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Ashley H, Gough S, Darlington C, Clark J, Mosley C. Hitting the target and missing the point? A BEME systematic review of evidence regarding the efficacy of statutory and mandatory training in health and care: BEME Guide No. 87. Med Teach 2024:1-10. [PMID: 38599334 DOI: 10.1080/0142159x.2024.2331048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Mandatory training is considered fundamental to establishing and maintaining high standards of professional practice. There is little evidence however, of the training either achieving its required learning outcomes, or delivering improvement in outcomes for patients. Whist organisations may be hitting their compliance target for mandatory training, is the purpose missing the point? This systematic review aims to synthesize and evaluate the efficacy of statutory and mandatory training. METHODS PubMed, EMBASE, CNAHL, ERIC and Cochrane Central registers were searched on 23rd May 2023. All research designs were included and reported training had to specify an organisational mandate within a healthcare setting. Data was coded using a modified Kirkpatrick (KP) rating system. Critical appraisal was undertaken using the Modified Medical Education Research Study Quality Instrument, Critical Appraisal Skills Programme Qualitative Studies checklist and Mixed Methods Assessment Tool. RESULTS Twenty-five studies were included, featuring 9132 participants and 1348 patient cases audited. Studies described evaluation of mandatory training according to Kirkpatrick's outcomes levels 1-4b, with the majority (68%) undertaken in the UK and within acute settings. Training duration varied from 5 min to 3 days. There is a lack of consensus regarding mandatory training rationale, core topics, duration, and optimum refresher training period. Currently, mandatory training does not consistently translate to widescale improvements in safe practice or improved patient outcomes. CONCLUSIONS Due to the lack of international consensus regarding the need for mandated training, most papers originated from countries with centrally administered national health care systems. The rationale for mandating training programmes remains undefined. The assumption that mandatory training is delivering safe practice outcomes is not supported by studies included in this review. The findings of this review offer a basis for further research to be undertaken to assist with the design, facilitation, and impact of mandatory training.
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Affiliation(s)
- Helen Ashley
- People and Organisational Development, The University of Manchester, Manchester, UK
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Carol Darlington
- Emergency Medicine, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Chiara Mosley
- Workforce Transformation, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
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Goldsworthy A, Chawla J, Birt J, Baumann O, Gough S. Use of extended reality in sleep health, medicine, and research: a scoping review. Sleep 2023; 46:zsad201. [PMID: 37498981 PMCID: PMC10636250 DOI: 10.1093/sleep/zsad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
STUDY OBJECTIVES This scoping review explores the use of extended reality (virtual, augmented, and mixed reality) within sleep health, sleep medicine, and sleep research. It aims to provide insight into current uses and implementation considerations whilst highlighting directions for future research. METHODS A systematic scoping review was undertaken informed by the preferred reporting items for systematic reviews and meta-analyses for scoping reviews and Johanna Briggs Institute. RESULTS The use of virtual reality (VR) as a research tool in the investigation of areas such as dreaming and memory reactivation is growing. Thirty-one articles were identified in total with 20 utilizing VR to improve sleep as a clinical intervention. CONCLUSIONS Research exploring the utility of VR as a clinical intervention in various patient populations and clinical settings is therefore warranted. Researchers and clinicians should ensure that extended reality interventions are developed based on clinical reasoning and informed by evidence of both sleep medicine and the effects of virtual and augmented reality. Where possible future research should utilize up-to-date technology and reporting frameworks to assist in the translation of research into clinical practice.
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Affiliation(s)
- Adrian Goldsworthy
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Jasneek Chawla
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - James Birt
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Oliver Baumann
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
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3
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Goldsworthy A, Chawla J, Baumann O, Birt J, Gough S. Extended Reality Use in Paediatric Intensive Care: A Scoping Review. J Intensive Care Med 2023; 38:856-877. [PMID: 37437084 PMCID: PMC10503262 DOI: 10.1177/08850666231185721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/06/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
Background: Extended reality (XR) technology such as virtual and augmented reality is increasingly being utilised in paediatric medicine due to its role in medical education and reported positive impacts on outcomes including pain, anxiety, and sleep. To the author's knowledge, no previous reviews investigating the use of XR in paediatric intensive care have been undertaken. Objectives: To scope the use of XR in paediatric intensive care, and assess its barriers to adoption, including safety considerations, cleaning and infection control. Eligibility criteria: All articles of any methodological design discussing the use of XR within paediatric intensive and critical care were included. Sources of evidence: Four databases (EMBASE, CINAHL, PsychInfo, PubMed) and Google Scholar were searched without any limitations on publication year. Charting methods: Data was extracted into Microsoft Excel by two authors independently (AG & SF) and cross-checked for completeness. Results: One hundred and eighty-eight articles were originally identified. Following the application of eligibility criteria 16 articles utilising XR in clinical interventions (n = 7) and medical education (n = 9) were included. Articles utilised VR and AR for highly variable purposes within both medical education (eg disaster preparedness, intubation) and clinical interventions (eg decrease pain, nausea, anxiety and improve Glasgow Coma Scale). Conclusions: While research into the use of XR in paediatric intensive care is still in its infancy it has increased dramatically over the past 5 years within two key areas. Firstly, in healthcare education, to assist in the acquisition of PICU-specific knowledge and practice of skills such as intubation of difficult airways. Secondly, studies have evaluated and demonstrated that with appropriate use, VR appears to be a safe and feasible intervention to decrease pain and anxiety in PICU patients.
