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1.
BMC Nurs ; 21(1): 252, 2022 Sep 08.
Article in English | MEDLINE | ID: covidwho-2038731

ABSTRACT

BACKGROUND: An essential component of becoming a professional nurse is a perspective of global health issues and an awareness of diverse populations. Collaborative online international learning (COIL) using digital technologies, offers meaningful and rewarding opportunities to develop international partnerships between nurses from other countries, without economic, organisational or geographical barriers. Despite reported advantages of using COIL, few COIL interventions have been identified in the nursing literature. The aims of this study are to develop, implement and evaluate a COIL program between Australian and Canadian pre-registration nursing students. METHODS: The study will utilize a mixed methods approach incorporating pre and post-test surveys, focus groups, and semi-structured interviews of key stakeholders. The design will adhere to The State University of New York (SUNY) COIL's criteria for intercultural/international learning opportunities. Participants will be recruited from nursing programs at an Australian Training and Further Education Institute and a Canadian college. Bennett's stages of intercultural competence will provide the theoretical framework for the research. Four specific research interventions will be developed for this project. For students, there will be an online virtual community to allow students and teachers to communicate, socially connect and share resources with each other. Virtual reality simulations will be employed within a virtual global classroom to promote collaborative, intercultural learning. For faculty, a virtual community of practice will provide a platform for faculty to share education and research ideas and participate in collaborate research opportunities. DISCUSSION: This study will evaluate the outcomes of a nursing COIL program. It will measure participants' views on COIL, its contribution to student learning, changes in cultural awareness, organisational impact and research productivity. It will provide nursing students with the opportunity to become global leaders in nursing care and for faculty to develop international research skills and outputs. The findings from the study will allow further refinement of future nursing COIL programs.

2.
Arch Dis Child ; 2022 May 12.
Article in English | MEDLINE | ID: covidwho-1846361

ABSTRACT

BACKGROUND: Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal. METHODS: Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions. OUTCOME MEASURES: Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed. RESULTS: 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin. CONCLUSIONS: Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.

3.
Journal of Thoracic Oncology ; 16(10):S853-S854, 2021.
Article in English | EMBASE | ID: covidwho-1482768

ABSTRACT

Introduction: Chemo-radiotherapy for lung cancer can be a morbid treatment, often in an older and co-morbid population. Our patients are not routinely seen by a dietitian. Methods: As a pilot project, all patients receiving either sequential or concurrent chemo-radiotherapy for lung cancer between May and November 2020, were identified by the lead lung radiographer and bookings team and referred to a specialist oncology dietitian. These patients were offered up to 3 routine fortnightly assessments on treatment. We recorded their symptoms (based on a standardised tool, PG-SGA) and weight during treatment. Results: 15 patients were referred to the dietitian: 7 male, 8 female. All patients accepted dietetic review. The median age was 64 years old;mean age 63 years old (range 50-79). The mean average number of cycles of chemotherapy was 3.4. Concurrent chemo-radiotherapy was given to 11 patients, with the remaining 4 having sequential treatment. Of all patients, 1 had small cell lung cancer, 1 had a mixed adenocarcinoma and small cell. The remaining 13 were non-small cell lung cancers, and of these 6 were adenocarcinomas and 6 were squamous cell carcinomas and 1 mixed histology. All patients were reviewed at least twice whilst on treatment. The most complete data was for the review in weeks 3/4 of radiotherapy. All 15 patients had scores for this time point. Mean number of symptoms was 5.5 (range 3-9). The commonest symptoms were fatigue (100%), loss of appetite (67%), pain (67%) and dysphagia (60%). For 12 patients receiving 6 weeks of radiotherapy median symptom number increased from 5 in 1st 2 weeks, to 5.5 in weeks 2nd 2 weeks, to 6.5 in final 2 weeks. All patients in this group lost weight. Median weight loss during treatment was 6.6% (range 1.8-15.9%). All patients received food fortification advice throughout their treatment and advice on symptom management. The symptom management advice for 12 of the 15 patients either reinforced advice, or, made adjustments to the timing of medications prescribed by medical or nursing staff. The other 3 patients did not have an existing prescription, and so recommendations were made of medications to manage symptoms, e.g. oxcetacaine, anti-emetics and laxatives. Oral nutritional supplements (ONS) were recommended if patients were not meeting their estimated nutritional requirements from dietary assessment. Seven patients received ONS prescription in addition to the food fortification advice. One patient declined an ONS prescription. Conclusion: 1. Routine dietetic review during radical chemo-radiotherapy is feasible and occurred successfully during the COVID-19 pandemic. It led to some simple, but vital changes in practice such as weekly weighing of patients on treatment 2. Patients undergoing chemo-radiotherapy have a high symptom burden. 3. All patients receiving 6 weeks of radiotherapy lost weight during treatment. 4. We received positive feedback from patients. Keywords: Dietitian, Dietician, radiotherapy

