Developing simulation games to advance public health nursing competence in baccalaureate education

We describe the development of an innovative baccalaureate nursing education strategy for public health nursing. Virtual simulation pedagogy is known to be effective for acute care nursing practice while less known for public health nursing. Three Canadian nursing schools, the Canadian Association of Schools of Nursing (CASN), and the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) partnered to develop three public health nursing virtual simulation games. Learners work through unfolding population health scenarios, simulating public health nursing practice focused on entry level public health nursing competencies. Each game fosters clinical reasoning and collaborative, community decision-making to respond to population health issues during community assessment, evidence-informed health promotion planning, and evaluation processes. A companion guide was developed to support best practices in implementing virtual simulation and promote optimum student learning using the public health nursing games.

Interspecific competition in germination of bird-dispersed seeds in a habitat with sparse tree vegetation in South Africa

BACKGROUND

By transporting and scarifying the seeds during ingestion, avian frugivores reduce the competition with siblings, and may improve the germination which is critical for dispersal effectiveness and population recruitment. However, generally, there is limited knowledge on how deposited seeds interact/compete in the new microsite. We tested the hypothesis that the bird-dispersed seeds benefit from improved germination after their passage through the bird's gut; and we investigated the potential impact of seed density on competition at the microsites by determining whether seed density and species diversity influence germination in the Free State Province, South Africa.

RESULTS

Overall, the results partly supported the hypothesis. Germination trials with defecated seeds of five plant species compared with the manually depulped seeds showed that only Searsia lancea had significantly higher seed germination success and improved germination speed after passage through the bird gut while Ziziphus mucronata only benefited rapid germination. There was a significant correlation between seed size and the germination of bird-ingested seeds except in Olea subsp. africana possibly due to possession of extremely hard protective seed cover. Seed competition experiments pointed to Z. mucronata and O. subsp. africana having significant germination performance that was positively correlated to seed density and seed size while Ehretia rigida did not germinate at all. Seed species diversity in the germination trays did not have a significant impact since the seeds of two former plant species consistently displayed significantly higher germination across the competition levels.

CONCLUSIONS

We conclude that different plant species respond differently to seed ingestion by birds, and that further long-term tests for germination physiological responses of the seeds' samples used in this study are required since poor germination observed in other tree/shrub species cannot be attributed to competition solely.

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

AIM

The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD).

METHOD

A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded.

RESULTS

A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases.

CONCLUSION

There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.

Systematic review: ileoanal pouch microbiota in health and disease

BACKGROUND

The resident gut microbiota is essential for physiological processes; the disturbance of its balance is linked to intestinal inflammation. The ileoanal pouch is a model for the study of intestinal inflammation, as inflammation of the pouch is common and mostly develops within 12 months following ileostomy closure. This allows the longitudinal study of the microbiota, giving insight into the microbiota changes during transition from a normal to an inflamed pouch.

AIM

To explore the literature on the microbiota of the ileoanal pouch in health and disease.

METHODS

A systematic computer search of the on-line bibliographic databases MEDLINE and EMBASE was performed between 1966 and February 2017. Randomised controlled trials, cohort studies and observational studies were included. Studies were included if they reported microbiota analysis on faecal samples or tissue from the ileoanal pouch.

RESULTS

Twenty-six papers were eligible. Following ileostomy closure, anaerobic bacteria are the abundant species in the ileoanal pouch with presence of a diverse microbiota key to maintaining a healthy ileoanal pouch. Acute pouchitis is associated with an increase in Clostridia species, while chronic pouchitis is associated with an increase in Staphylococcus aureus. In the treatment of pouchitis, a decrease in Clostridia species appears to be associated with treatment response.

CONCLUSION

The microbiota plays an important role in both the inflamed and the healthy ileoanal pouch. A direct causal relationship between individual microbiota changes and inflammation has not yet been established, but manipulation of the ileoanal pouch microbiota may be a novel therapeutic avenue to explore.

