases] OR [mood disorders] OR [anxiety] OR [sleeplessness] which yielded around 800 articles. The number was later reduced to be centered around the main area of interest and produced around 40 articles.
Results
Results show that many contributing factors play an unavoidable role in promoting suicidal ideation that can lead to suicidal attempts in epilepsy. The stigma associated with epilepsy leads to social isolation, lack of opportunities, financial constraints, and impact on close relationships which can be the reasons for depression. According to the review, the foremost contributing factor is the underlying social, emotional, and economic condition of epilepsy patients. Depression and anxiety are the most prevalent psychiatric comorbidities in epileptic patients. Epileptic patients who develop psychiatric ailments show decreased adherence to medications that further worsen the problem.
Conclusions
Though, this area in neurology has started getting attention for further research and guidelines. But efforts are still inadequate for this to be put into clinical practice. More desperate actions needed to be taken for proper diagnosis and management of suicidal ideations by proper use of assessment tools so that timely actions are planned. This is a highly demanding area due to the impact of depressive symptoms on the prognosis of the chronic neurologic condition.
Death is a complex construct to understand as it is influenced by the perceptions that HCP may have regarding end of life. Understanding these perceptions helps in addressing death anxiety in HCP which can otherwise negatively influence physician well-being and patient interactions such as breaking bad news.
Objectives
To identify association between attitudes towards death among HCP and their perceived well-being.
Methods
This is a cross-sectional study on 109 HCP including nurses (n=29), physicians (n=43), resident (n=25) and interns (n=12) across various specialties at AKU. Death anxiety was assessed through the death attitude profile revised scale and its correlation was seen with the perception of one’s own wellbeing through Perceived well-being scale. A semi-structured pro-forma was used to collect demographic data.
Results
The results showed that death anxiety was highest in interns (150.83 ± 17.94) followed by nurses (139 ± 20.67), residents (137.84 ± 15.79) and physicians (137.99 ± 21.59) and perceived well-being was lowest in interns (71.00 ± 10.10) followed by nurses (72.41 ± 10.43), residents (74.16 ± 12.83) and physicians (75.98 ± 12.19). The results of this study demonstrated a negative correlation between death anxiety and perceived well-being.
Conclusions
The negative correlation between death anxiety and perceived well-being suggest that health care professionals are most vulnerable in the preliminary years of their career. It is therefore recommended that psychology of death and dying is given equal weightage in medical curriculum to enable physicians deal effectively with the trauma of bereavement and loss relating to or patients.
The National Institute for Health and Care Research Innovation Observatory (IO) is a horizon scanning centre based at Newcastle University, United Kingdom. The IO provides horizon scanning intelligence on new and innovative medicinal products to the National Institute for Health and Care Excellence (NICE) as technology briefing notifications (TBNs). We present an analysis of how TBNs produced between April 2017 and October 2021 feed into the NICE HTA process and used to inform their Technology Appraisal (TA) programme.
Methods
TBNs were mapped to relevant published NICE TA guidance and time from horizon scanning identification to NICE recommendation was studied. For mapping technologies undergoing appraisal, provisional guidance-in-development (GID) identification numbers (IDs) were used. For technologies that had not reached the NICE scoping stage yet, the NICE Topic Selection decision and ID was used.
Results
Six hundred and ninety-three TBNs were submitted to NICE between April 2017 and October 2021; 653 were prioritised for TA. Of those, eleven percent mapped to a published NICE TA guidance; forty-three percent to a GID, twenty-two percent were undergoing consultation, and three percent were not traced. Further twenty-one percent mapped to a suspended or terminated TA. Reasons for this included HTA timeliness, regulatory issues or companies unwilling to submit evidence to NICE. Time from technology identification to TA guidance publication ranged from twenty-two to 115 months. The average time from TBN submission to NICE recommendation was thirty months.
Conclusions
Timely notification is key in achieving TA recommendation aligned with market authorization but not the only influencing factor. After issuing a TBN, the NICE appraisal process might be terminated, suspended or withdrawn due to unforeseen factors. Horizon scanning plays a key role triggering the NICE TA process; understanding factors that influence the successful TA completion would streamline processes and find efficiencies.
