ABSTRACT
Simulated (or standardized) patients (SPs) play a crucial role in the teaching and assessment of communication skills in healthcare. As this methodology has evolved, the SP educator has emerged as its own profession. In 2017, an international team from the Association of SP Educators (ASPE) published Standards of Best Practice (SOBPs) to guide practitioners. Investigators sought to assess the applicability of the SOBPs to the diverse contexts in which SP educators work around the world. In this study, investigators addressed two questions: 1. Are SOBPs relevant to SP educators around the world?;and 2. How can the SOBPs be enhanced or altered in future iterations? Investigators used 60-minute, semi-structured interviews with 12 respondents from 11 countries. Researchers used purposive sampling. Respondents were intentionally recruited from 6 continents. Respondents included individuals who are active SP educators, but who are not ASPE members. All interviews were recorded and transcribed. The data were analyzed using NVivo and investigators used thematic analysis. While respondents provided many insights into the SOBPs and SP methodology, preliminary analysis has revealed three main themes. First, respondents described the role of the SOBPs in affirming current practices and guiding the development of future practices, including domains of safety in simulation and quality control. Second, respondents described how the SOBPs enable professional development through empowering evidence-based practice and promoting scholarship. Third, respondents offered recommendations for adaptation of the SOBPs to online simulation in the context of the Covid-19 pandemic. Successful simulation requires the utilization of practices most likely to lead to optimal learner outcomes. This study indicates that SP educators around the world view ASPE's SOBPs as a powerful tool providing both guidance and flexibility. Results: suggest that the SOBPs serve as a valuable guide for working with SPs in diverse cultural contexts. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
BACKGROUND AND OBJECTIVES: Government-mandated health and safety restrictions to mitigate the effects of COVID-19 intensified challenges in caring for older adults in long-term care (LTC) without family/care partners. This article describes the experiences of a multidisciplinary research team in implementing an evidence-based intervention for family-centred, team-based, virtual care planning - PIECES TM approach - into clinical practice. We highlight challenges and considerations for implementation science to support care practices for older adults in LTC, their families, and the workforce. RESEARCH DESIGN AND METHODS: A qualitative descriptive design was used. Data included meetings with LTC directors and Registered Practical Nurses (i.e., licensed nurse who graduated with a 2-year diploma program that allows them to provide basic nursing care); one-on-one interviews with family/care partners, residents, Registered Practical Nurses, and PIECES mentors; and reflections of the academic team. The Consolidated Framework for Implementation Research (CFIR) provided sensitizing constructs for deductive coding, while an inductive approach also allowed themes to emerge. RESULTS: Findings highlighted how aspects related to planning, engagement, execution, reflection, and evaluation influenced the implementation process from the perspectives of stakeholders. Involving expert partners on the research team to bridge research and practice, developing relationships from a distance, empowering front-line champions, and adapting to challenging circumstances led to shared commitments for intervention success. DISCUSSION AND IMPLICATIONS: Lessons learned include the significance of stakeholder involvement throughout all research activities; the importance of clarity around expectations of all team members; and the consequence of readiness for implementation with respect to circumstances (e.g., COVID-19) and capacity for change.
ABSTRACT
Cross-species spillover events are responsible for many of the pandemics in human history including COVID-19; however, the evolutionary mechanisms that enable these events are poorly understood. We have previously modeled this process using a chimeric vaccinia virus expressing the rhesus cytomegalovirus-derived protein kinase R (PKR) antagonist RhTRS1 in place of its native PKR antagonists: E3L and K3L (VACVΔEΔK + RhTRS1). Using this virus, we demonstrated that gene amplification of rhtrs1 occurred early during experimental evolution and was sufficient to fully rescue virus replication in partially resistant African green monkey (AGM) fibroblasts. Notably, this rapid gene amplification also allowed limited virus replication in otherwise completely non-permissive human fibroblasts, suggesting that gene amplification may act as a 'molecular foothold' to facilitate viral adaptation to multiple species. In this study, we demonstrate that there are multiple barriers to VACVΔEΔK + RhTRS1 replication in human cells, mediated by both PKR and ribonuclease L (RNase L). We experimentally evolved three AGM-adapted virus populations in human fibroblasts. Each population adapted to human cells bimodally, via an initial 10-fold increase in replication after only two passages followed by a second 10-fold increase in replication by passage 9. Using our Illumina-based pipeline, we found that some single nucleotide polymorphisms (SNPs) which had evolved during the prior AGM adaptation were rapidly lost, while thirteen single-base substitutions and short indels increased over time, including two SNPs unique to human foreskin fibroblast (HFF)-adapted populations. Many of these changes were associated with components of the viral RNA polymerase, although no variant was shared between all three populations. Taken together, our results demonstrate that rhtrs1 amplification was sufficient to increase viral tropism after passage in an 'intermediate species' and subsequently enabled the virus to adopt different, species-specific adaptive mechanisms to overcome distinct barriers to viral replication in AGM and human cells.
ABSTRACT
BACKGROUND: Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes including isolating older adults in their rooms, cancelling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviours (e.g., yelling, hitting, calling out) to express frustration, fear, restricted movement and boredom. To respond to the challenges in LTC and support frontline staff, older adults and family members, a novel Registered Practical Nurse (RPN)-led delivery of the PIECESTM approach for addressing responsive behaviours among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECESTM employs a person and family/care partner-centred, collaborative team-based approach to provide education and capacity building for nurses, engages families as active participants in care, and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs including dementia. OBJECTIVE: To describe experiences of LTC staff, family/care partners, and older adult research partners with implementing a novel RPN-led virtual adaptation of the PIECES care planning approach for responsive behaviors in two Canadian long-term care homes during the COVID-19 pandemic. METHODS: Using a qualitative descriptive design, two focus groups were held with three to four staff members (e.g., RPNs, managers) per LTC home in Ontario. A third was held with three PIECES mentors. Individual semi-structured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was conducted. RESULTS: A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation, and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences. CONCLUSIONS: Findings give promising support to adopting virtual PIECES - a team approach to gather valuable family input and engagement to address residents' unmet needs and responsive behaviours in LTC. Future research should investigate a hybridized communication format to foster sustainable person and family-centered care planning practices to include active collaboration of families in individualized care plans. CLINICALTRIAL: Not applicable.