Cohort study of depressed mood during pregnancy and after childbirth

OBJECTIVE

To follow mothers' mood through pregnancy and after childbirth and compare reported symptoms of depression at each stage.

DESIGN

Longitudinal cohort study.

SETTING

Avon.

PARTICIPANTS

Pregnant women resident within Avon with an expected date of delivery between 1 April 1991 and 31 December 1992.

MAIN OUTCOME MEASURES

Symptom scores from the Edinburgh postnatal depression scale at 18 and 32 weeks of pregnancy and 8 weeks and 8 months postpartum. Proportion of women above a threshold indicating probable depressive disorder.

RESULTS

Depression scores were higher at 32 weeks of pregnancy than 8 weeks postpartum (difference in means 0.88, 95% confidence interval 0.79 to 0.97). There was no difference in the distribution of total scores or scores for individual items at the four time points. 1222 (13.5%) women scored above threshold for probable depression at 32 weeks of pregnancy, 821 (9.1%) at 8 weeks postpartum, and 147 (1.6%) throughout. More mothers moved above the threshold for depression between 18 weeks and 32 weeks of pregnancy than between 32 weeks of pregnancy and 8 weeks postpartum.

CONCLUSIONS

Symptoms of depression are not more common or severe after childbirth than during pregnancy. Research and clinical efforts need to be moved towards understanding, recognising, and treating antenatal depression.

A holistic approach to pressure sore management

Caring for a pressure sore requires a holistic approach. Incontinence complicates the management of wounds. Encouraging patient participation in pressure sore management promotes ownership of the sore. Consistency in documentation allows a consistent and objective evaluation of healing. Recognition of any deficits in knowledge, and education to meet these, enhances patient safety.

The contingent negative variation in positive and negative types of schizophrenia

The authors analyzed the contingent negative variations of 20 medicated patients with schizophrenia diagnosed according to DSM-III-R and 20 age- and sex-matched normal comparison subjects. For the patients with schizophrenia, there were significant correlations between contingent negative variation amplitude and two items on the Scale for the Assessment of Negative Symptoms (affective flattening and avolition-apathy) and the total score on this scale. These findings have implications regarding the underlying pathology of negative and positive symptoms of schizophrenia.

Pilot study of computerised differentiation of Huntington's disease, schizophrenic, and Parkinson's disease patients using the contingent negative variation

In this study a potential known as the contingent negative variation was used to differentiate between schizophrenic, Parkinson's disease (PD), Huntington's disease (HD) patients and normal control subjects. The aim was to assist diagnosis and the avoidance of false diagnosis. 20 schizophrenic, 16 PD, 11 HD and 43 normal control subjects were enrolled for this study. The discriminatory variables were generated by applying spectral analysis to pre- and post-stimulus sections of the CNV responses. The patient differentiation was achieved by using the measured variables in a discriminant analysis program. It was possible to accurately differentiate between HD, schizophrenic, PD patients and normal control subjects. It was also attempted to differentiate between HD and schizophrenic patients, HD and PD patients, and schizophrenic and PD patients. The test results indicated that the method is useful in differentiating between these patients. This study had a number of limitations. It was based on a limited number of individuals, and an analysis of medication effects on the test results and the test-retest reliability assessment could not be carried out.

Referrals to child psychiatry--a survey of staff attitudes

A questionnaire study was conducted in a health district to evaluate the attitudes of paediatricians and child psychiatry staff as to which categories of problems should be referred to child psychiatry. In the majority of categories the two groups disagreed as to the frequency with which the problem should be referred. In the categories relating to child sexual abuse responses were often not in accord with Department of Health and Social Security guidelines. Reasons for not referring were also looked at and again it was found that there were a number of significant differences in opinion as to what are reasons for not referring to child psychiatry. Both groups agree that lack of communication is a reason for non-referral. Some suggestions are made as to how this problem could be addressed.