The book begins with a background reference to the importance and impact that both teaching and research activities have traditionally had on a university’s status in terms of its reputation and standing. It focuses on the political changes in the United Kingdom and highlights how the shifts in political thinking in recent years has changed the demographics of students entering higher education. Higher education is funded and the shift from being state funded to the student-funded model has meant that focus has shifted for higher education institutes to one in which the student is now being viewed as a fee-paying customer seeking value for money. As a consequence, universities are expected to be held more accountable to the service they are providing.
The book explores a range of student-centered approaches to teaching and learning that are proving to be very effective in enhancing the overall student teaching experience, and it also examines the argument that a one-size-fits-all model does not necessarily work well in higher education. With the ever more advances in digital technology, the book considers ways in which this technology can assist academics in helping to enhance the teaching and learning in the classroom as well as in cases of emergency scenarios such as the shutdown of education institutions in March 2020 due to COVID-19.
It should be universally understood that there is a moral obligation on all Higher Education Institutions (HEIs) to provide their students with the highest quality of teaching standards possible. In countries where students must pay for their own Higher Education (HE), students are investing significant amounts of their own time and money in their HE studies and therefore they are customers expecting the highest quality academic experience in return. Before 1998, in the United Kingdom, HE was free for all students continuing to study for their first degree at the undergraduate level. A radical political shift in educational ethos in 1998 introduced student fees and loans. With this substantial level of personal investment, surely students must be entitled to value for money when it comes to the teaching quality they receive throughout the duration of their studies. This resulted in the introduction of the teaching quality assessment process across the HE sector: the Teaching Excellence Framework (TEF). This move to the marketisation of HE is not just a UK phenomenon but can be seen across many countries around the world and has resulted in the production of league tables for research and teaching along with ‘student satisfaction’ rates; these metrics are having a greater impact when it comes to institutions competing for student numbers. Clearly, now there is a greater emphasis than ever before on the teaching quality of universities, and it is vitally important to be able to measure accurately teaching excellence within the HE sector.
A contentious issue within HEIs is the notion of what constitutes ‘teaching excellence’ and more importantly if it can be measured. HE by its very nature provides a diversity of learning opportunities to students depending on the various disciplines studied from courses that are highly vocational in nature to the more theoretically based subjects. If teaching quality is to be measured, it could be more appropriately achieved through qualitative rather than quantitative measures. It may be possible to capture the main features, describe them and then use a guide to make judgements of what teaching excellence represents. From empirical studies carried out within HE, it is considered that an excellent teacher should be one that has the following attributes (Wood and Su, 2017; Kreber, 2002):
Teaching excellence is of increasing importance within the Higher Education (HE) sector. In the current climate universities strive to demonstrate the value of their programmes and courses as they seek to attract students in a competitive marketplace. Within the context of this drive to attract students, institutions will readily state that they seek to pursue excellence in learning and teaching. However, it is less clear what constitutes ‘excellence’ when considered across a diverse sector with different traditions and practices relating to different disciplines. The problems associated with the ability to quantify and denote excellence in HE are compounded by the broad range of provision, the variation between institutions and the way in which universities position themselves and their offer to students. An unevenness exists across the sector in relation to teaching practices, class sizes and the philosophy of individual programmes and disciplines, and different contexts and approaches can exist even within a single university. There is no singular, identifiable culture for HE within the United Kingdom, and this makes comparisons between institutions potentially problematic.
Teaching is a complex practice affected by many factors: context, resources, learners, subject discipline, teacher experience, learning expectations and learning needs. It is also affected by the prevailing culture of the day; this includes, but is not limited to, the demographic of students and staff, the rise of social media, widening participation, funding constraints, digital technology and professional body requirements. These are but a few of the factors which impinge on the educational experience. Hence teaching is affected by multiple variables and is a dynamic, evolving practice that is impacted by a range of other elements and effects. Some of these are foreseeable and some are unanticipated but far-reaching, such as the Covid-19 pandemic of 2020 which altered the shape of HE suddenly and rapidly, creating a new ‘normal’ and a new set of comparisons. It is clear that HE does not and cannot operate in isolation to other factors. Developments and changes in one location can directly impact the sector globally. This is not just because students often travel to study but also because digital learning enables students to pursue courses remotely via e-learning across the world.