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Affiliation(s)
| | - Jasneek Chawla
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
- Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, South Brisbane, Australia
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Yates N, Gough S, Brazil V. Self-assessment: With all its limitations, why are we still measuring and teaching it? Lessons from a scoping review. Med Teach 2022; 44:1296-1302. [PMID: 35786121 DOI: 10.1080/0142159x.2022.2093704] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Self-Assessment (SA) is often assumed to be essential for learning, however, this assumption has been extensively rebutted. Research shows SA has significant limitations, including its lack of correlation with competence. METHOD We undertook a scoping review of SA in medical education (2011-2021) and surprisingly discovered substantial research where SA was erroneously assumed to be a valid measure of successful learning, or a skill needing to be taught. Although the initial intent of our scoping review was to explore where SA is being effectively used to advance lifelong learning, we paused to explore the extent of the problem of its misuse and resulting in wasted research, by examining excluded studies. RESULTS From 1151 articles, we identified 207 which ignored the documented limitations of SA. Thirty-nine studies explored SA of learning. This research has limited utility: increasing the accuracy of SA does not improve performance or lifelong learning. One hundred and sixty-eight used SA as an outcome measure to assess a program or intervention, including 63 where self-assessed improvement in knowledge/skills was the sole measure. SA of self-confidence was measured in 62 studies. When confidence was compared with an objective measure of performance, both invariably increased, but confidence did not always align with competence when measured. DISCUSSION Many researchers mistakenly assume the ability to accurately self-assess is essential for learning, so focus on teaching self-calibration rather than evidence-based methods of advancing learning. Other researchers incorrectly suppose that self-reported improvements in knowledge/skills provide evidence of the efficacy of a program/intervention. This is particularly troubling with regards to novices, who may believe that because they self-assess to have improved/gained confidence, they are now competent. CONCLUSION Our findings highlight the significant volume of research being done where SA is misunderstood and/or misused as a measurement. We posit reasons that such research continues to take place and suggest solutions moving forward.
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Affiliation(s)
- Natasha Yates
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
- Translational Simulation Collaborative, Gold Coast, Australia
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Aliprandi M, Pan Y, Mosley C, Gough S. What is the cost of including virtual reality in neurological rehabilitation? A scoping review. Physical Therapy Reviews 2022. [DOI: 10.1080/10833196.2022.2094102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Martina Aliprandi
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Yvonne Pan
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Chiara Mosley
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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Walker A, Hing W, Gough S, Lorimer A. 'Such a massive part of rehab is between the ears'; barriers to and facilitators of anterior cruciate ligament reconstruction rehabilitation: a qualitative focus group analysis. BMC Sports Sci Med Rehabil 2022; 14:106. [PMID: 35701850 PMCID: PMC9199234 DOI: 10.1186/s13102-022-00499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 12/05/2022]
Abstract
Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 19–51 years old). Utilising a semi-structured interview guide, participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight management and interactions with teams and coaches, which present barriers or facilitators for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. These aspects, such as the rehabilitation characteristics, service delivery, psychological and physiological factors, and interactions with others, were consistently identified by this cohort as factors which affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must be evaluated in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00499-x.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia. .,Bond Institute of Health and Sport, Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
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Rappazzo L, Seagrave S, Gough S. Forming and shaping of professional identity within pre-registration physiotherapy curricular: A scoping review. Nurse Educ Today 2022; 109:105250. [PMID: 35033886 DOI: 10.1016/j.nedt.2021.105250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this review was to explore how professional identity is formed and shaped within pre-registration physiotherapy curricular. DESIGN A scoping review using the PRISMA guidelines from the Joanna Briggs Institute to capture a range of evidence describing how professional identity has been formed and shaped in pre-registration physiotherapy curricular. DATA SOURCES Databases searched included: PubMed 1996-Present, Embase 1974-Present, CINAHL 1961-Present, ProQuest Health and Medical Collection 1938-Present and Google Scholar (2004-Present). Additional studies were identified by scanning reference lists and hand searching for relevant articles. REVIEW METHODS The research team collaboratively designed the data charting table and two project leads independently extracted and screened the data as per guidance from the Joanna Briggs Institute Reviewers Manual. A meta-synthesis was conducted in this scoping review to identify common themes from qualitative research to provide a deeper understanding of literature. To ensure feasibility of collating results, components of pre-registration curricular in physiotherapy students describing associations of forming and shaping professional identity were charted. RESULTS A total of 21 articles were reviewed. Articles were categorised into three categories of shaping (5, 24%), forming (9, 43%) or forming and shaping (7, 33%). Five themes emerged from the meta-synthesis pertaining to forming and shaping professional identity: self, skills, curriculum, program, location. CONCLUSIONS This scoping review illustrates the evidence for multidimensional components of physiotherapy curricular involved to assist in shaping and forming professional identity in pre-registration physiotherapy students. The results of this review can provide a foundation level into the understanding of what professional identity is, although further research is required to understand how it could be best implemented in pre-registration physiotherapy curricular.
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Affiliation(s)
- Laura Rappazzo
- Faculty of Health Science and Medicine, Bond University, 14 University Drive, Robina, Australia, 4226
| | - Sara Seagrave
- Faculty of Health Science and Medicine, Bond University, 14 University Drive, Robina, Australia, 4226
| | - Suzanne Gough
- Faculty of Health Science and Medicine, Bond University, 14 University Drive, Robina, Australia, 4226.
