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Healthcare-associated infections and more specifically surgical site infections, represent one of the biggest challenges facing practitioners in the perioperative environment. This chapter addresses the key points related to the causes of infection, and how they can be prevented. Infections are caused by pathogenic organisms, consequently, it is important to understand how they enter the body. The chain of infection model describes a series of links that outlines how infections can spread and provides a foundation to understand how they can be prevented. It is essential that perioperative practitioners understand how to break the chain of infection as well as the consequences of not doing so.
The aim of the project was to assess completion rates for the VTE prophylaxis assessment for patients admitted to Dova Unit, Dane Garth. Another aim of the project was to identify areas for improvement and changes which could increase compliance rates.
In the first cycle of the audit 20 randomly selected patients admitted to Dova Unit, Dane Garth between June and December 2020 were identified and included in the project. Data were then collected from the online patient record system Rio and analysed using an excel spreadsheet.
In the second cycle of the audit 10 randomly selected patients admitted to Dova Unit, Dane Garth between January and February 2021 were identified and included in the project. Data were then collected from the online patient record system Rio, analysed using an excel spreadsheet and compared with the results obtained in the first cycle of the project.
In the first cycle of the audit the overall compliance was found to be 35%. VTE Risk assessment was completed for 50% of patients included in the study. ‘Active VTE on admission’ section of the VTE prophylaxis admission assessment was completed for 30% of patients included in the study. ‘Active VTE at 72 hours’ section was completed for 20% of the patients in the study and the ‘risk assessment for VTE' form was completed for 40% of patients included in the study.
In the second cycle of the audit the overall compliance was found to be 50%. VTE Risk assessment was completed for 60% of patients included in the study. ‘Active VTE on admission’ section of the VTE prophylaxis admission assessment was completed for 40% of patients included in the study. ‘Active VTE at 72 hours’ was completed for 40% of the patients included in the study and ‘risk assessment for VTE' form was completed for 60% of patients included in the study.
There was an overall improvement in the completion rates for the VTE prophylaxis admission assessment as a result of conducting the project. Working with the junior doctors and other healthcare professionals responsible for completing the VTE prophylaxis admission assessment, we aim to improve our completion rates of vital information even further.
The British Society for Parasitology (BSP) holds a biannual symposium devoted to the kinetoplastids, and seeks to cover the full gamut of research into these important organisms, and alternates with the Woods Hole Kinetoplastid Molecular Cell Biology meeting that serves a similar community. While normally embedded within the main BSP Spring meeting, on several occasions the symposium has enjoyed the opportunity of being hosted on mainland Europe. In 2020, the BSP was fortunate to spend some time in Granada in Spain, where a superb meeting with excellent science in a spectacular setting was overshadowed by news of an emerging novel coronavirus. In this editorial, we hope to have captured some of that excellent science and to highlight aspects of the many great papers and reviews in this special issue, as well as provide a few images from the meeting, which we hope for this who attended will bring back some fond memories.
The number of mental health-related 999 calls to emergency services has increased in recent years. However, emergency services staff have an unfavourable reputation when it comes to supporting people experiencing mental health problems.
To assess the levels of explicit and implicit mental health stigma among accident and emergency, ambulance and police staff, and draw comparisons with the general population. Additional analyses sought to identify which variables predict mental health stigma among emergency services staff.
A cross-sectional survey of 1837 participants, comprising four independent groups (accident and emergency, ambulance and police staff, and the general population).
Levels of mental health stigma across all four groups were lower than those reported in recent surveys of the general population by the ‘Time to Change’ campaign. Within this study, explicit levels of mental health stigma were lower among the general population compared with emergency services staff. There was no difference between emergency service professions, nor were there any between-group differences in terms of implicit mental health stigma. The only consistent predictors of mental health stigma were attitudes and future behavioural intentions, whereby increased stigma was predicted by increased fear, reduced sympathy and greater intended discrimination.
Our findings suggest that levels of mental health stigma have improved over time, but there is room for improvement in emergency services staff. Interventions to improve mental health stigma may be most effective if, in line with the cognitive–behavioural model of stigma, they target attitudes and behavioural intentions.
Aquaglyceroporins (AQPs) are membrane proteins that function in osmoregulation and the uptake of low molecular weight solutes, in particular glycerol and urea. The AQP family is highly conserved, with two major subfamilies having arisen very early in prokaryote evolution and retained by eukaryotes. A complex evolutionary history indicates multiple lineage-specific expansions, losses and not uncommonly a complete loss. Consequently, the AQP family is highly evolvable and has been associated with significant events in life on Earth. In the African trypanosomes, a role for the AQP2 paralogue, in sensitivity to two chemotherapeutic agents, pentamidine and melarsoprol, is well established, albeit with the mechanisms for cell entry and resistance unclear until very recently. Here, we discuss AQP evolution, structure and mechanisms by which AQPs impact drug sensitivity, suggesting that AQP2 stability is highly sensitive to mutation while serving as the major uptake pathway for pentamidine.
Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life.
Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness.
In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals.
These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.
Building on the recent advances in next-generation sequencing, the integration of genomics, proteomics, metabolomics, and other approaches hold tremendous promise for precision medicine. The approval and adoption of these rapidly advancing technologies and methods presents several regulatory science considerations that need to be addressed. To better understand and address these regulatory science issues, a Clinical and Translational Science Award Working Group convened the Regulatory Science to Advance Precision Medicine Forum. The Forum identified an initial set of regulatory science gaps. The final set of key findings and recommendations provided here address issues related to the lack of standardization of complex tests, preclinical issues, establishing clinical validity and utility, pharmacogenomics considerations, and knowledge gaps.
We sought to conduct a major objective of the CAEP Academic Section, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools.
We developed an 84-question questionnaire, which was distributed to academic heads. The responses were validated by phone by the lead author to ensure that the questions were answered completely and consistently. Details of pediatric emergency medicine units were excluded from the scan.
At eight of 17 universities, emergency medicine has full departmental status and at two it has no official academic status. Canadian academic emergency medicine is practiced at 46 major teaching hospitals and 13 specialized pediatric hospitals. Another 69 Canadian hospital EDs regularly take clinical clerks and emergency medicine residents. There are 31 full professors of emergency medicine in Canada. Teaching programs are strong with clerkships offered at 16/17 universities, CCFP(EM) programs at 17/17, and RCPSC residency programs at 14/17. Fourteen sites have at least one physician with a Master’s degree in education. There are 55 clinical researchers with salary support at 13 universities. Sixteen sites have published peer-reviewed papers in the past five years, ranging from four to 235 per site. Annual budgets range from $200,000 to $5,900,000.
This comprehensive review of academic activities in emergency medicine across Canada identifies areas of strengths as well as opportunities for improvement. CAEP and the Academic Section hope we can ultimately improve ED patient care by sharing best academic practices and becoming better teachers, educators, and researchers.
Following the inaugural Australian Association for Environmental Education (AAEE) research symposium in November 2014, we — a group of emerging researchers in Environmental Education/Sustainability Education (EE/SE) — commenced an online collaboration to identify and articulate our responses to the main themes of the symposium. Identifying as #aaeeer, our discussions coalesced into four main areas that we felt captured not only some of our current research interests, but also ‘under-explored’ areas that need further attention and that also held the potential for meaningful and ‘dangerous’ contributions to EE/SE research and practice. These themes were: (1) uncertain futures, (2) traditional knowledges for the future, (3) community EE/SE, and (4) the rise of the digital, explorations of which we present in this article. By no means intended to capture all that is worth researching in this field, these themes, and this article, are deliberately presented by #aaeeer to spark discussions, as well as showcase an example of online collaboration between researchers in a number of countries.
Materiality and the material are important in medieval romance. The essays here focus both on the physical forms of romance texts (manuscripts, verse form, illustrations and visual portryals), and on how romances themselves inhabit and reflect on the material culture of the Middle Ages. Specific themes discussed include social, historical, and physical space; bodies and gender politics; and romance illustrations in manuscripts, and in other media. Nicholas Perkins is University Lecturer and Tutor in medieval English, University of Oxford. Contributors: Siobhain Bly Calkin, Nancy Mason Bradbury, Aisling Byrne, Anna Caughey, Neil Cartlidge, Mark Cruse, Morgan Dickson, Rosalind Field, Elliott Kendall, Megan Leitch, Henrike Manuwald, Ad Putter, Raluca Radulescu, Robert Rouse,
Non-invasive survey in the Stonehenge ‘Triangle’, Amesbury, Wiltshire, has highlighted a number of features that have a significant bearing on the interpretation of the site. Geophysical anomalies may signal the position of buried stones adding to the possibility of former stone arrangements, while laser scanning has provided detail on the manner in which the stones have been dressed; some subsequently carved with axe and dagger symbols. The probability that a lintelled bluestone trilithon formed an entrance in the north-east is signposted. This work has added detail that allows discussion on the question of whether the sarsen circle was a completed structure, although it is by no means conclusive in this respect. Instead, it is suggested that it was built as a façade, with other parts of the circuit added and with an entrance in the south.