4.
Eur. J. Econ. Econ. J. Policy-Interv. ; 18(2):119-144, 2021.
Article in English | Web of Science | ID: covidwho-1459061

ABSTRACT

The US economic expansion which began in 2009 was unusually prolonged but relatively weak. Profitability and investment strengthened between 2010 and 2015 but then began to falter. After Trump took office in 2017 there was a minor recovery in investment but the proceeds of major tax cuts were overwhelmingly used to finance payouts to share owners. Unemployment fell steadily from 2010 but with a shift towards lower-paid jobs. Median wages increased from around 2014, but while those for women had risen steadily since the 1980s, those for men only recuperated to their 1980 level in 2018. By contrast, top incomes soared. The impact of the COVID-19 epidemic was partly cushioned by huge government spending programmes, but unemployment among less-skilled workers increased strongly, while the massive monetary response led to an unprecedented bonanza for the rich. The Biden government's first major initiative extended unemployment benefits and promoted a national response to the health emergency, but failed to secure an increase in the national minimum wage to $15 an hour.

5.
Cancer Immunology Research ; 9(2 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1186412

ABSTRACT

New therapeutic antigen-specific approaches are required to generate and sustain therapeutic immune responses against tumour specific antigens in cancer. Based on twenty years of experience with attempt to maximise the induction of potent T cell responses against infectious pathogens in humans we have begun to assess the utility of non-replicating viral vectors in cancer. Two trials in prostate cancer patients have completed enrolment and another in lung cancer is planned. We have reported efficacy data for a novel vaccine based on two replication-deficient viruses, chimpanzee adenovirus (ChAdOx1) and MVA, targeting an oncofetal self-antigen 5T4, administered as a single agent and in combination with anti-PD-1 in mouse tumour models. Based on recently reported encouraging safety and exceptional T cell immunogenicity in a phase I "VANCE" study (NCT02390063) of me with localised prostate cancer, the phase I/II trial, ADVANCE (NCT03815942) was undertaken to test vaccine safety and efficacy in combination with PD-1 blockade in metastatic prostate castrate-resistant cancer (mCPRC). We find a satisfactory safety profile for the use of these viral vectored vaccines with anti-PD1 in mCRPC patients but with lower immunogenicity than in localised prostate cancer patients. However, an encouraging response rate, as measured the reduction in PSA levels by 50%, was observed in this trial and options for enhancing immunogenicity and efficacy further will be discussed.

