Teaching to learn: Using peer-assisted learning to complement the undergraduate dental curriculum.

INTRODUCTION: Peer-assisted learning (PAL) is a method of teaching in which students teach their often less-experienced peers. Whilst they gain more knowledge, peer tutors are able to convey information at a level that tutees can engage with. Whilst the use of PAL has increased in popularity within the healthcare faculty, there are fewer reports of its efficacy within dental education. Our aim is to explore the advantages and disadvantages of PAL, identifying factors that make it effective within undergraduate dental teaching. METHOD: 3rd-year dental students enrolled in supplementary PAL sessions taught by 4th-year dental student volunteers alongside their curriculum on an Integrated Human Disease course. Tutees participating in more than one PAL session were invited to a focus group to discuss the value of PAL within teaching, as were their tutors. Semi-structured focus groups in which they reflected on their learning experience and satisfaction were recorded, transcribed and analysed thematically. RESULTS: The qualitative data gathered from the focus groups for peer tutees (n = 4) and peer tutors (n = 5) revealed that the sessions stimulated learning, built confidence, developed skills out with the core topics and were complementary to the course. CONCLUSION: Our study confirms that PAL enhances the learning experience and is mutually advantageous to both tutees and tutors. Whilst further training, a larger sample size and higher quality research are required to confirm the more general use of PAL, the promise shown in this study would suggest that PAL is an extremely useful method, complementing the undergraduate dental curriculum.

Changing Practice in Gastrointestinal Endoscopy: Reducing Distractions for Patient Safety.

Failure in communication during the process of delivering healthcare can have dangerous repercussions. Specifically, failure in interdisciplinary team communication contributes to lapses in patient care. Distractions in procedural areas disrupt team communication. Application of a structured communication algorithm creates agreed-upon cues that promote team communication and facilitate clinical decision making. Frequent disruptions before, during, and after gastro-intestinal endoscopy procedures place veterans at risk for an error. A hierarchical culture promotes intimidation and reduces the likelihood that staff will speak up for patient safety. An endoscopy procedure area implemented a "sterile cockpit" methodology to reduce the number of distractions during procedures. Data collected from a self-reported safety awareness were measured by two different questionnaires and collected through observation of actual practice. Improved awareness of distraction and the impact on patient safety was reported, with a reduction from 24 observed interruptions to zero in 9 months. After reducing distractions in the procedural area, there is a perception of improved nursing quality of care. Additional support is required to consistently remove electronic distractions during a procedure.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District.

BACKGROUND: Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. STUDY DESIGN AND METHODS: Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. RESULTS: The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. CONCLUSIONS: The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed.

Quality control in homograft valve processing: when to screen for microbiological contamination?

Human donor heart valves remain essential for many reconstructive heart procedures. Heart valve donations are a scarce resource which must be used efficiently and safely. Infection transmission remains a potential risk with homograft valve use. Early experience with homograft valves identified high rates of microbial contamination at collection and initiated the practise of immersion in an antibiotic cocktail. Many centres rely on the microbiology screening after exposure to the antibiotic cocktail. We in our centre accept or reject valves on the basis of the microbiology screening at the time of collection prior to immersion in antibiotic solution. We wanted to compare our rate of valve discard and the rate of microbial contamination at implant with other centres. Valves are collected for the Irish Heart Valve Tissue Bank through partnership between the National Centre for Cardiothoracic Surgery and the Irish Blood Transfusion Service. Valves are collected in a surgical theatre setting and processed in dedicated section of the Irish Blood Transfusion Board. Tissues are screening for microbiology at collection and also at implantation. A total of 564 human heart valves and valve conduits were processed through the service during the study period. 167 (29.6%) were discarded during the processing and storage stages. The major reason for this in 117 cases was unsatisfactory microbiology on initial tissue screening. Repeat screening of accepted valves at the time of implantation identified positive cultures in only 0.9%. Optimal use of these limited resources is clearly important. However recipient safety remains paramount. One-fifth of collected valves are discarded at the processing stage due to positive microbiology screening. This is a higher rate of discard then other centres which reject 5.6-10% due to positive microbiology. However our rate of contamination at time of implant is lower then the 3% rate reported elsewhere. We are satisfied that our current discard rate, although significant, reflects rigorous quality control and the optimal balance between valve availability and patient safety.

