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PurposeDrawing on human capital theory and sustainable career theory, this paper aims to explore the impact of undertaking an industrial placement on the "Great Eight" competencies as perceived by university students and line managers.Design/methodology/approach618 students and their line managers across three cohorts (pre-COVID-19) took part in a longitudinal quantitative study. Students completed a three-wave questionnaire at the placement's start, middle, and end. Line managers completed the questionnaire during waves two and three to offer 360-degree feedback. Descriptive statistics and repeated measures ANOVA were applied to the dataset.FindingsThe impacts of undertaking a placement were highly variable for different competencies at the sub-scale level, although at the eight-scale level, the nuance was less pronounced. However, students self-perceived that all eight competencies increased between the start and end of the placement. Surprisingly, line managers perceived students' competencies to be higher than perceived by the students.Originality/valueThe value of undertaking a placement is often poorly measured (e.g. satisfaction) rather than competency-based outcomes, which can lead to conclusions that are overly simplistic and difficult to use in practice. Theoretically, this study advances understanding of human capital theory and sustainable career theory by understanding the role placements can play in developing human capital and preparing university students for sustainable careers. Practically, the findings of this study can help to close the university-industry skills gap by informing curriculum and placement scheme design and supporting students to acquire personal resources and signal these to prospective employers as an antecedent to career sustainability.
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BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Aim/Introduction: Technegas is fast becoming the gold standard for lung ventilation scintigraphy in Canada. Technegas is a carbonbased nanoparticle bound to 99mTc which is small enough to behave more like a gas than an aerosol. Due to its small size, Technegas can easily perfuse the peripheral airways and does not aggregate in the central airways like larger aerosol particles often do. Furthermore, since the Covid-19 pandemic began, there has been a significant drop in ventilation studies performed due to the risk of exposure to the virus when using traditional aerosols. Improved image quality, fast and easy administration, enhanced patient comfort, and ability to safely administer Technegas with Covid-19 positive patients makes Technegas far superior to traditional Tc-based aerosols. Material(s) and Method(s): A review of the literature comparing Technegas to other commonly used 99mTcbased lung ventilation imaging agents was conducted. Recent purchasers of Technegas units were interviewed to determine their motivation for switching to Technegas and their overall impression with using it after changing over. Result(s): The small particle size, reduced central airways deposition, and lack of lung clearance leads to improved count-statistics and better target-to-non-target ratio, which allows for SPECT imaging, which is not feasible when using traditional aerosols. Technologists report that administering Technegas is far easier and faster than administering traditional aerosols. Often patients only require 1 or 2 breaths of Technegas to achieve the desired count rate, as opposed to 5 or more minutes of breathing an aerosol. Technegas is a 'dry' aerosol, which means that it is considered a non-aerosol generating procedure, so it is safe to use on Covid-19 positive patients. Justifying the small start-up cost to purchase a Technegas generator was the limiting factor for departments delaying their switch to Technegas. Canada's health care system is publicly-funded, which often delays widespread access to technological advancements. The Covid-19 pandemic has increased demand for Technegas across Canada, which has resulted in increased funding to purchase more Generators. Conclusion(s): Technegas is far superior to other 99mTc-based aerosols used in ventilation imaging and is fast replacing Tc-based aerosols as the agent of choice in nuclear medicine departments across Canada.
ABSTRACT
Aim/Introduction: Technegas is fast becoming the gold standard for lung ventilation scintigraphy in Canada. Technegas is a carbonbased nanoparticle bound to 99mTc which is small enough to behave more like a gas than an aerosol. Due to its small size, Technegas can easily perfuse the peripheral airways and does not aggregate in the central airways like larger aerosol particles often do. Furthermore, since the Covid-19 pandemic began, there has been a significant drop in ventilation studies performed due to the risk of exposure to the virus when using traditional aerosols. Improved image quality, fast and easy administration, enhanced patient comfort, and ability to safely administer Technegas with Covid-19 positive patients makes Technegas far superior to traditional Tc-based aerosols. Material(s) and Method(s): A review of the literature comparing Technegas to other commonly used 99mTcbased lung ventilation imaging agents was conducted. Recent purchasers of Technegas units were interviewed to determine their motivation for switching to Technegas and their overall impression with using it after changing over. Result(s): The small particle size, reduced central airways deposition, and lack of lung clearance leads to improved count-statistics and better target-to-non-target ratio, which allows for SPECT imaging, which is not feasible when using traditional aerosols. Technologists report that administering Technegas is far easier and faster than administering traditional aerosols. Often patients only require 1 or 2 breaths of Technegas to achieve the desired count rate, as opposed to 5 or more minutes of breathing an aerosol. Technegas is a 'dry' aerosol, which means that it is considered a non-aerosol generating procedure, so it is safe to use on Covid-19 positive patients. Justifying the small start-up cost to purchase a Technegas generator was the limiting factor for departments delaying their switch to Technegas. Canada's health care system is publicly-funded, which often delays widespread access to technological advancements. The Covid-19 pandemic has increased demand for Technegas across Canada, which has resulted in increased funding to purchase more Generators. Conclusion(s): Technegas is far superior to other 99mTc-based aerosols used in ventilation imaging and is fast replacing Tc-based aerosols as the agent of choice in nuclear medicine departments across Canada.
