Non-technical skills simulation-based training model for managing intraoperative posterior capsule rupture during cataract surgery.

OBJECTIVES: To develop and implement a simulation-based training model for the management of posterior capsule rupture (PCR) from a non-technical skills (NTS) perspective, and analyse changes in participant's NTS and technical skills (TS). METHODS: The simulation-based training model consisted of two identical PCR simulations with NTS stressors applied, separated by a predominantly NTS focussed training intervention. Participants' TS and NTS were evaluated by two blinded assessors using the Objective Structured Assessment of Technical Skill (OSATS) global rating scale and the HUman Factors in intraoperative Ophthalmic Emergencies Scoring System (HUFOES) respectively. Paired t-tests were used to establish the difference in mean HUFOES and OSATS scores between initial and repeat simulations; p < 0.05 indicated statistical significance. McGaghie's model of translational outcomes for simulation-based learning was used to establish the simulation model's educational status. RESULTS: Seventeen cataract surgeons of varying training grades participated in the simulation-based training model. NTS improved with statistical significance; mean HUFOES scores increased from 48.7 ± 16.6 to 59.2 ± 14.8 (p < 0.001). Mean OSATS scores increased without statistical significance from 16.0 ± 7.3 to 17.9 ± 8.3 (p = 0.07). This simulation model achieved Level 1 (internal acceptability) and Level 2 (contained effects) according to McGaghie's model. CONCLUSIONS: This novel simulation-based training model was designed to improve the NTS required for managing intraoperative PCR, through the provision of an interactive training session. Statistically significant improvements in participants' NTS in combination with statistically insignificant improvements in TS demonstrate that the simulation-based training model has specificity within the NTS domain.

Student mental health in higher education: the contextual influence of "cuts, competition & comparison".

BACKGROUND: The mental health of students in UK higher education (HE) is receiving increased attention, and support services for students are under increased pressure. AIMS: Drawing on ecological systems theory (EST), this study sought to explore possible contextual influences, over time, on student distress within HE. METHOD AND SAMPLES: We conducted a two-stage Delphi study, first asking UK professionals (n = 236) from primary, secondary, further education, and HE to provide possible reasons for increases in student distress. The material was reduced to 58 representative statements across all sectors with a further 10 specific to HE. In stage 2, 89 participants rated each statement in terms of whether it: (1) takes place and (2) contributes to distress. RESULTS: The results suggest multiple contextual influences potentially contributing to student distress. They can be summarized using the words: cuts, competition, and comparison. Education professionals in our sample reported that, upstream from HE, pressures on schools and colleges have led to a narrowing of curricula, with a more singular focus on assessment. Reduced teaching teams and pressurized staff unintentionally embed an assessment focus within students who unhelpfully compare themselves with peers while also struggling with wider societal cuts, austerity, and political uncertainty. CONCLUSIONS: The discussion draws on the peer-reviewed literature and relevant reports, discussing them in the context of EST, finding considerable support for these influences. The potential importance of adopting a contextual approach and incorporating this knowledge into the way we understand and tackle students' distress and their preparedness for HE is discussed.

Development of isotope-enriched phosphatidylinositol-4- and 5-phosphate cellular mass spectrometry probes.

Synthetic phosphatidylinositol phosphate (PtdInsP n ) derivatives play a pivotal role in broadening our understanding of PtdInsP n metabolism. However, the development of such tools is reliant on efficient enantioselective and regioselective synthetic strategies. Here we report the development of a divergent synthetic route applicable to the synthesis of deuterated PtdIns4P and PtdIns5P derivatives. The synthetic strategy developed involves a key enzymatic desymmetrisation step using Lipozyme TL-IM®. In addition, we optimised the large-scale synthesis of deuterated myo-inositol, allowing for the preparation of a series of saturated and unsaturated deuterated PtdIns4P and PtdIns5P derivatives. Experiments in MCF7 cells demonstrated that these deuterated probes enable quantification of the corresponding endogenous phospholipids in a cellular setting. Overall, these deuterated probes will be powerful tools to help improve our understanding of the role played by PtdInsP n in physiology and disease.

Optimization of Platelet-Derived Growth Factor Receptor (PDGFR) Inhibitors for Duration of Action, as an Inhaled Therapy for Lung Remodeling in Pulmonary Arterial Hypertension.

A series of potent PDGFR inhibitors has been identified. The series was optimized for duration of action in the lung. A novel kinase occupancy assay was used to directly measure target occupancy after i.t. dosing. Compound 25 shows 24 h occupancy of the PDGFR kinase domain, after a single i.t. dose and has efficacy at 0.03 mg/kg, in the rat moncrotaline model of pulmonary arterial hypertension. Examination of PK/PD data from the optimization effort has revealed in vitro:in vivo correlations which link duration of action in vivo with low permeability and high basicity and demonstrate that nonspecific binding to lung tissue increases with lipophilicity.

Attuned practice: a service user study of specialist child and adolescent mental health, UK.

AIMS: Best practice emphasises user involvement. This exploratory study addresses the views of teenage clients and their parents on service delivery in a specialist Child and Adolescent Mental Health Service (CAMHS) serving a population of 250,000. It aims to explore some of the complexities inherent in children's services when parents are integral to modes of treatment. METHODS: Twenty-seven teenage clients from specialist CAMHS were recruited with their parents (n=30). All were white British, 11 boys and 16 girls, from a range of socioeconomic backgrounds. Focus groups were employed using a series of structured interactive technique to elicit information, preceded by home visits. Analysis of interview data followed standard approaches to qualitative data analysis. Descriptive statistics were generated from both home interview data and focus groups. RESULTS: Three themes emerged: the core values implicated in establishing a therapeutic alliance; the style of therapy and mode of practice (i.e. its inclusiveness of different family members). PRACTICE IMPLICATIONS: Core therapeutic skills are of fundamental importance. Our paper supplements a model of organisational user involvement with a model of therapeutic user involvement for use in negotiating mode of practice. CONCLUSIONS: This exploratory study was a collaboration between service users, researchers and health professionals exploring three important themes of therapy and the complexities inherent in children's services. The process of eliciting views was therapeutic in itself leading to the formation of a parent-led self-help group. The design can be replicated in other specialist CAMHS to achieve attuned practice.