Safe patient handling and mobility (SPHM) for increasingly bariatric patient populations: Factors related to caregivers' self-reported pain and injury.

This study was conducted at 5 Veterans Administration Medical Centers (VAMCs). A cross sectional survey was administered to 134 workers who routinely lift and mobilize patients within their workplaces' safe patient handling and mobility (SPHM) programs, which are mandated in all VAMCs. The survey was used to examine a comprehensive list of SPHM and non-SPHM variables, and their associations with self-reported musculoskeletal injury and pain. Previously unstudied variables distinguished between "bariatric" (≥300 lb or 136 kg) and "non-bariatric" (<300 lb or 136 kg) patient handling. Significant findings from stepwise and logistic regression provide targets for workplace improvements, predicting: lower injury odds with more frequently having sufficient time to use equipment, higher back pain odds with more frequent bariatric handling, lower back pain odds with greater ease in following SPHM policies, and lower odds of upper extremity pain with more bariatric equipment, and with higher safety climate ratings.

Changing trends in corneal transplantation: a national review of current practices in the Republic of Ireland.

BACKGROUND: First Irish National Corneal Transplant Registry report. AIM: To report about current corneal transplantation practices in Ireland including patient demographics, indications and types of transplant performed and to compare the findings with other developed countries. METHODS: Nationwide retrospective review of the corneal transplants performed in Ireland between 2016 and 2019. RESULTS: Overall, 536 keratoplasties were carried out: 256 (47.8%) Penetrating Keratoplasties (PK), 212 (39.6%) Descemet Stripping Automated Endothelial Keratoplasties (DSAEK), 30 (5.6%) Descemet Membrane Endothelial Keratoplasties (DMEK), and 25 (4.7%) Deep Anterior Lamellar Keratoplasties (DALK). The most common indication was Keratoconus (KC, 19%), followed by Fuchs endothelial dystrophy (FED, 18.8%), and Pseudophakic bullous keratopathy (PBK, 17%). KC (34%) and re-grafting (17%) were the leading indications for PK, whereas FED and PBK were the major indications for DSAEK (38% and 33%) and DMEK (67% and 20%), respectively. During the period studied, the number of transplants increased from 11.3 to 14 grafts per month. The number of PKs remained stable, whereas Endothelial Keratoplasties, DSAEK and DMEK, increased (3.8 to 5.6 and 0.2 to 1.6 per month, respectively), becoming the most commonly performed grafts since 2018. Only a small number of DALK were performed. CONCLUSIONS: Corneal transplantation in Ireland is following international trends as endothelial procedures have become the most common approach since 2018. However, a low overall number of transplants is performed in Ireland compared with other countries suggesting that care pathways should be implemented to improve access to corneal transplantation.

Using storytelling to improve student experience of outreach placements.

Storytelling has been used as a pedagogical approach in medicine and nursing for a number of years now. It is a way for students to consider themselves and the world around them as it creates a supportive space in which they can listen and be heard. It allows students to process their experience and listening to stories can widen their perspective. Storytelling can be useful as a way to encourage student reflection, and help students understand their future learning needs. The aim of this study is to enhance the understanding of the role that storytelling can play in the education of dental students. At the end of each outreach placement a teaching session was held in which the students were asked to relate their experiences in the form of a story. The sessions were evaluated using both a questionnaire and focus groups. The results show that storytelling helps students remember. It not only stimulates reflection but also helps them develop teamworking skills, communication and organisation and technical skills. Storytelling has far reaching effects on learning and development of communities of practice. It allows students to see things from many perspectives, develop professional competence, improve reflection and deepen understanding.