6.
Thorax ; 76(SUPPL 1):A133-A134, 2021.
Article in English | EMBASE | ID: covidwho-1147433

ABSTRACT

Introduction: and Objectives: The Covid: 19 pandemic has had a monumental effect on healthcare services. Within the NHS, the majority of services are delivered face to face, and during the height of the pandemic, this became impossible. There is an undeniable body of evidence that traditional PR classes offer those living with chronic lung disease an opportunity to learn and understand how best to manage their condition. There are well established Virtual PR platforms in the UK but most have expensive licence fees. Recognising many months without intervention would have a detrimental effect to the health of service users, it became essential to offer virtual pulmonary rehabilitation (VPR). Outcomes from VPR have been gathered and analysed against those from traditional PR to see if the new intervention was safe, effective and worthwhile, whilst providing meaningful changes to exercise capacity and psychological wellbeing. Methods: Participants completed a seven week course run by Qualified Physiotherapists and Occupational Therapists. They were given a programme of aerobic and strength exercises were advised to complete twice weekly exercise sessions building up intensity and frequency as the weeks progressed. During the intervention patients were contacted up to twice weekly via telephone or video call. Education was provided informally in booklet format. Patients were assessed pre-and post-intervention using the 1 minute sit-to stand test, Chronic Respiratory questionnaire - self reported (CRQ-SR), GAD-7 and PHQ-9, and MRC. Results: 40 participants have completed VPR in the first wave. 61% of participants achieved the MCID for the 1 minute STS test. 52% achieved the MCID in all domains of CRQ-SR. Average MRC scores improved from 3.2 to 2.7;an average improvement of 0.5. Conclusions: The Covid pandemic offered an opportunity to explore the potential of VPR. There is evidence of good individual successes, however upon reflection, outcomes were collectively less favourable than traditional PR. Longterm, VPR offers a welcome alternative method of accessing PR services for those unable to access traditional PR. However, further research should be completed into identifying characteristics of those who will be most likely to succeed at VPR.

7.
Multiple Sclerosis Journal ; 26(3 SUPPL):8, 2020.
Article in English | EMBASE | ID: covidwho-1067106

ABSTRACT

Background: Previously, we used frequency domain nearinfrared spectroscopy (fdNIRS), a non-invasive imaging modality, to show that brain hypoxia exists in a subset of MS patients. Currently, there is limited knowledge on the effects of hypoxia in MS. However, some studies suggest that hypoxia may exacerbate inflammation of the central nervous system (CNS). It is important to elucidate the time-course of hypoxia in relation to inflammation to further understand its role in MS. Objectives: The aim of the present study was to use fdNIRS to determine if hypoxia in MS resolves quickly or if it is a chronic condition. Methods: We used fdNIRS to quantify cortical microvasculature hemoglobin saturation (StO2) in 55 controls and 85 MS patients. StO2 values that were 2 standard deviations (SD) below the control mean were defined as hypoxic (<55.7%). Arterial oxygen saturation (SaO2) was measured using a pulse oximeter to confirm that reduced StO2 was not systemic in origin. To determine whether the temporal pattern of StO2 relates to changes in acute CNS inflammation, we recruited a subset of MS patients (hypoxic: n=12;normoxic: n=7) for a longitudinal study. We measured StO2 once a week for 4 consecutive weeks, and then once a month for 5 subsequent months. Due to COVID-19- related lab closures, we were only able to obtain StO2 data for the first 8 weeks for 13 of these patients (hypoxic: n=8;normoxic: n=5). Results: StO2 in MS patients was significantly lower compared to controls (57.6±7.6% vs. 62.3±3.6%, respectively, p=0.002), with no differences in SaO2. For the longitudinal study, we found that StO2 values for normoxic and hypoxic MS groups did not change significantly over the course of 8 weeks (F(9, 36.9) =1.44, p=0.255). Conclusions: To our knowledge, we are the first group to use fdNIRS to identify a subset of MS patients who experience persistent brain hypoxia. As hypoxia in MS patients persists beyond 4 weeks, we argue that it can present as a chronic condition. This indicates that, in these patients, physiological responses such as angiogenesis have not occurred or are not sufficient to result in resolution of hypoxia. With such chronic hypoxia we would predict that in these patients, some symptoms may be a result of this chronic hypoxia. Also, we argue that such chronic hypoxia could exacerbate and further stimulate a pathological immune response (a hypoxia inflammation cycle).

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