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8
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Hannan AL, Hing W, Coombes JS, Gough S, Climstein M, Adsett G, Jayasinghe R, Furness J. Effect of personal activity intelligence (PAI) monitoring in the maintenance phase of cardiac rehabilitation: a mixed methods evaluation. BMC Sports Sci Med Rehabil 2021; 13:124. [PMID: 34629086 PMCID: PMC8503999 DOI: 10.1186/s13102-021-00350-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Personal activity intelligence (PAI) is a single physical activity metric based upon heart rate responses to physical activity. Maintaining 100 PAI/week is associated with a 25% risk reduction in cardiovascular disease mortality and 50 PAI/week provides 60% of the benefits. The effect of utilising this metric within a cardiac population has not been previously investigated. The aim of this study was to determine the effect of PAI monitoring on the amount and/or intensity of physical activity for people in the maintenance phase of cardiac rehabilitation and to explore participants' perceptions of this approach. METHODS A concurrent mixed methods approach was undertaken. Participants in the maintenance phase of cardiac rehabilitation monitored PAI for six weeks via a wearable physical activity monitoring device (WPAM). In the first three weeks participants were blinded to their PAI score. A quality-of-life questionnaire (EQ-5D-5L) was completed, and semi-structured interviews conducted to investigate attitudes to PAI monitoring. Daily PAI data was collected throughout the 6-week period. RESULTS Twenty participants completed the trial. PAI earned/day was increased after participants could view their data (mean difference: 2.1 PAI/day (95% CI 0.3, 4.0), p = 0.027). The median change in percentage of days participants achieved a Total PAI score of 25 (p = 0.023) and 50 (p = 0.015) were also increased. The mean change in total scores for the EQ-5D-5L and EQVAS were improved after 6 weeks (0.6 ± 1.05; 95% CI (0.11-1.09); p = 0.019); (5.8/100; 95% CI (2.4-9.2); p = 0.002 respectively). Thematic framework analysis identified three global themes (perceptions on the WPAM, PAI and factors affecting exercise). Most participants stated motivation to exercise increased after they could view their PAI data. Many of the participants believed they would continue to use PAI long-term. Others were undecided; the latter primarily due to technical issues and/or preferring devices with greater functionality and attractiveness. All participants would recommend PAI. CONCLUSION This exploratory study showed monitoring PAI via a WPAM increased the amount and/or intensity of physical activity within the cardiac population. Participants found PAI interesting, beneficial, and motivating. If technical issues, aesthetics, and functionality of the WPAM were improved, participants may continue to use the approach long-term. PAI may be a viable strategy to assist people with cardiac disease maintain physical activity adherence.
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Affiliation(s)
- Amanda L Hannan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia. .,Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Mike Climstein
- Clinical Exercise Physiology, School of Health and Human Sciences, Southern Cross University, Bilinga, QLD, Australia.,Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, NSW, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
| | | | - Rohan Jayasinghe
- Cardiology Department, Gold Coast University Hospital, Queensland, Griffith University, Brisbane, QLD, Australia.,Macquarie University, Sydney, NSW, Australia
| | - James Furness
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
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Condon C, Lam WT, Mosley C, Gough S. A systematic review and meta-analysis of the effectiveness of virtual reality as an exercise intervention for individuals with a respiratory condition. Adv Simul (Lond) 2020; 5:33. [PMID: 33292807 PMCID: PMC7678297 DOI: 10.1186/s41077-020-00151-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/02/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Respiratory diseases impose an immense health burden worldwide and affect millions of people on a global scale. Reduction of exercise tolerance poses a huge health issue affecting patients with a respiratory condition, which is caused by skeletal muscle dysfunction and weakness and by lung function impairment. Virtual reality systems are emerging technologies that have drawn scientists' attention to its potential benefit for rehabilitation. METHODS A systematic review and meta-analysis following the PRISMA guidelines was performed to explore the effectiveness of virtual reality gaming and exergaming-based interventions on individuals with respiratory conditions. RESULTS Differences between the virtual reality intervention and traditional exercise rehabilitation revealed weak to insignificant effect size for mean heart rate (standardized mean difference, SMD = 0.17; p = 0.002), peak heart rate (SMD = 0.36; p = 0.27), dyspnea (SMD = 0.32; p = 0.13), and oxygen saturation SpO2 (SMD = 0.26; p = 0.096). In addition, other measures were collected, however, to the heterogeneity of reporting, could not be included in the meta-analysis. These included adherence, enjoyment, and drop-out rates. CONCLUSIONS The use of VRS as an intervention can provide options for rehabilitation, given their moderate effect for dyspnea and equivalent to weak effect for mean and maximum peak HR and SpO2. However, the use of virtual reality systems, as an intervention, needs further study since the literature lacks standardized methods to accurately analyze the effects of virtual reality for individuals with respiratory conditions, especially for duration, virtual reality system type, adherence, adverse effects, feasibility, enjoyment, and quality of life.
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Affiliation(s)
- Christina Condon
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wing Tung Lam
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Chiara Mosley
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
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Brooke T, Brown M, Orr R, Gough S. Stress and burnout: exploring postgraduate physiotherapy students' experiences and coping strategies. BMC Med Educ 2020; 20:433. [PMID: 33198724 PMCID: PMC7670805 DOI: 10.1186/s12909-020-02360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE The impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students' higher educational institution outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three timepoints in the first year of a postgraduate, pre-registration physiotherapy program. METHODS A qualitative and quantitative survey design was utilised at one Australian Higher Education Institution. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory - General Survey for Students (MBI-GS (S)), and open-ended questions. The questionnaire was administered at three timepoints (T) in the program: T1 at the start of semester 1, T2 before the first placement in semester 2 and T3 after 10-weeks of placement. Data were analysed using descriptive, statistical and thematical analysis. SUBJECTS All first year Doctor of Physiotherapy students. RESULTS A response rate of 62% (n = 38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1-3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating, and gaming. CONCLUSION Student consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout, and coping mechanisms to optimise student welfare and enhance Higher Education Institution outcomes.
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Affiliation(s)
- Tess Brooke
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia
| | - Makaela Brown
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia
| | - Robin Orr
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia
- Tactical Research Unit, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia.
- Tactical Research Unit, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD, 4226, Australia.
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Waterworth V, Procyk A, Canetti E, Hing W, Gough S. The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review. Journal of Concussion 2020. [DOI: 10.1177/2059700220941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes. Study design Systematic review. Methods A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk. Results Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p < 0.001. Conclusion Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.