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BACKGROUND AND AIM: Physiological surveillance systems significantly reduced adult mortality in two large UK hospitals. In hospitalised children mortality is low, but there may be potential to reduce the morbidity associated with critical deterioration (CD). However, the risk models for adults are unsuitable for use in children because the signs associated with deterioration [heart rate, breathing rate, blood pressure], alter significantly across the age range. The aim is to evaluate whether this technology improves clinical outcomes for in-hospital deterioration, including sepsis in children. METHOD(S): ISRCTN61279068. https://bit.ly/36HtEGF Participants: Paediatric in-patients, aged less than 18 years at a tertiary hospital (240 beds). Intervention(s): Careflow Vitals and Connect app platform configured to incorporate the Alder Hey age-specific Paediatric Early Warning score (PEWS) and modified National Institute of Health and Clinical Excellence (NICE) Sepsis screening. The documentation of vital signs and clinical observations occur at the patient's bedside at intervals determined by the PEWS risk model. PEWS categorised CD risk as low, moderate, high and critical and provided targeted escalation advice and automated alerts to the Nurse in Charge of the shift and the responsible Clinical Teams. Primary Outcome:Emergency transfers to Critical Care (PICU/ HDU). RESULT(S): Prospective data collection baseline year March 2018 - February 2019 compared with 2 years postintervention March 2020-February 2022 (Extended due to COVID). Summary of results in Figure 1. CONCLUSION(S): The absolute number of CD and patients affected reduced by 29%. Associated review of the cases using the Predictability/Preventability framework showed reduction in the late recognition and CD with modifiable factors. (Figure Presented).
ABSTRACT
We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Study Objectives: COVID-19 dramatically changed weekly academic conferences with virtual presentations replacing in-person didactics. Through group chat functions, modern communication platforms provide the opportunity for synchronous online discussions to occur in parallel with didactic presentations. We sought to qualitatively characterize the content, nature, and educational uses of synchronous online discussions occurring during weekly academic conferences and to assess the attitudes of lecturers and audience members towards these discussions. Methods: Transcripts of synchronous online discussions occurring from 7/1/20 to 12/31/20 were qualitatively analyzed using a grounded theory approach. Initial themes were identified by the primary author. Following a preliminary coding by the study authors, the themes were iteratively refined to arrive at a final coding strategy. Each month’s transcripts were coded by 2 study authors. When there was disagreement between coders, the primary author made a final coding determination. Following the study period, a survey distributed to residents and faculty assessed attitudes towards the synchronous online discussions. Results: The qualitative analysis of the transcripts identified 2352 coded messages. The final coding schema can be seen in Figure 1. Of 1720 identified content codes, the most commonly identified themes were cultural communications (40.8%) and knowledge sharing (39.0%). Within the broader theme of knowledge sharing, participants were most likely to share individual practice experience (366/671 codes). Statements with uncited data/evidence (113 codes) occurred in similar frequency to sharing of academic resources (137 codes). Questions directed towards other members of the audience (48.8% of questions) were only slightly less common than questions directed to the lecturer (51.2% of questions). There were 56 respondents to the survey (30 residents, 25 faculty, 1 fellow). Of the 44 respondents that had presented didactics, 54.5% (24/44) identified that it was challenging to keep up with the synchronous online discussion. From the perspective of the audience, 82.1% (46/56) felt it was easy to keep up with the discussion. Presenters of didactics felt identifying a member of the audience as a surrogate was the easiest means to keep up with the discussion (75%, 33/44 presenters). Audience members agreed that they were much more likely to ask a question in a synchronous online discussion as opposed to speaking out loud (71.4%, 40/56). Conclusions: Weekly academic conferences are a critical component of residency education, enabling not only the acquisition of knowledge but also the social sharing of knowledge/experiences developing of robust communities of practice. Our qualitative analysis found that cultural communication occurred with near equal frequency to knowledge sharing and that sharing of individual practice experiences was more common than sharing of academic resources. These synchronous online discussions may make it more likely for audience members to ask questions of each other or the lecturer but keeping up with the discussion was challenging for lecturers. [Formula presented]
