Using staged teaching and assessment approaches to facilitate inter-university collaboration and problem-based learning

This article describes the segmented module design and problem-based learning approaches employed to enable parts of a higher education environmental health module (course) to be shared between universities in Wales, Northern Ireland, and Australia. The module requires students to identify the needs and assets of a community then design community-based interventions to address problems and undertake an evaluation of those interventions. Accreditation body and the degree program learning outcome requirements in the UK and Australia were found to hold many comparable knowledge, skills, and graduate attribute criteria, eliminating a potential barrier for international learning and teaching collaboration between higher education institutions. Instead, barriers to collaboration were associated with institutional issues and practicalities such as timetabling and assessment requirements. Taking a segmented approach to module design allowed staged and varied levels of collaboration between participating institutions, all delivering modules (courses) with similar learning outcomes. This provided a more sustainable environment to facilitate shared learning and teaching and fostered closer relations between programs, within these constraining factors. Students using problem-based learning and its group-working component exhibited the development of leadership, communication, and independent learning skills.

Short‐ and long‐term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010‐2020)

OBJECTIVES

To report the short- and long-term outcomes following attenuation of congenital extrahepatic portosystemic shunts in dogs using a novel polyethylene band.

MATERIALS AND METHODS

Records were retrospectively reviewed for dogs that underwent congenital extrahepatic portosystemic shunt attenuation by a polyethylene banding technique, at a single institution between 2010 and 2020. Short-term outcome data were collected from peri-operative clinical records with follow-up examinations, scheduled at 6 and 18 weeks post-operatively, and post-operative imaging when performed. Long-term follow-up was collected by validated owner questionnaire, telephone interview or medical records. Long-term outcomes were categorised by "excellent", "good" or "poor".

RESULTS

Sixty dogs were included. Post-operative complications occurred in 10 of 60 dogs (16.7%), four major and six minor, with a peri-operative mortality of 6.7%. Persistent shunting was identified in nine of 53 dogs (17%) available for follow-up examination and four dogs underwent a revision surgery. Long-term follow-up was available for 44 dogs at a median of 75 months post-operatively (range 7 to 128). Long-term outcomes were "excellent" (26) or "good" (8) in 81.8% of dogs and "poor" (8) in 18.2%. At the time of follow-up, 30 of 44 (68.2%) dogs were not receiving any medical treatment and 27 of 28 (96.4%) questionnaire respondents were satisfied with the response to surgery.

CLINICAL SIGNIFICANCE

Polyethylene band attenuation of congenital extrahepatic portosystemic shunts provides comparable outcomes to cellophane. The material used in this study is widely available and consistent while being pre-sterilised and pre-folded makes it easy to use.

Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial

OBJECTIVE

To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer.

DESIGN

Multicentre, randomised, non-inferiority trial.

SETTING

Five centres in the North West of England.

SAMPLE

A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up.

METHODS

Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU.

MAIN OUTCOME MEASURES

Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence.

RESULTS

The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005).

CONCLUSIONS

The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups.

TWEETABLE ABSTRACT

ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer.

Tear physiology in dry eye associated with chronic GVHD

The purpose of this study was to compare tear physiology characteristics of chronic GVHD (cGVHD)-associated dry eye to dry eye caused by Sjogren's syndrome (SS), a extreme form of aqueous-deficient dry eye, and meibomian gland dysfunction (MGD), the major cause of evaporative dry eye. Tear turnover rate, evaporation and osmolarity along with meibomian gland dropout and lipid layer interferometric patterns were assessed in the right eyes of 12 patients with dry eye associated with cGVHD, 12 age-matched patients with SS and 12 age-sex matched subjects with MGD. In cGVHD, the decrease in tear turnover rate was similar (P=0.33), but the number of non-functioning meibomian glands was significantly higher (P<0.01) than in SS. Tear evaporation rate in cGVHD dry eye was found to be similar to that in MGD (P=0.36) and significantly higher than in SS (P<0.01). The lipid layer was most unstable in cGVHD compared with other groups. There was no variation in tear volume across all groups. Although statistical significance was not detected, the mean tear osmolarity (333.51±14.67mOsm/L) was highest in cGVHD. Major aspects of tear physiology were severely impaired in cGVHD-associated dry eye.

Neuronal differentiation in Drosophila ommatidium

Using monoclonal and polyclonal antibodies as differentiation markers, we have found that the eight photoreceptors of the Drosophila ommatidium differentiate in a fixed sequence. The foundation photoreceptor, R8, expresses neural antigens first. The paired photoreceptors R2/5 are next to express, followed by the pair R3/4, followed by the pair R1/6; R7 is the final photoreceptor to differentiate. From previous studies it is known that Drosophila photoreceptors use local, positional cues to select their identities. Together with the morphological picture of ommatidial development, the sequential order of photoreceptor differentiation demonstrated here suggests that these cues may be encoded in the particular combination of cells an undetermined cell finds itself in contact with.

Cellular communication in the developing Drosophila eye

Undetermined cells are directed to their fate in the Drosophila eye by positional cues which are probably presented by adjacent differentiating cells. The sevenless protein is thought to function as a signal-receiving protein on the plasma membrane of the cell destined to form the seventh photoreceptor, R7. Localization of the protein indicates the interactions between undetermined and differentiating cells and suggests the existence of other receptor proteins similar to sevenless.