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Affiliation(s)
- Victoria Waterworth
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Alexander Procyk
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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12
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Williams J, Saken M, Gough S, Hing W. The effects of message framing characteristics on physical activity education: A systematic review. Cogent Medicine 2019. [DOI: 10.1080/2331205x.2019.1666619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Jayde Williams
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Melissa Saken
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Berry M, Burrell F, Chapman R, Gough S, Ewings S, Thackray D. Simulation-based training can improve on-call physiotherapists’ clinical reasoning abilities and self-reported competency. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gough S, Yohannes A, Murray J. The integrated simulation and technology enhanced learning (ISETL) framework: facilitating robust design, implementation, evaluation and research in healthcare. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gough S, Yohannes AM, Murray J. Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists. Adv Simul (Lond) 2016; 1:9. [PMID: 29449978 PMCID: PMC5806348 DOI: 10.1186/s41077-016-0010-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Upon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown. Methods A focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken. Results Participants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others' actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design. Conclusions This study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice.
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Affiliation(s)
- Suzanne Gough
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | | | - Janice Murray
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Grunberger G, Forst T, Fernández Landó L, Pechtner V, Shaginian R, Jia N, Gough S. Early fasting glucose measurements can predict later glycaemic response to once weekly dulaglutide. Diabet Med 2016; 33:391-4. [PMID: 26179454 DOI: 10.1111/dme.12833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/01/2022]
Abstract
AIMS To assess whether early measures of fasting blood glucose predict later glycaemic response with once-weekly dulaglutide in patients with Type 2 diabetes mellitus. METHODS Post hoc analyses were conducted separately for two phase 3 studies (AWARD-5 and AWARD-1) in patients assigned to once-weekly dulaglutide. Week 2 fasting blood glucose was used as a predictor variable, and glycaemic treatment response was defined by HbA1c response based on a composite efficacy endpoint. The association between fasting blood glucose and the glycaemic response was analysed using chi-square tests. RESULTS There was a strong association between fasting blood glucose < 7.9 mmol/l at week 2 and achieving the HbA1c composite efficacy endpoint at week 26 (P < 0.01). Higher fasting blood glucose at week 2, however, did not predict absence of glycaemic response and requires further assessment. CONCLUSIONS Fasting blood glucose measured at 2 weeks may be an early and useful predictor of glycaemic response to once-weekly dulaglutide treatment.
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Affiliation(s)
- G Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA
| | - T Forst
- Profil Mainz, Mainz, Germany
| | | | - V Pechtner
- Eli Lilly and Company, Neuilly-Sur-Seine, France
| | - R Shaginian
- Eli Lilly and Company, Houten, The Netherlands
| | - N Jia
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S Gough
- Oxford Centre for Diabetes, Endocrinology and Metabolism, and NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
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Kaiser M, Gough S, Woo V, Rodbard H, Linjawi S, Poulsen P, Korsholm L, Bode B. IDegLira bei Patienten mit Typ 2 Diabetes: Wirksamkeit und Sicherheit nach 1 Jahr. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Blüher M, Rodbard H, Woo V, Vilsbøll T, Korsholm L, Gough S. Einfluss des Body Mass Index auf HbA1c-Reduktion, Hypoglykämieraten und Insulinbedarf unter IDegLira bei Patienten mit Typ 2 Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Forst T, Gough S, Grunberger G, Pechtner V, Shaginian R, Wang H, Fernandez L. The 2 week fasting blood glucose (FBG) level as a predictor of HbA1c treatment response (HbA1c-TR) to once weekly dulaglutide 1.5 mg in patients with type 2 diabetes (T2DM). DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lüdemann J, Holst J, Gough S, Rodbard H, Woo V, Linjawi S, Poulsen P, Damgaard L, Bode B. Verbesserte postprandiale Blutzuckereinstellung bei Typ 2 Diabetes mit einer Fikombination von Insulin degludec und Liraglutid: Ergebnisse eines Mahlzeitentests. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rendle DI, Litchfield E, Gough S, Cowling A, Hughes KJ. The effects of sample handling and N-phenylmaleimide on concentration of adrenocorticotrophic hormone in equine plasma. Equine Vet J 2014; 47:587-91. [PMID: 24980684 DOI: 10.1111/evj.12319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY Previous reports suggest that adrenocorticotrophic hormone (ACTH) degrades rapidly, limiting its use as a diagnostic test. OBJECTIVES This study quantified effects of processing delays on ACTH concentrations and investigated the addition of N-phenylmaleimide (maleimide), a protease inhibitor, as a means of reducing ACTH degradation. STUDY DESIGN Experimental study. METHODS Venous blood was collected from 8 healthy horses and 8 horses with pituitary pars intermedia dysfunction (PPID) with a range of ACTH concentrations. Baseline ACTH concentrations were established immediately using a chemiluminescent assay. Plasma samples were then: 1) centrifuged immediately, 2) centrifuged immediately with the addition of maleimide, or 3) allowed to separate by gravity followed by the addition of maleimide, before all samples were stored at 22°C and analysed at 4, 8, 24 and 48 h post collection. A linear mixed effects model and Bland-Altman analyses were performed. Significance was set at P < 0.05. RESULTS No significant effect of plasma treatment (P = 0.1) on change in ACTH concentration was identified. However, significant effects of horse health status (P < 0.001) and time (P < 0.001) on change in ACTH concentration were identified. No significant interactions were found. Significant decreases in ACTH concentration occurred in horses with PPID between 4 and 8 h after blood collection. In non-PPID horses, the decrease in ACTH concentration over time was not significant. Agreement with baseline values decreased over time and was greater for non-PPID horses than for PPID horses. CONCLUSIONS Clinically useful results are still obtained if ACTH concentration is measured up to 48 h after sample collection. Allowing samples to separate by gravity rather than centrifugation did not have a significant effect on ACTH concentration, and the addition of maleimide was of no benefit.
