Sowing Across a State: Development and Delivery of a Grassroots Pediatric Palliative Care Nursing Curriculum.

BACKGROUND: Rural pediatricians and adult-trained hospice teams report feeling ill-prepared to care for children at end of life, resulting in geographies in which children are not able to access home-based services. OBJECTIVES: To develop a pediatric palliative care curriculum for inpatient nurses and adult-trained hospice teams caring for children in a rural region. METHODS: Curriculum design and delivery was informed by local culture through an interdisciplinary, iterative development approach with confidence, intention, and support measured pre-, post-, and 4 months after delivery. A needs assessment was completed by pediatric nurses caring for children receiving palliative or end-of-life care to inform curricular content (phase 1). A curriculum was designed by an interdisciplinary pediatric palliative care team and piloted with nursing cohorts annually through educational conferences with monthly discussion series for 3 consecutive years (phase 2). Curricular content was then provided for 31 rural hospice team members (phase 3). RESULTS: Self-reported confidence in caring for children increased by 1.1/10 points for adult-trained hospice team members. Mean score for intention to care for children increased by 5.2 points (sustained 5.1 points above baseline at 4 months). Perception of support in caring for children increased by 5 points (mean sustained 5.4 points above baseline at 4 months). Family needs, care goals, and symptom management were prioritized learning topics. Rural hospices previously unwilling to accept children enrolled pediatric patients in the 4 months following the conference. CONCLUSION: Grassroots curricular initiatives and ongoing educational mentorship can grow pediatric palliative and hospice services in rural regions.

The influence of online video learning aids on preparing postgraduate chiropractic students for an objective structured clinical examination.

OBJECTIVE: To investigate the influence of providing online procedural videos to postgraduate chiropractic students preparing for an objective structured clinical examination (OSCE). METHODS: Eighty-three postgraduate chiropractic students enrolled in a diagnostic unit during 2017 received supplemental video resources prior to their final OSCE. Ninety students enrolled in the 2016 offering of the unit acted as the control group. Two-sample t tests were used to compare OSCE results between groups and paired t tests were used for within-group comparisons. Regression analysis was used to examine the association of age, undergraduate grade point average, and gender with the final OSCE scores. Students were also surveyed regarding their perceptions of the video resources using a purpose-built questionnaire. RESULTS: A paired t test comparing initial and final OSCE scores found a small but significant increase in scores for the 2017 (mean change 3.6 points; p = .001) but not the 2016 (mean change -1.1 scores; p = .09) cohort. The 2017 cohort had significantly more change than the 2016 cohort (mean difference 4.7 points; p < .001). Analysis of responses to the questionnaire highlighted overall positive feedback for the procedural videos. CONCLUSION: Online procedural videos as learning resources had a small but positive effect on OSCE performance for a group of postgraduate chiropractic students. Students perceived the resource as being helpful for OSCE preparation.

Symptom clusters in chronic obstructive pulmonary disease: A systematic review.

AIM: To conduct a comprehensive literature review to identify symptom clusters commonly present in Chronic obstructive pulmonary disease (COPD) patients. BACKGROUND: COPD is the fourth leading cause of death worldwide. Substantial research has been studied regarding single symptoms that burden patients with this disease and the profound impacts that these symptoms can have on physical and psychological health. However, these symptoms rarely occur in isolation and limited research has been conducted identifying clinically significant relationships or clusters of symptoms associated with COPD afflicted patients. METHODS: PubMed, Web of Science, and Embase databases were used to identify potential articles limited to records published between 2005 and 2018 with human-conducted trials on adults with COPD, examining symptom clusters in this population. Only 5 studies met inclusion criteria. RESULTS: Across the five studies, 596 participants were included with a mean age of 70.49. Two themes emerged including psychological symptom clusters and respiratory-related symptom clusters. Anxiety-related symptoms appeared to be a common theme among psychological symptom clusters and varied greatly based on instrument selection. Inconsistent results were found in respiratory-related symptom clusters, but included difficulty breathing as a common symptom component. Only one study examined for stability of symptoms over time. CONCLUSION: There were inconsistent results across all studies which may be contributed to the heterogeneity amongst patients, instruments administered, and statistical approach. Future research should be conducted to further elucidate COPD related symptom clusters, their effects on somatic and cognitive health, and the stability of these symptom clusters over time.

Practical independent research projects in science: a synthesis and evaluation of the evidence of impact on high school students.

Practical independent research projects (IRPs) are a feature of school science in a number of countries. To assess the impact of IRPs on students, a systematic review of the literature was undertaken. Thirty-nine papers met the review inclusion criteria, reporting on work from twelve countries. The review indicates that IRPs are often associated with wider initiatives such as authentic science, problem-based learning, and project-based learning. There is considerable variability in the nature of IRP work in relation to focus, models of provision, assessment, the involvement of external partners such as universities and employers, and funding, and this diversity affects judgements on the quality of the evidence base on impact. The majority of the research reviewed explored areas such as conceptual understanding, motivation to study science once it is no longer compulsory and attitudes to science, and the development of practical skills. Benefits were identified in relation to the learning of science ideas, affective responses to science, views of pursuing careers involving science, and development of a range of skills. Studies focusing on traditionally under-represented groups indicated that such students felt more positive about science as a result of undertaking IRPs. The review findings indicate that further work is needed to enhance the quality of the available evidence, to consider the ways in which IRPs can be validly assessed, to explore more fully the potential benefits for traditionally under-represented groups, and to explore more fully the potential longer-term benefits of participation in IRPs at high school level.

Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, which may result from alteration of the gastrointestinal microbiota following gastrointestinal infection, or with intestinal dysbiosis or small intestinal bacterial overgrowth. This may be treated with antibiotics, but there is concern that widespread antibiotic use might lead to antibiotic resistance. Some herbal medicines have been shown to be beneficial, but their mechanism(s) of action remain incompletely understood. To try to understand whether antibacterial properties might be involved in the efficacy of these herbal medicines, and to investigate potential new treatments for IBS, we have conducted a preliminary study in vitro to compare the antibacterial activity of the essential oils of culinary and medicinal herbs against the bacterium, Esherichia coli. METHODS: Essential oils were tested for their ability to inhibit E. coli growth in disc diffusion assays and in liquid culture, and to kill E. coli in a zone of clearance assay. Extracts of coriander, lemon balm and spearmint leaves were tested for their antibacterial activity in the disc diffusion assay. Disc diffusion and zone of clearance assays were analysed by two-tailed t tests whereas ANOVA was performed for the turbidometric assays. RESULTS: Most of the oils exhibited antibacterial activity in all three assays, however peppermint, lemon balm and coriander seed oils were most potent, with peppermint and coriander seed oils being more potent than the antibiotic rifaximin in the disc diffusion assay. The compounds present in these oils were identified by gas chromatography mass spectrometry. Finally, extracts were made of spearmint, lemon balm and coriander leaves with various solvents and these were tested for their antibacterial activity against E. coli in the disc diffusion assay. In each case, extracts made with ethanol and methanol exhibited potent antibacterial activity. CONCLUSIONS: Many of the essential oils had antibacterial activity in the three assays, suggesting that they would be good candidates for testing in clinical trials. The observed antibacterial activity of ethanolic extracts of coriander, lemon balm and spearmint leaves suggests a mechanistic explanation for the efficacy of a mixture of coriander, lemon balm and mint extracts against IBS in a published clinical trial.