The comparative diagnostic accuracy of conventional and liquid-based cytology in a colposcopic setting

OBJECTIVE

This study was conducted to compare the performance of liquid-based cytology (LBC) and conventional cytology (CS) in the high prevalence setting of colposcopy clinic.

DESIGN

A split sample of matched ThinPrep (TP) and conventional smear from 563 patients were evaluated blindly. The performance of both techniques was compared with the gold standard of biopsy results or normal colposcopy examination in 441 cases.

SETTING

Colposcopy clinic of an inner city hospital for women and children.

SAMPLE

Five hundred and sixty-three women referred to colposcopy clinic over 14-month period.

METHODS

Cervical smears were taken from 563 women referred for colposcopy. Using the split-sample technique, the material was spread on a conventional (CS) slide and the remaining material rinsed in a PreservCyt solution. A T2000 processor was used to prepare LBC preparations. All women underwent colposcopy/biopsy according to local protocol. Four hundred and forty-one women met the diagnostic standard criteria of the study, which was either a normal colposcopy or histopathology result. Sensitivity, specificity and positive and negative predictive values were calculated for both methods of cytology preparations.

MAIN OUTCOME MEASURES

Matched TP and conventional smears, detection of abnormality, matched biopsies, sensitivity, specificity, and positive and negative predictive values.

RESULTS

Inadequate rates for CS and LBC (TP) were 4.3% and 0.68%, respectively. In 73% of cases, the CS and the LBC preparations showed exact agreement, whereas 77% agreement was seen when comparison was made for amalgamated low grade and high grade abnormalities. Low grade cytological abnormalities accounted for 44% of LBC slides versus 37% in CS slides. High grade cytological abnormalities accounted for 22% of LBC versus 17% seen in CS cases (P < 0.001). LBC showed increased sensitivity in the detection of CIN2 or worse than CS (92% and 83%, respectively) and CS showed greater specificity than LBC (82% and 76%, respectively).

CONCLUSIONS

In high prevalence setting, LBC performed at least as well as CS. The inadequate rate was significantly lower with LBC. The numbers are too small, however, to make confident comments about increased sensitivity and negative predictive value with LBC. Larger studies are required to verify these findings.

Visualizing the photonic band gap in hollow core photonic crystal fibers

The light radiated from the guided mode of a hollow core photonic crystal fiber into free space is measured as a function of angle and wavelength. This enables the direct experimental visualization of the photonic band gap and the identification of localized modes of the core region.

Ultimate low loss of hollow-core photonic crystal fibres

Hollow-core photonic crystal fibres have excited interest as potential ultra-low loss telecommunications fibres because light propagates mainly in air instead of solid glass. We propose that the ultimate limit to the attenuation of such fibres is determined by surface roughness due to frozenin capillary waves. This is confirmed by measurements of the surface roughness in a HC-PCF, the angular distribution of the power scattered out of the core, and the wavelength dependence of the minimum loss of fibres drawn to different scales.

Does improving communication and information for women increase attendance at colposcopy in an inner city clinic? A randomised controlled trial

PURPOSE

To establish whether information leaflets and appointment reminders improve attendance for diagnostic colposcopy.

DESIGN & SETTING

Randomised controlled trial in an inner city colposcopy clinic.

PARTICIPANTS

500 women newly referred to the colposcopy clinic with abnormal cervical screening smear results were randomly assigned to an intervention or control group using computer-generated numbers.

INTERVENTION

233 women referred for colpoposcopy were sent a comprehensive information leaflet with their appointment details and additionally were sent reminder letters regarding their appointment 7-10 days prior to their appointment date.

CONTROL

267 women were sent the standard basic information prior to their appointment.

MAIN OUTCOME MEASURE

Attendance and default rates for diagnostic colposcopy.

RESULTS

Default in the intervention arm was 42 out of 233 (18%) compared with 93 out of 267 (35%) in the control arm.

CONCLUSION

Improved communication and information in the form of a detailed leaflet and a reminder letter for women with a recently abnormal smear result increased attendance for initial colposcopy assessment.

ISABEL: a web-based differential diagnostic aid for paediatrics: results from an initial performance evaluation

AIMS

To test the clinical accuracy of a web based differential diagnostic tool (ISABEL) for a set of case histories collected during a two stage evaluation.

SETTING

acute paediatric units in two teaching and two district general hospitals in the southeast of England.

MATERIALS

sets of summary clinical features from both stages, and the diagnoses expected for these features from stage I (hypothetical cases provided by participating clinicians in August 2000) and final diagnoses for cases in stage II (children presenting to participating acute paediatric units between October and December 2000).

MAIN OUTCOME MEASURE

presence of the expected or final diagnosis in the ISABEL output list.

RESULTS

A total of 99 hypothetical cases from stage I and 100 real life cases from stage II were included in the study. Cases from stage II covered a range of paediatric specialties (n = 14) and final diagnoses (n = 55). ISABEL displayed the diagnosis expected by the clinician in 90/99 hypothetical cases (91%). In stage II evaluation, ISABEL displayed the final diagnosis in 83/87 real cases (95%).

CONCLUSION

ISABEL showed acceptable clinical accuracy in producing the final diagnosis for a variety of real as well as hypothetical case scenarios.