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Affiliation(s)
- D I Rendle
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - E Litchfield
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - S Gough
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - A Cowling
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - K J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Armstrong S, Woodgate R, Gough S, Heller J, Sangster N, Hughes K. The efficacy of ivermectin, pyrantel and fenbendazole against Parascaris equorum infection in foals on farms in Australia. Vet Parasitol 2014; 205:575-80. [DOI: 10.1016/j.vetpar.2014.08.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/23/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Gough S, Jones N, Hellaby M. Innovations in interprofessional learning and teaching: providing opportunities to embed patient safety within the pre-registration physiotherapy curriculum. A Pilot Study. Physical Therapy Reviews 2013. [DOI: 10.1179/1743288x13y.0000000103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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25
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Gough S, Yohannes AM, Thomas C, Sixsmith J. Simulation-based education (SBE) within postgraduate emergency on-call physiotherapy in the United Kingdom. Nurse Educ Today 2013; 33:778-784. [PMID: 22520240 DOI: 10.1016/j.nedt.2012.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 03/02/2012] [Accepted: 03/21/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND The application and extent of simulation-based education use within cardiorespiratory physiotherapy postgraduate education (in-house/regional provisions) and emergency oncall services were previously unexplored. OBJECTIVES This survey aimed to investigate the extent to which simulation-based education is currently utilised by physiotherapy services in the UK. DESIGN A national postal questionnaire-based survey. SETTING All 280 National Health Service Critical/Intensive Care Units in England, Northern Ireland, Scotland and Wales, providing emergency on-call physiotherapy services were included in the survey. PARTICIPANTS Emergency on-call physiotherapy service leads. METHOD A self-administered 20-item postal questionnaire survey was designed to establish the extent to which simulation-based education was currently being used within cardio-respiratory physiotherapy post-registration training. RESULTS A useable response rate of 55% (155/280) was achieved, representing a range of respiratory and emergency on-call service leads. Sixty-one Trusts (39%) currently use simulation within acute respiratory or emergency on-call postgraduate training. The provision of simulation equipment varied with respect to type, fidelity and accessible to the physiotherapy service. Simulation-based education featured in emergency on-call induction, updates, competency assessment, assessment skills, treatment skills and scenarios (75, 92, 39, 28, 82, 48% respectively). CONCLUSIONS Simulation is currently used to teach a wide variety of cardio-respiratory physiotherapy skills relevant to the acute respiratory and on-call environments. Adoption was dependent upon local facilities, needs and training requirements. National inconsistencies in availability, fidelity and accessibility were identified. The evidence base surrounding the current use of simulation-based education within physiotherapy is limited and evidence of transferability to the practice arena remains relatively unknown. Future research is warranted to determine the education outcomes, impact on skill performance, competency, retention and patient safety when integrating SBE within EOC training activities.
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Schumm-Draeger PM, Roadbard H, Gough S, Garber A, Colagiuri S, Rasmussen S, Wilhelm B. Niedrigere Hypoglykämieraten insgesamt und nächtlich mit Insulin degludec vs. Insulin glargin bei Behandlungsintensivierung von Patienten mit Typ 2 Diabetes mit mittelmäßiger Ausgangs-Blutzuckereinstellung (HbA1c 7,5 - 8,5%): eine Metaanalyse. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Interprofessional simulation-based education (IPSE) is becoming an increasingly popular educational strategy worldwide within undergraduate healthcare curricular. The purpose of the literature review was to examine qualitative, quantitative and mixed/multi-method research studies featuring undergraduate IPSE. A literature review was conducted using CINAHL, MEDLINE, and PsycINFO databases from January 1999 to September 2011 and pre-set criteria. The criteria used to screen all 120 abstracts included: (a) the article pertained to both simulation and undergraduate IPE and (b) the article reported a research study. Eighteen articles which met the pre-set criteria were included in the literature review. All studies featured outcome measures; many were purposely designed and lacked psychometric development and evaluation. Key IPSE drivers included capacity planning, preparedness for disaster management and improving patient care through the evaluation of teambuilding, teamwork skills or communicating within inter-disciplinary teams. Studies evaluated/explored either student or teacher perspectives of learning within the context of IPSE or both. The IPSE learning processes varied considerably in relation to duration, fidelity and professions involved. The scenarios ranged from managing adults admitted to hospital settings, mass casualty/mock disaster patient management to the use of training wards. The majority of the articles identified common IPSE outcomes relating to increased confidence, knowledge, leadership, teamwork, and communication skills. Based on the findings of this review, the authors suggest that further multi-site, longitudinal research studies are required to provide evidence of the transferability of skills developed during IPSE and their overall impact on both undergraduate education and healthcare.
