PharmaMemory: an interactive, animated web application for learning autonomic physiology and pharmacology

Medical students face challenging but important topics they must learn in short periods of time, such as autonomic pharmacology. Autonomic pharmacology is difficult in that it requires students to synthesize detailed anatomy, physiology, clinical reasoning, and pharmacology. The subject poses a challenge to learn as it is often introduced early in medical school curricula. To ease the difficulty of learning autonomic pharmacology, we created a free web application, PharmaMemory (www.pharmamemory.com), that interactively depicts the effects of high-yield autonomic drugs on the human body. PharmaMemory provides users with the opportunity to read and quiz themselves on the mechanisms, side effects, indications, and contraindications of these drugs while interacting with the application. We provided PharmaMemory to first-year medical students for three consecutive years of quality improvement and assessed the application's perceived effects on learning via user surveys. Survey feedback showed that users viewed PharmaMemory favorably and self-reported increased knowledge and confidence in the subject of autonomic pharmacology. Comments revealed that users liked the website's visuals, opportunity for challenged recall, and conciseness. PharmaMemory utilizes challenged recall, visual stimulation, and interactive learning to provide users with a multifaceted learning tool. Preliminary data suggest that students find this method of learning beneficial. Further studies are needed to assess PharmaMemory compared with more traditional learning methods such as PowerPoint or text-based learning. Additionally, further research is needed to quantitatively assess reduction in cognitive load.NEW & NOTEWORTHY PharmaMemory (www.pharmamemory.com) is a free web application that interactively depicts the effects of high-yield autonomic drugs on the human body.

Impact of a dissemination strategy on family day care educators' intentions to adopt outdoor free play guidelines introduced in response to COVID-19: a randomized controlled trial

In 2021, guidelines for early childhood education and care were released recommending children are provided access to outdoor areas during all free play sessions to reduce the risk of coronavirus disease of 2019 transmission, aligning with the existing recommendations to increase children's physical activity. There is a need to understand how to disseminate guidelines in this setting as dissemination is a prerequisite of adoption and implementation. This randomized controlled trial explored the impact of a video-based strategy to disseminate guidelines on family day care educators' intentions to adopt outdoor free play guidelines. Educators (N = 255) were randomized to receive a video (intervention) or text-based (usual care) resource via email describing recommendations. Educators were invited to participate in a post-intervention survey at 5-week follow-up assessing intentions to adopt guidelines. The secondary outcomes included knowledge, beliefs about capabilities, beliefs about consequences, social/professional role and identity, goals, implementation of guidelines, acceptability of resource and intervention reach. There was no statistically significant difference between groups in intentions to adopt guidelines [ß = 0.01 (95% confidence interval -0.50 to 0.52), P = 0.97], nor for any secondary outcomes. Further investigation is needed to identify effective dissemination strategies in the family day care setting to increase the adoption of public health guidelines.

Adapting implementation strategies: a case study of how to support implementation of healthy canteen policies

OBJECTIVES

Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy makers and practitioners if they do not align with end users' needs. As such, adaptations to EBIs and implementation approaches are likely to occur to increase 'fit' with end users' capacity. This article describes an approach undertaken by a population health service delivery unit in one Australian state to develop an adapted implementation strategy to support the implementation of the mandatory healthy canteen policy (EBI) to all schools located in the service delivery region.

STUDY DESIGN

This is a case study of adapting an intervention to improve implementation of the healthy canteen policy.

METHODS AND RESULTS

This is a six-step pragmatic, empirically driven approach. The steps include (i) adapt, where appropriate, the EBI to facilitate implementation; (ii) identify end users' capacity for implementation; (iii) identify opportunities to adapt the implementation interventions while preserving meaningful intervention impact; (iv) undertake program adaptation; (v) develop training and resources to support delivery of implementation strategies and; (vi) evaluate the adapted intervention. This article describes the application of these steps by the authors to develop an adapted support strategy consistent with end users' needs.

CONCLUSIONS

This study provides some guidance on how to adapt implementation support approaches particularly when EBIs cannot be adapted. Future empirical research providing guidance on making practical adaptation decisions are needed.

A pilot randomized controlled trial examining the impact of a sleep intervention targeting home routines on young children's (3-6 years) physical activity

BACKGROUND

Given evidence suggesting that sleep impacts on metabolic processes, interventions targeting sleep may improve child physical activity (PA).

OBJECTIVES

To describe the potential effect of an intervention to increase sleep on young children's (3-6 years) moderate to vigorous PA (MVPA) and total PA. To determine adherence to the intervention, impact on sleep duration as well as feasibility, uptake and acceptability was also assessed.

METHODS

Pilot randomized controlled trial with 76 parent-child dyads randomly allocated to an intervention (n = 38) or control group (n = 38). Parents in the intervention group received a 3-month theory-informed intervention consisting of an online video, a telephone call and two text messages. Child PA was assessed using accelerometers at baseline and approximately 3 months. Parents also completed a sleep log and a telephone interview.

RESULTS

The consent rate was 41% (76/186). Estimated effect size for the intervention relative to control was 10.8 min/day for MVPA, 2.7 min/day for PA and 0.9 h for sleep. Sixteen (44%) parents accessed the video, and 18 (50%) received the telephone call. Over 40% of parents found the video and telephone call useful/very useful.

CONCLUSIONS

This study reports promising effects that an intervention targeting sleep may improve child MVPA and sleep duration. Some modifications to data collection methods and intervention delivery are needed.