Learning is a fundamental aspect of human existence. It forms one of the essential building blocks of growth and development and continues throughout life. We are constantly surrounded by opportunities to learn. Teaching is one of the key activities which shapes and contextualises our learning, and the choice to continue to formally learn beyond compulsory education is an important life choice, driven by a number of factors. It is a choice that an increasing number of young people and mature students take in the United Kingdom. The Higher Education (HE) sector is eager to demonstrate the benefits of continued post-compulsory education and the importance of a ‘good’ learning experience. The well-used term ‘teaching excellence’ is often employed as an articulation of the pedagogy, learning and learner experience, which come together to ensure effective teaching. There are inherent problematic issues in seeking to universally compare teaching and in finding ways to articulate and measure what can be diverse learning experiences.
This book explores the importance of teaching excellence and how this has risen to prominence in a changing landscape of HE where access to university education has been substantially increased. The book explores some of the factors which have shaped the provision of HE and the responses to the challenge of ensuring that students gain a quality education which provides a satisfactory return on their investment in attending university. Taking in the complexities of the differing perspectives on a university education from sector to student and acknowledging the experience of academics who seek to be excellent teachers, this book offers a guide to understanding the key mechanisms by which teaching is measured and evaluated and offers insights into some of the more contemporary innovative methodologies that can help to enhance teaching excellence.
Although offering a broad overview of teaching excellence in the United Kingdom, the book is of course not comprehensive in its coverage. The field of university metrics is extensive, multilayered and diverse; the coverage here will be sufficient to help readers understand the concept of ‘teaching excellence’ and the role of different players and lens through which it is viewed. The following overview of the teaching excellence terrain provides an introduction to inspire further reading and exploration of the areas included here.
Teaching Excellence remains both a high priority and an elusive measurement. It remains a high priority partly due to the commercialisation of Higher Education (HE) which reconfigures ‘Teaching’ as a product to be valued, commodified and sold, and it remains elusive to measure because teaching is always only one-half of the equation, paired as it is with ‘learning’. Although ‘Learning and Teaching’ are often put together as if two sides of the same coin, educators and students alike will know that they do not always occupy the same space. Sometimes learning can occur totally independent of teaching, often through circumstance, reflection and experience. Likewise teaching, even good teaching, requires a fertile audience to result in impactful learning. The emphasis within the HE sector has placed ‘Teaching’ at the heart of the agenda, without fully acknowledging the role that learners play in their own education. This places the emphasis on the part of the process which is costed in financial terms and less on the social and personal investment required from learners if they are to succeed. The responsibility is placed upon the educator and the educational establishment to ensure that learning is taking place. This in no way negates the importance of teaching excellence or the role of the teacher, but it is interesting that a two-way process is often viewed through a single, institutionally based lens. Interestingly institutions are seeking to actively engage students more readily in learning and to provide them with insights on how to learn effectively as an adjunct on how to be successful. But this part of the equation is also quantified by the organisation's success in engaging students; the responsibility is perceived as essentially that of the university. This configuration of learners as passive within the learning process and the recipients of initiatives, knowledge, innovations and information is at times a problematic one in that it leads institutions to be involved in ever more complex arrangements to engage students. The language of HE is often about ‘attracting’ students to courses, programmes and institutions. Therefore the offer must be rendered ‘attractive’ – buildings, estates, timetables, value-added experience – and although all of these are important, there can be a tendency to overlook the need for students to be clear on what they want to learn and be ready and equipped to learn it.
‘Teaching excellence’ is not a simple concept and, as a concept, lacks precision. (Elton, 1998, 3).
While excellence is often perceived as a concept linked with individual virtue or quality, it is also referred to as an organisational characteristic by which universities recognise a vertical stratification which promotes exceptionality (Tavaras, 2014).
Excellence in Higher Education (HE) has more often become the expectation of all. ‘Teaching Excellence’ in particular is the definition of how we teach, how students learn and how we justify value to students and stakeholders. An internet search of HE providers suggests that many promote themselves as offering excellent teaching. The UK regulator for HE, the Office for Students (OfS), and the UK professional standards framework both articulate minimum expectations for teaching excellence. Inherent in these definitions is that excellence is the expectation, not a definition of exceptionality. For the purpose of this chapter the concept of excellence is therefore that of an expected customer service standard: one which underpins our professionalism, our values and our sense of success.