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Zinman B, Gough S, Pratley RE, Buse J, Rendschmidt T. Die Wirkung von Liraglutid, Exenatid und Sitagliptin auf den zusammengesetzten Endpunkt von Blutzuckereinstellung und Gewichtsreduktion. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gough S, Feldt-Rasmussen B, Davidson J, Scott D, Lüthgens B. Nierenfunktionsstörungen beeinträchtigen bei Patienten mit Typ 2 Diabetes nicht die glykämische Wirksamkeit und Sicherheit der Behandlung mit Liraglutid. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zinman B, Schmidt WE, Moses A, Lund N, Gough S. Achieving a clinically relevant composite outcome of an HbA1c of <7% without weight gain or hypoglycaemia in type 2 diabetes: a meta-analysis of the liraglutide clinical trial programme. Diabetes Obes Metab 2012; 14:77-82. [PMID: 21883806 DOI: 10.1111/j.1463-1326.2011.01493.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM Effective type 2 diabetes management requires a multifactorial approach extending beyond glycaemic control. Clinical practice guidelines suggest targets for HbA1c, blood pressure and lipids, and emphasize weight reduction and avoiding hypoglycaemia. The phase 3 clinical trial programme for liraglutide, a human glucagon-like peptide 1 analogue, showed significant improvements in HbA1c and weight with a low risk of hypoglycaemia compared to other diabetes therapies. In this context, we performed a meta-analysis of data from these trials evaluating the proportion of patients achieving a clinically relevant composite measure of diabetes control consisting of an HbA1c <7% without weight gain or hypoglycaemia. METHODS A prespecified meta-analysis was performed on 26-week patient-level data from seven trials (N = 4625) evaluating liraglutide with commonly used therapies for type 2 diabetes: glimepiride, rosiglitazone, glargine, exenatide, sitagliptin or placebo, adjusting for baseline HbA1c and weight, for a composite outcome of HbA1c <7.0%, no weight gain and no hypoglycaemic events. RESULTS At 26 weeks, 40% of the liraglutide 1.8 mg group, 32% of the liraglutide 1.2 mg group and 6-25% of comparators (6% rosiglitazone, 8% glimepiride, 15% glargine, 25% exenatide, 11% sitagliptin, 8% placebo) achieved this composite outcome. Odds ratios favoured liraglutide 1.8 mg by 2.0- to 10.5-fold over comparators. CONCLUSIONS As assessed by the composite outcome of HbA1c <7%, no hypoglycaemia and no weight gain, liraglutide was clearly superior to the other commonly used therapies. However, the long-term clinical impact of this observation remains to be shown.
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Affiliation(s)
- B Zinman
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
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Armstrong MJ, Houlihan DD, Gough S, Newsome PN, Kretzschmar Y. Auswirkung einer 2-jährigen Liraglutid-Behandlung auf bestehende Fettlebererkrankungen bei Patienten mit Typ 2 Diabetes: Auswertung der LEAD-2-Verlängerungsstudie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farrar MW, Taylor R, Gough S. Use of an echocardiographic contrast agent to establish safety of cardioversion in a patient with a ligated left atrial appendage. J Am Soc Echocardiogr 2003; 16:1316-7. [PMID: 14652612 DOI: 10.1067/j.echo.2003.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transesophageal echocardiographic-guided cardioversion is a safe, accepted technique to minimize risk of stroke and embolic events when electrically converting atrial fibrillation to normal sinus rhythm. The presence of thrombus in the left atrial appendage (LAA) is a contraindication to performing cardioversion in these patients. For patients with a surgically ligated LAA, thrombus may be more prevalent and may still represent an embolic risk because of incomplete closure of the LAA. We report use of an echocardiographic contrast agent in a patient with a thrombus in a ligated LAA to determine safety of cardioversion.
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Affiliation(s)
- Michael W Farrar
- Cardiology Department, North Kansas City Hospital, MO 64116, USA
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36
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Gough S. The Diabetic Foot. Medical and Surgical Management. Eur J Vasc Endovasc Surg 2002. [DOI: 10.1053/ejvs.2002.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fodje MN, Hansson A, Hansson M, Olsen JG, Gough S, Willows RD, Al-Karadaghi S. Interplay between an AAA module and an integrin I domain may regulate the function of magnesium chelatase. J Mol Biol 2001; 311:111-22. [PMID: 11469861 DOI: 10.1006/jmbi.2001.4834] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In chlorophyll biosynthesis, insertion of Mg(2+) into protoporphyrin IX is catalysed in an ATP-dependent reaction by a three-subunit (BchI, BchD and BchH) enzyme magnesium chelatase. In this work we present the three-dimensional structure of the ATP-binding subunit BchI. The structure has been solved by the multiple wavelength anomalous dispersion method and refined at 2.1 A resolution to the crystallographic R-factor of 22.2 % (R(free)=24.5 %). It belongs to the chaperone-like "ATPase associated with a variety of cellular activities" (AAA) family of ATPases, with a novel arrangement of domains: the C-terminal helical domain is located behind the nucleotide-binding site, while in other known AAA module structures it is located on the top. Examination by electron microscopy of BchI solutions in the presence of ATP demonstrated that BchI, like other AAA proteins, forms oligomeric ring structures. Analysis of the amino acid sequence of subunit BchD revealed an AAA module at the N-terminal portion of the sequence and an integrin I domain at the C terminus. An acidic, proline-rich region linking these two domains is suggested to contribute to the association of BchI and BchD by binding to a positively charged cleft at the surface of the nucleotide-binding domain of BchI. Analysis of the amino acid sequences of BchI and BchH revealed integrin I domain-binding sequence motifs. These are proposed to bind the integrin I domain of BchD during the functional cycle of magnesium chelatase, linking porphyrin metallation by BchH to ATP hydrolysis by BchI. An integrin I domain and an acidic and proline-rich region have been identified in subunit CobT of cobalt chelatase, clearly demonstrating its homology to BchD. These findings, for the first time, provide an insight into the subunit organisation of magnesium chelatase and the homologous colbalt chelatase.
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Affiliation(s)
- M N Fodje
- Department of Molecular Biophysics, Lund University, Lund, 221 00, Sweden
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Morris CM, Haataja L, McDonald M, Gough S, Markie D, Groffen J, Heisterkamp N. The small GTPase RAC3 gene is located within chromosome band 17q25.3 outside and telomeric of a region commonly deleted in breast and ovarian tumours. Cytogenet Cell Genet 2000; 89:18-23. [PMID: 10894930 DOI: 10.1159/000015583] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The closely related small GTP-binding proteins Rac1, Rac2, and Rac3 are part of a larger Rho subfamily of Ras proteins. Because disruption of Ras signaling pathways is relevant to the pathogenesis of a wide variety of cancers, it is important to clearly define the structural and functional characteristics of the participating proteins and their encoding genes. Rho subfamily members are involved in a range of signal transduction pathways relevant to cell growth, differentiation, motility, and stress, and Rac proteins are now recognised as a necessary component of Ras-mediated cellular transformation. We previously mapped RAC3 to chromosome band 17q23--> q25, a region that contains a number of candidate tumour suppressor genes. Because of its oncogenic potential, we have now further refined the location of this gene. Here we confirm that RAC3 maps to chromosome band 17q25.3 and further show that it maps some distance telomeric of a well-characterised minimal breast and ovarian candidate tumour suppressor gene region, BROV. The genomic structure of RAC3, including exon and intron boundaries, is also presented.