Use of a Cancer Registry to Evaluate Patient-Reported Outcomes of Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors (ICIs) are increasingly used for advanced lung cancer, but few studies have reported on patient-reported outcomes (PROs) outside the context of a clinical trial. The goal of the current study was to assess PROs in participants of a lung cancer registry who had been treated with an ICI. Patients participating in the GO2 Foundation's Lung Cancer Registry who reported receiving atezolizumab, durvalumab, nivolumab, or pembrolizumab were invited to participate in a survey about their experiences during treatment. Quality of life was evaluated using the Functional Assessment of Cancer Therapy-General (FACT-G). Common symptomatic adverse events were evaluated using an item bank generated for ICIs. Internationally, 226 patients (mean age 61, 75% female) participated. Patients reported worse quality of life at the time of assessment than U.S. population and cancer normative samples. The most common moderate to severe adverse events during ICI treatment were fatigue (41%), aching joints (27%), and aching muscles (20%). Due to toxicity, 25% reported a treatment delay, 11% an emergency room visit, and 9% a hospitalization. This study is among the first to our knowledge to report on PROs of ICIs outside the context of a clinical trial. Results suggest higher rates of adverse events than previously reported in clinical trials.

Delphi study to determine the key qualities consultant histopathologists look for in their trainees.

AIMS: A Delphi study to triangulate and determine the relative importance of the key qualities of trainees identified from qualitative interviews that sought to understand how consultant histopathologists determine diagnostic competences in trainees. METHODS: Twelve participants were purposively chosen for the Delphi to form an expert panel of relevant stakeholders. Participants were asked to score and rank the items presented to them. RESULTS: A total of 22 out of 27 of the key qualities of trainees (items) reached 'consensus in' after round 2 suggesting participants were able to agree that the majority of the items identified in the qualitative interviews were important to diagnostic competence. Five items reached 'no consensus'. Participants did not suggest any additional items. Participants particularly valued qualities of reflection and professionalism and trainees who understood the process of reaching a diagnosis and how their pathological report could impact on patient care. CONCLUSIONS: This study has triangulated findings from our qualitative interviews and show that consultants value a wide variety of qualities when determining diagnostic competence in their trainees. The judgement is complex and is therefore best assessed longitudinally and on a number of cases, so consultants can look for consistency of both approach to diagnosis and of trainee behaviour.

How consultants determine diagnostic competence in histopathology trainees.

AIMS: This is a qualitative study exploring how consultant histopathologists determine diagnostic competence in their trainees. METHODS: Semi-structured interviews were conducted with consultants and trainees and analysed using the Framework Method. RESULTS: Five major themes emerged from the data: process, person, stage of training, trust and time. Within these major themes, there were multiple subthemes which reflect the complex, longitudinal nature of the judgement, as well as the knowledge, skills and attitudes which are most relevant to diagnostic competence. A conceptual framework is proposed to illustrate the judgement ecology, which is supported by anonymised quotes from interview participants. CONCLUSIONS: Our study is the first to explore in depth how consultant histopathologists determine diagnostic competence in their trainees. This is particularly important as histopathology is a unique medical specialty for which there is little evidence to support the current assessment strategies during training. The resulting conceptual model and findings from this study may help to form an evidence base to inform future assessment tools in histopathology.

Conflicting demands that dentists and dental care professionals experience when using social media: a scoping review.

Introduction There are many conflicting demands for dentists and dental care professionals (DCPs) when using social media, for example between using social media for marketing and as professional provider of information. To gain a fuller understanding of how dentists/DCPs should optimally use social media, these conflicting demands need to be explored. The aim of this scoping review was to map out the current state of the literature describing the conflicting demands encountered by dentists and DCPs when using social media and the approaches used to manage these conflicting demands.Methods A scoping review was carried out. PubMed and Web of Science Core Collection were searched using inclusion and exclusion criteria. Data was extracted from the identified articles and analysed.Results The review identified 39 articles for inclusion. Conflicting demands were related to marketing and education with little information about how these conflicting demands can be managed.Conclusions The published literature on dentists'/DCPs' use of social media highlights that there are conflicting demands and little advice on management strategies. To gain an understanding of these conflicting demands, further research is required, including looking at the patient perspective, to inform future practice.