This chapter explores those aspects that define teaching excellence in the UK HE sector. It recognises the importance of teaching excellence to learners, professionals, the sector and HE policy agendas. In conclusion it recognises how a focus on teaching excellence has changed behaviours within the sector.
Student Numbers Entering HE
The number of students going into HE in the United Kingdom has been growing steadily since the mid-1990s. This was a stated objective of government policy back in 1999 when the then Prime Minister Tony Blair made a pledge that 50 per cent of all young people should be in HE by the year 2010. Although this objective was not reached fully by the 2010 deadline, it did reach around 49 per cent by the year 2017 (Adams, 2017).
Figure 1 summarises trends over a 25-year period since the Universities and Colleges Admissions Service (UCAS) was created following the reform of the sector in the early 1990s. It is clearly observed that student application numbers have been steadily rising since the mid-1990s except for the years 2006 and 2012 when there were dips corresponding to the introduction of variable fees and a rise in fees to £9,000 per year respectively.
Implementation of the teaching excellence framework
There are now more students entering Higher Education (HE) in the United Kingdom than ever before. HE is no longer limited just to the privilege of the elite few but where one in three school leavers continue to study at university level (Kershaw, 2019). With the changes in the early 1990s that created the post-1992 modern universities, the number of institutions with the title ‘university’ has also increased dramatically to now well over one hundred in the United Kingdom.
In many countries across the world the cost of HE is expensive with students having acquired a huge debt by the end of their programme that ultimately must be repaid. In the United States, for instance, typically, one year in a private university can cost around $30,000 when all costs are accounted for. In the United Kingdom, student debts are now averaging around £35,000 which is expected to be paid back but only when graduates are earning above a certain threshold amount and they do not have to make any repayments if they are out of work or their income goes below the threshold level.
In the United Kingdom, the government, as part of its reforms of the HE sector, placed a greater emphasis on giving students more choices about their options for HE. Where previously there was a general lack of information for students regarding the quality of teaching within an institution, students were not able to make informed choices regarding the suitability of a university for their needs, now information is available in the form of league tables and Teaching Excellence Framework (TEF) awards.
Variability related to teaching activities within different institutions is high and has meant that some students only receive a few hours of actual teaching contact time on a weekly basis compared to other students that have a significantly higher number of hours of contact per week while studying the same course in another location. Students entering HE need to make important decisions regarding what and where to study.
The UK government considers that the best way these choices can be made by students is to have a framework that can gather information which measures teaching in the broadest possible way. As previously discussed, this is comparable to the Research Excellence Framework (REF).
The aim of this study is to ascertain the psychological impacts of coronavirus disease (COVID-19) among the Pakistani health care workers (HCWs) and their coping strategies.
Methods:
This web-based, cross-sectional study was conducted among HCWs (N = 398) from Punjab Province of Pakistan. The generalized anxiety scale (GAD-7), patient health questionnaire (PHQ-9), and Brief-COPE were used to assess anxiety, depression, and coping strategies, respectively.
Results:
The average age of respondents was 28.67 years (SD = 4.15), with the majority being medical doctors (52%). Prevalences of anxiety and depression were 21.4% and 21.9%, respectively. There was no significant difference in anxiety and depression scores among doctors, nurses, and pharmacists. Females had significantly higher anxiety (P = 0.003) and depression (P = 0.001) scores than males. Moreover, frontline HCWs had significantly higher depression scores (P = 0.010) than others. The depression, not anxiety, score was significantly higher among those who did not receive the infection prevention training (P = 0.004). The most frequently adopted coping strategies were religious coping (M = 5.98, SD = 1.73), acceptance (M = 5.59, SD = 1.55), and coping planning (M = 4.91, SD = 1.85).
Conclusion:
A considerable proportion of HCWs are having generalized anxiety and depression during the ongoing COVID-19 pandemic. Our findings call for interventions to mitigate mental health risks in HCWs.