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Affiliation(s)
- C M Morris
- Cytogenetic and Molecular Oncology Unit, Department of Pathology, Christchurch School of Medicine, Christchurch, New Zealand.
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Lehnert K, Ni J, Leung E, Gough S, Morris CM, Liu D, Wang SX, Langley R, Krissansen GW. The integrin alpha10 subunit: expression pattern, partial gene structure, and chromosomal localization. Cytogenet Cell Genet 2000; 87:238-44. [PMID: 10702680 DOI: 10.1159/000015434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Herein we report the cloning of cDNAs and incompletely processed hnRNAs from endothelia and heart that encode the alpha10 subunit forming part of the novel collagen type II-binding integrin alpha10beta1 of chondrocytes. Analysis of hnRNA clones and reported expressed sequence tags revealed the positions of 17 putative intron-exon splice junctions shared with those of the p150,95 (ITGAX) gene. Human alpha10 transcripts of 5.4 and 1.8 kb were not restricted to chondrocytes but, instead, were widely expressed in a panel of 24 tissue types, where the highest expression was found in muscle and heart. The human alpha10 subunit gene (ITGA10) was localized to band q21 of chromosome 1.
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Affiliation(s)
- K Lehnert
- Department of Molecular Medicine, Faculty of Medicine and Health Science, The University of Auckland, Auckland, New Zealand
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Berg RW, Leung E, Gough S, Morris C, Yao WP, Wang SX, Ni J, Krissansen GW. Cloning and characterization of a novel beta integrin-related cDNA coding for the protein TIED ("ten beta integrin EGF-like repeat domains") that maps to chromosome band 13q33: A divergent stand-alone integrin stalk structure. Genomics 1999; 56:169-78. [PMID: 10051402 DOI: 10.1006/geno.1998.5707] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Herein we describe the cDNA sequence of a novel human gene, ITGBL1, encoding a beta integrin-related protein termed TIED [for ten beta integrin epidermal growth factor (EGF)-like repeat domains]. Overlapping cDNA clones from fetal lung, HUVEC, and osteoblast cDNA libraries encode a sequence comprising a typical signal peptide, followed by a hydrophilic 471-amino-acid domain containing 10 tandem EGF-like repeats strikingly similar to those found in the cysteine-rich "stalk-like" structure of integrin beta subunits. The EGF-like repeats of TIED and beta integrins are unique in that they alternate in homology and possess two additional cysteines (eight in total) whose positions differ from those in the other eight-cysteine EGF-like domains of laminin, fibrillin, and the latent TGF-beta binding proteins. TIED mRNA transcripts of 2.8 kb were detected in aorta, thymus, and osteogenic sarcoma cells. The ITGBL1 gene was mapped to human chromosome 13, band 13q33. We suggest that ITGBL1 may be linked in some way with the evolution of the integrin beta subunits.
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MESH Headings
- 3' Untranslated Regions
- Alternative Splicing
- Amino Acid Sequence
- Base Sequence
- Binding Sites
- Chromosome Banding
- Chromosome Mapping
- Chromosomes, Human, Pair 13/genetics
- Cloning, Molecular
- DNA, Complementary/chemistry
- DNA, Complementary/genetics
- Epidermal Growth Factor
- Gene Expression Regulation
- Humans
- In Situ Hybridization, Fluorescence
- Integrins/chemistry
- Integrins/genetics
- Molecular Sequence Data
- Protein Structure, Tertiary
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Sequence Alignment
- Sequence Analysis, DNA
- Sequence Homology, Amino Acid
- Tissue Distribution
- Tumor Cells, Cultured
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Affiliation(s)
- R W Berg
- Faculty of Medicine and Health Science, The University of Auckland, Auckland, New Zealand
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Love G, Gough S, Brady D, Barron N, Nigam P, Singh D, Marchant R, McHale AP. Continuous ethanol fermentation at 45 °C using Kluyveromyces marxianus IMB3 immobilized in Calcium alginate and kissiris. ACTA ACUST UNITED AC 1998. [DOI: 10.1007/pl00008982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gough S, Flynn O, Hack CJ, Marchant R. Fermentation of molasses using a thermotolerant yeast, Kluyveromyces marxianus IMB3: simplex optimisation of media supplements. Appl Microbiol Biotechnol 1996; 46:187-90. [PMID: 8987649 DOI: 10.1007/s002530050803] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of molasses as a substrate for ethanol production by the thermotolerant yeast Kluyveromyces marxianus var. marxianus was investigated at 45 degrees C. A maximum ethanol concentration of 7.4% (v/v) was produced from unsupplemented molasses at a concentration of 23% (v/v). The effect on ethanol production of increasing the sucrose concentration in 23% (v/v) molasses was determined. Increased sucrose concentration had a similar detrimental effect on the final ethanol produced as the increase in molasses concentration. This indicated that the effect may be due to increased osmotic activity as opposed to other components in the molasses. The optimum concentration of the supplements nitrogen, magnesium, potassium and fatty acid for maximum ethanol production rate was determined using the Nelder and Mead (Computer J 7:308-313, 1965) simplex optimisation method. The optimum concentration of the supplements were 0.576 g1(-1) magnesium sulphate, 0.288 g1(-1) potassium dihydrogen phosphate and 0.36% (v/v) linseed oil. Added nitrogen in the form of ammonium sulphate did not affect the ethanol production rate.