Experiences implementing a 6-month pilot of a 7-day community CNS service in an urban hospice in Scotland

BACKGROUND

Patients and carers may face challenges in the out-of-hours period, with inadequate support and variations in service provision, including access to specialist palliative care. A pilot was undertaken to extend availability of the community clinical nurse specialist (CNS) team to include weekends and public holidays.

AIM

To examine the need for a 7-day community CNS service.

METHOD

Activity data was collected for 6 months and feedback was sought from service users and the CNS team.

RESULTS

There were 132 out-of-hours telephone contacts in the 6-month period, generating 35 home visits. Almost two thirds of these calls were proactive, 'planned' contacts. Most unplanned calls (68%) were from a carer for advice about symptom management and support as the patient's condition changed.

CONCLUSION

The pilot demonstrated the need for a CNS service 7 days a week, and the service is now embedded in practice. Seven-day working benefits patients and families while being valued by the professional team.

Hospice at home 2: evaluating a crisis intervention service

This article presents an evaluation of a rapid-response crisis-intervention service, hospice at home (H@H), for patients with advanced cancer. The project took place in Glasgow, UK, between July 1999 and May 2001. An integral part of the (H@H) project was the concurrent evaluation, which attempted to explore a range of service and user outcomes. The service was able to prevent admission to, or facilitate discharge from, institutional care on 62 occasions. The evaluation found significant improvements in some areas of pain and symptom management. High levels of satisfaction were recorded by all service users. A partial cost analysis revealed that the medical and nursing support costs for the (H@H) would have been substantially reduced if throughput had been higher. The (H@H) project team agreed that a valuable lesson learned from the project was the importance of involving all key players from the outset when determining the requirements of a new service initiative.

Hospice at home 1: the development of a crisis intervention service

This article is the first in a series of two which report on the development and evaluation of a rapid response crisis intervention service for patients in the advanced stages of cancer. A number of recent studies have identified the need for rapid response teams who are able to provide palliative and specialist palliative care in the home setting (King et al, 2000; Mantz, 2000; Thomas, 2001). By providing an overview of the relevant literature and describing the experience of developing this scheme the authors' aim is to share good practice with interested professionals who may be contemplating setting up similar schemes. This article outlines the development of a 'hospice at home' scheme until its launch and identifies the strategies used to ensure the early success of the project.

Macropuncture study of polycystic disease in adult human kidneys

Solute composition, volume, and hydrostatic pressure were measured in cysts from eight patients with the adult form of polycystic kidney disease (PCKD). Five azotemic patients had elective nephrectomies in preparation for renal transplantation, two nonazotemic patients had their polycystic kidneys removed several weeks after a successful renal allograft, and one nonazotemic cadaver was inadvertently nephrectomized as a potential kidney donor. In all patients, the pattern of solute concentrations in cyst fluid segregated into two principal groups: Proximal cysts had sodium, potassium, chloride, hydrogen ion, creatinine, and urea values virtually equal to their respective sera, whereas distal cysts had sodium and chloride concentrations lower and potassium, hydrogen ion, creatinine, and urea concentrations greater than serum. In the two subjects who received renal allografts and were not azotemic, creatinine and urea concentrations in the proximal cysts reflected nonazotemic values, indicating redistribution of these solutes across proximal cyst walls after the extracellular fluid was normalized. By contrast, distal cysts maintained steep concentration gradients for creatinine and urea. Transmural hydrostatic pressures were similar in proximal and distal cysts and were not different from normal intratubular pressures. These studies provide strong support for the view that cysts are massively enlarged segments of nephrons and collecting tubules that qualitatively maintain their basic solute transport functions throughout the life of the patient.

Species distribution of ribonucleoprotein-derived brain antigens

Acidic glycoproteins (AP) specific for brain were derived from human brain ribonucleoprotein (RNP). Immunodiffusion against homologous antiserum confirmed the presence of three distinct antigens. Comparable materials form brain RNP of monkey and hamster contained the same three antigens; from rabbit, two identical and one related antigens. Mouse and rat material appeared to contain progressively less related antigens.

Neuraminidase treatment of human AP resulted in the unmasking of two new determinants. These were also present in material from monkey and hamster; that from rabbit showed partial identity with one of these and lacked the other. Corresponding mouse and rat fractions appeared to contain one identical masked determinant, but lacked the other.

Preparation, derivation and partial characterization of organ-specific antigens from human brain

Fractional ethanol precipitation was used to prepare a concentrate of brain-specific components of thermostable (BE) antigens derived from heated extract of human brain. Chromatography on DEAE-cellulose yielded a well-defined acidic protein peak containing brain-specific material corresponding to a minimum of two brain-specific components.

Preparation of a protein fraction (RSP) from unheated human brain ribonucleoprotein is described. Chromatography of RSP on DEAE-cellulose permitted the isolation of an acid protein fraction (AP) containing brain-specific antigens identical with those from heated brain extracts. AP contained a minimum of three distinct antigenic components which emerged as a single peak on rechromatography, and were incompletely separable by immunoelectrophoresis or analytical ultracentrifugation.

Pronase digestion liberated material with the general properties of a glycolipid; digestion products lost ability to precipitate with antiserum to the intact material.

Neuraminidase treatment resulted in the appearance of at least one previously masked determinant, presumably related to oligosaccharide residues since the new determinant was destroyed by periodate treatment.

Periodate did not affect ability of AP to form immunoprecipitin arcs unless AP was previously desialized. A chloroform-soluble fraction liberated during acid hydrolysis of AP has not been identified.

The possible chemical nature and intracellular association of AP are discussed.