Effect of high-flow nasal therapy on patient-centred outcomes in patients at high risk of postoperative pulmonary complications after cardiac surgery: a study protocol for a multicentre adaptive randomised controlled trial.

BACKGROUND: High-flow nasal therapy is a non-invasive form of respiratory support that delivers low-level, flow dependent positive airway pressure. The device can be better tolerated by patients than alternatives such as continuous positive airway pressure. The primary objective is to determine if prophylactic high-flow nasal therapy after tracheal extubation can result in an increase in the number of days alive and at home within the first 90 days after surgery, when compared with standard oxygen therapy. The co-primary objective is to estimate the incremental cost-effectiveness and cost-utility of high-flow nasal therapy vs standard oxygen therapy at 90 days, from the view-point of the public sector, the health service and patients. METHODS: This is an adaptive, multicentre, international parallel-group, randomised controlled trial with embedded cost-effectiveness analysis comparing the use of high-flow nasal therapy with control in patients at high risk of respiratory complications following cardiac surgery. Participants will be randomised before tracheal extubation and allocated either high-flow nasal therapy or standard oxygen therapy for a minimum of 16 h immediately post extubation. Participants will be followed up until 90 days after surgery. The total sample size needed to detect a 2-day increase in DAH90 with 90% power with an intention to treat analysis is 850 patients. The adaptive design includes an interim sample size re-estimation which will provide protection against deviations from the original sample size assumptions made from the single-centre pilot study and will allow for a maximum sample size increase to 1152 patients. DISCUSSION: Evidence to support routine use of high-flow nasal therapy will inform the development of effective enhanced recovery care bundles. Reducing complications should reduce length of stay and re-admission to hospital and provide an important focus for cost reduction. However; high-quality studies evaluating the clinical and cost effectiveness of high-flow nasal therapy after cardiothoracic surgery are lacking. TRIAL REGISTRATION: The study has been registered with ISRCTN ( ISRCTN14092678 , 13/05/2020) Clinicaltrials.gov Registration Pending.

Creative teaching method as a learning strategy for student midwives: A qualitative study.

BACKGROUND: Traditional ways of teaching in Higher Education are enhanced with adult-based approaches to learning within the curriculum. Adult-based learning enables students to take ownership of their own learning, working in independence using a holistic approach. Introducing creative activities promotes students to think in alternative ways to the traditional learning models. The study aimed to explore student midwives perceptions of a creative teaching method as a learning strategy. RESEARCH DESIGN: A qualitative design was used adopting a phenomenological approach to gain the lived experience of students within this learning culture. PARTICIPANTS: Purposive sampling was used to recruit student midwives (n=30). METHODS: Individual interviews were conducted using semi-structured interviews with open-ended questions to gain subjective information. Data were transcribed and analyzed into useful and meaningful themes and emerging themes using Colaizzi's framework for analyzing qualitative data in a logical and systematic way. Over 500 meaningful statements were identified from the transcripts. FINDINGS: Three key themes strongly emerged from the transcriptions. These included'meaningful learning','inspired to learn and achieve', and 'being connected'. A deep meaningful learning experience was found to be authentic in the context of theory and practice. Students were inspired to learn and achieve and positively highlighted the safe learning environment. The abilities of the facilitators were viewed positively in supporting student learning. This approach strengthened the relationships and social engagement with others in the peer group and the facilitators. On a less positive note, tensions and conflict were noted in group work and indirect negative comments about the approach from the teaching team. CONCLUSIONS: Incorporating creative teaching activities is a positive addition to the healthcare curriculum. Creativity is clearly an asset to the range of contemporary learning strategies. In doing so, higher education will continue to keep abreast of the needs of graduating students in a complex and rapidly changing professional environment.

Comparing two theories of health behavior: a prospective study of noncompletion of treatment following cervical cancer screening.

Some women receiving abnormal cervical screening tests do not complete recommended treatment. A prospective study (N = 660) investigated the value of conceptualizing attendance at colposcopy for treatment as either (a) an active problem-solving response to a health threat, motivated by attitudes toward an abnormal result, as implied by self-regulation theory (H. Leventhal, D. Meyer, & D. Nerenz, 1980); or (b) as a behavior motivated by attitudes toward clinic attendance, as implied by the theory of planned behavior (TPB; I. Ajzen, 1985). Responses to questionnaires containing variables specified by these models were used to predict women's subsequent attendance or nonattendance for treatment over the following 15 months. Although the TPB offered superior prediction of intentions and completion of treatment, discriminant function analyses showed that consideration of both models was important in distinguishing between those who attended all their appointments as scheduled, attended after being prompted, or ceased attending. Implications for measurement and theory in health protection are discussed.

Appraisal theory and emotional sequelae of first visit to colposcopy following an abnormal cervical screening result.

OBJECTIVES: Attendance at colposcopy following an abnormal cervical smear is potentially a highly distressing event. This study evaluates the role of cognitive appraisal components (Lazarus, 1991; Smith et al., 1993) in explaining emotional reactions to this event. We also compare the psychological sequelae of immediate treatment at first colposcopy (See and Treat, ST) vs. colposcopy with treatment deferred to a later date (Diagnose and Defer, DD). METHOD: One thousand and eighty-five women referred for colposcopy completed a questionnaire assessing appraisal and emotion following their attendance. Clinical data were abstracted from medical records and social deprivation scores were estimated from postal code information based on normative data. RESULTS: Diagnosis and cognitive appraisals were each significantly associated with emotion, together accounting for between 3 and 15% of variance in different emotions. Specific patterns of appraisal explained specific emotions in line with theoretical predictions. Women with Cervical Intraepithelial Neoplasia (CIN) 2 or CIN 3 undergoing 'ST' were less anxious, less embarrassed and significantly more relieved compared with a matched sample of women undergoing 'DT', and perceived their first appointment as more motivationally congruent. CONCLUSION: Diagnosis, motivationally incongruent experiences and low emotion-focused coping potential are the most important determinants of anxiety after colposcopy. 'See and Treat' appears to have a positive psychological impact by increasing motivational congruence.