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Affiliation(s)
- S Gough
- Biotechnology Research Group, School of Applied Biological and Chemical Sciences, University of Ulster, Coleraine, Co. Londonberry, Northern Ireland.
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45
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Aoki M, Koranyi L, Riggs AC, Wasson J, Chiu KC, Vaxillaire M, Froguel P, Gough S, Liu L, Donis-Keller H. Identification of trinucleotide repeat-containing genes in human pancreatic islets. Diabetes 1996; 45:157-64. [PMID: 8549859 DOI: 10.2337/diab.45.2.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the search for diabetes genes, the combined approaches of positional cloning with random markers and subsequent evaluation of candidate genes mapping to areas of interest will be increasingly used. For islet candidate genes of unknown function, expressed trinucleotide (triplet) repeats represent a unique subset. It is unlikely that abnormal expansion of expressed islet triplet repeats would be a major cause of diabetes, yet the triplet repeats are frequently polymorphic and can thus be used to map the genes in the human genome. In this study, a human islet cDNA library was screened with (CGG)7 and (CAG)7, and 23 triplet repeats were isolated. Sequencing revealed four known and six novel islet genes containing 4-15 triplet repeats. The four known cDNAs included ferritin, the major iron-binding protein in cells; HSGSA2R, a full-length clone of the alpha-subunit of the G-regulatory protein; HUMSATB1A, a DNA-binding protein expressed predominantly in thymus; and HUMPPA-PRO, a ribosomal protein. The triplet repeats in ferritin and HUMPPAPRO were found to be monomorphic. Characterization of the six unique novel expressed islet triplet cDNAs revealed that they were 0.6-1.5 kb in size, contained 4-15 triplet repeats, and were expressed in islets and all other tissues examined. Four of the novel clones, CGG-isl 10, CGG-isl 11, CAG-isl 6, and CAG-isl 7, were mapped to human chromosomes 19, 16, 12, and 3, respectively, via somatic cell hybrids. One islet cDNA, CAG-isl 7, contained a repeat that was highly polymorphic, with 14 alleles (4-18 triplets) in African-Americans (heterozygosity = 0.86) and 6 alleles (heterozygosity = 0.77) in whites. Northern analysis indicated that the mRNA was abundant in pancreatic islets. A putative full-length clone contained an open reading frame encoding 213 amino acids with a variable number of alanines (4-18) within the COOH-terminal. The gene was uniquely mapped with odds > 1,000:1 on chromosome 3p in Centre d'Etude du Polymorphisme Humain pedigrees. There were no differences in CAG-isl 7 allele frequencies between African-American patients with NIDDM (n = 108) and control subjects (n = 116), nor was expansion above 18 repeats noted. Linkage analysis in 14 nonglucokinase maturity-onset diabetes of the young pedigrees showed a cumulative logarithm of odds score of -33.19 at theta = 0.00. Abnormal expansion was not observed in 20 IDDM patients with one NIDDM parent. While these data suggest no major role for CAG-isl 7 in diabetes, at least four of the six novel islet triplet genes are coexpressed in pancreatic islets and neural tissue, and these genes can now be considered as candidates for diabetes and/or neuropsychiatric diseases.
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MESH Headings
- Amino Acid Sequence
- Base Sequence
- Chromosome Mapping
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 16
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 3
- DNA Primers/chemistry
- DNA, Complementary/genetics
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 2/genetics
- Gene Expression
- Gene Frequency
- Genetic Linkage
- Humans
- Islets of Langerhans/physiology
- Molecular Sequence Data
- RNA, Messenger/genetics
- Trinucleotide Repeats
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Affiliation(s)
- M Aoki
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Affiliation(s)
- D. Von Wettstein
- Department of Physiology, Carlsberg Laboratory, Gamle Carlsberg Vej 10, DK-2500 Copenhagen Valby, Denmark
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Affiliation(s)
- D. Von Wettstein
- Department of Physiology, Carlsberg Laboratory, Gamle Carlsberg Vej 10, DK-2500 Copenhagen Valby, Denmark
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Chaudhry B, Müller-Uri F, Cameron-Mills V, Gough S, Simpson D, Skriver K, Mundy J. The barley 60 kDa jasmonate-induced protein (JIP60) is a novel ribosome-inactivating protein. Plant J 1994; 6:815-24. [PMID: 7849755 DOI: 10.1046/j.1365-313x.1994.6060815.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The N-terminal region of a 60 kDa, jasmonate-induced protein of barley leaves (JIP60) is shown to be homologous to the catalytic domains of plant ribosome-inactivating proteins (RIP). Western blotting of leaf extracts and in vitro reconstitution experiments indicate that JIP60 is synthesized as a precursor which is processed in vivo. This is in keeping with in vitro translation experiments indicating that a deletion derivative of the N-terminal region, but not the putative precursor, strongly inhibits protein synthesis on reticulocyte ribosomes. The inhibition of ribosome function is associated with depurination of 26S rRNA, characteristic of plant RIPs. This indicates that JIP60 is a novel ribosome-inactivating protein requiring at least two processing events for full activation. JIP60 derivatives do not significantly inhibit in vitro protein synthesis on wheat germ ribosomes. These and other results suggest that JIP60 may be involved in plant defence.
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Affiliation(s)
- B Chaudhry
- Carlsberg Research Laboratory, Carlsberg Laboratory, Valby, Denmark
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Gough S. Low molecular weight heparin. BMJ 1991; 303:784. [PMID: 1657259 PMCID: PMC1671030 DOI: 10.1136/bmj.303.6805.784-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gough S. Quality assurance in dietetics: a criteria audit study. Aust Clin Rev 1989; 8:207-10. [PMID: 2719601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S Gough
- Graylands Hospital, Western Australia
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