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Aim: Several papers have analysed the clinical benefits and safety of Virtual Fracture Clinics (VFCs). A significant increase in the use of Trauma and Orthopaedic (T&O) VFCs was seen during the COVID-19 pandemic. This study aims to investigate the social impact of VFCs on the travel burden and travel costs of T&O patients, as well as the potential environmental benefits in relation to fuel consumption and travelrelated pollutant emissions. Method: All patients referred for T&O VFC review from March 2020 to June 2020 were retrospectively analysed. The travel burden and environmental impacts of hypothetical face-to-face consultations were compared with these VFC reviews. The primary outcomes measured were patient travel time saved, patient travel distance saved, patient cost savings and reduction in air-pollutant emissions. Results: Over a four-month period, 1359 VFC consultations were conducted. The average travel distance saved by VFC review was 88.6 kilometres (range 3.3-615), with an average of 73 minutes (range 9-390) of travel-time saved. Patients consumed, on average, 8.2 litres (range 0.3-57.8) less fuel and saved an average of e11.02 (range 0.41-76.59). The average reduction in air-pollutant vehicle emissions, including carbon dioxide, carbon monoxide, nitric oxides and volatile organic compounds was 20.3 kilograms (range 0.8-140.8), 517.3 grams (g) (range 19.3-3592.3), 38.1g (range 1.4-264.8) and 56.9g (range 2.1-395.2), respectively. Conclusions: VFCs reduce patient travel distance, travel time and travel costs. In addition, VFCs confer significant environmental benefits through reduced fuel consumption and reduction of harmful environmental emissions.
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Introduction and Objectives Bacterial and fungal co-infections contribute to mortality and morbidity to patients with Influenza. We aimed to evaluate respiratory tract flora, degree of co-infection and outcomes of patients admitted with COVID- 19 to ICU in a UK hospital. Productive cough is rare in COVID-19 and therefore identification of co-pathogens requires invasive sampling which is non-practical outside of ICU. Methods A retrospective cohort of patients admitted to ICU with confirmed SARS-CoV-2 infection was identified. Demographic data, co-morbidities, microbiology results from respiratory samples, clinical biomarkers and clinical outcomes were analysed. Respiratory samples were divided into early samples within 5 days of hospital admission that would represent community acquired organisms and late samples that would represent hospital acquired organisms. Results 77 patients were admitted to ICU with COVID-19 from February to June 2020. Respiratory samples were collected by non-directed bronchoalveolar lavage(NBL)(171 samples) and BAL from 61 patients. 37/61(60.7%) patients isolated a pathogen. 39 patients had an early sample with 14/ 39(35.9%) isolating a pathogen. Table 1 lists organisms isolated from early and late samples. On antimicrobial susceptibility testing of early respiratory isolates 2/7 Staphylococcus aureus were methicillin resistant and 2/5 Haemophilus influenza isolates were co-amoxiclav resistant. 29/77(37.7%) patients died during their admission to hospital. There was no significant correlation between in hospital mortality and isolation of a pathogen in early or any respiratory sample (Fisher's exact test p=0.512 and p=1.0 respectively). Conclusions A higher proportion of bacterial co-pathogens were seen in our study population compared to previously reported non-UK data1. Identifying true co-infection is complicated by fever, chest x-rays infiltrates and high CRP being characteristic of severe COVID-19. Staphylococcus aureus was commonly isolated in both early and late respiratory samples and supports empiric antibiotic regimens with staphylococcal activity for secondary bacterial pneumonia in COVID-19 as currently recommended by NICE2. However the proportion of resistant organisms isolated needs to be studied in larger cohorts to ensure guideline recommended antibiotics are appropriate.