Assessors' and trainees' perceptions of workplace-based assessments in histopathology.

AIM: Workplace-based assessments (WBAs) are an integral part of specialist medical and dental training in the UK. Histopathology represents a very different training environment to the surgical specialities so it is important to know that the current WBAs are fit for purpose. A literature search revealed very little evidence regarding the perception of WBAs in histopathology. The aim of this study was therefore to assess the current perception of WBAs in histopathology by assessors and trainees. METHODS: A questionnaire was sent to all histopathology assessors and trainees on the Royal College of Pathologists database. Data were analysed using basic descriptive statistics. Free text comments were analysed by thematic analysis. RESULTS: The questionnaire was completed by 242/2175 assessors (response rate 11.1%) and 91/519 trainees (response rate 17.5%). There was no significantly different perception of WBAs between trainers and trainees (p>0.05). Key findings included respondents stating that they strongly disagreed or disagreed WBAs identify diagnostic competence (68% of trainees; 62% of assessors), identify trainees in difficulty (69% of trainees; 64% of assessors) or accurately reflect trainee progress (62% of trainees; 59% of assessors). Analysis of free text comments identified three main issues related to WBAs: their utilisation, purpose and design. CONCLUSION: There was an overall negative perception of WBAs, particularly their perceived regulatory nature. It appears that the current WBAs do not always meet the criteria of a useful test in that they are perceived as being applied variably, produce results with questionable validity and have little apparent educational value.

Comparative transcriptomic analysis of cultivated limbal epithelium and donor corneal tissue reveals altered wound healing gene expression.

PURPOSE: The improved surgical outcomes associated with transplantation of cultivated amniotic membrane expanded limbal epithelium (AMLE) compared to traditional donor methods has led to substantial adoption of this technique for treatment of limbal stem cell deficiency. METHODS: The mRNA expression profiles of AMLE and CE were assayed using microarrays. Transcripts with a 1.5-fold change in either direction in addition to a Bonferroni adjusted P value < 0.05 were considered to be differentially expressed. Expression changes detected by microarray profiling and important corneal-limbal markers were assessed using quantitative real-time PCR (qRT-PCR) and immunofluorescence staining. RESULTS: A total of 487 probe sets (319 upregulated and 168 downregulated) were found to be differentially expressed between AMLE and CE. Enrichment analysis revealed significant overrepresentation of multiple biological processes (e.g., response to wounding, wound healing, and regulation of cell morphogenesis) within the differentially expressed gene list. The expression of a number of genes that were upregulated (ABCG2, S100A9, ITGA5, TIMP2, FGF5, PDGFC, SEMA3A) and downregulated (KLF4, P63α) in AMLE was confirmed using qRT-PCR. Immunofluorescence confirmed that AMLE cultures were P63α, ABCG2, CK3, CK12, and E-cadherin (E-cad) positive. CONCLUSIONS: In this study, we have shown that genes associated with wound healing processes are upregulated in AMLE. These gene expression changes may contribute to corneal restoration and the positive outcomes associated with transplantation.

Informal care and terminal illness.

This paper is based on a study of the care and services received by people in the year before death in one Yorkshire health authority. In the spring of 1997 in-depth interviews were carried out with bereaved relatives and carers of a weighted sample of 33 people who had died in one Yorkshire health authority in the previous 18 months. Deaths where people were judged to have needed no input from palliative care services were excluded. The sample covers a range of different caring arrangements, experiences of caring for someone who is dying, support from formal services, place and manner of death. All those interviewed were providing some form of informal care or support to those who died, in some cases 24-h care. The interviews provided a valuable insight into ordinary people's experiences of death and of caring for someone who is dying. Most importantly for the purposes of this study, they gave insight into their experiences of services to support both the dying person and themselves in their caring role. The paper discusses the ways in which care of the terminally ill is distinctive. It explores the role of informal care in relation to the wider character and history of the local community, in particular the significance of its declining industrial base, and secondly, the availability of appropriate services to support those caring for the terminally ill. Finally, it makes recommendations about service planning and delivery which challenge the current framework for providing services to the terminally ill.