Emergency nurses' knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study.

AIM: Sepsis is a significant and time-sensitive clinical concern for patients who present to Emergency Departments (EDs). Existing guidelines do not define nurses' roles in managing sepsis. This study explored ED nurses' experiences and perceptions around recognising and responding to patients with sepsis, and their awareness of sepsis screening and prognostic tools. The knowledge and insights gained from this study may be used to inform local and international ED policies, and enrich nursing educational packages that may be used to improve quality of patient care and patient outcomes. METHODS: Qualitative design incorporating semi-structured interviews with 14 ED nurses was undertaken. Thematic and consensus-based content analyses were used to explore transcripts. FINDINGS: Six key themes were identified; (1) contribution of the organisation, (2) appreciation of knowledge, (3) appreciation of clinical urgency, (4) appreciation of importance of staff supervision, (5) awareness of the importance of staff experience, and (6) awareness of the need to seek advice. CONCLUSION: ED nurses' identified deficits in their capacity to recognise and respond to patients with sepsis, despite their vital role within the multidisciplinary team that cares for patients with sepsis. The knowledge and insights gained from this study can be used to inform ED policies, to enrich context-specific educational packages that aim to improve quality of patient care and outcomes and identify areas for further research. Development and implementation of a nurse-inclusive sepsis pathway may address many deficits identified in this study.

Compression socks and the effects on coagulation and fibrinolytic activation during marathon running.

PURPOSE: Compression socks are frequently used in the treatment and prevention of lower-limb pathologies; however, when combined with endurance-based exercise, the impact of compression socks on haemostatic activation remains unclear. OBJECTIVES: To investigate the effect of wearing compression socks on coagulation and fibrinolysis following a marathon. METHODS: Sixty-seven participants [43 males (mean ± SD: age: 46.7 ± 10.3 year) and 24 females (age: 40.0 ± 11.0 year)] were allocated into a compression (SOCK, n = 34) or control (CONTROL, n = 33) group. Venous blood samples were obtained 24 h prior to and immediately POST-marathon, and were analyzed for thrombin-anti-thrombin complex (TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI), and D-Dimer. RESULTS: Compression significantly attenuated the post-exercise increase in D-Dimer compared to the control group [median (range) SOCK: + 9.02 (- 0.34 to 60.7) ng/mL, CONTROL: + 25.48 (0.95-73.24) ng/mL]. TF increased following the marathon run [median (range), SOCK: + 1.19 (- 7.47 to 9.11) pg/mL, CONTROL: + 3.47 (- 5.01 to 38.56) pg/mL] in all runners. No significant post-exercise changes were observed for TAT and TFPI. CONCLUSIONS: While activation of coagulation and fibrinolysis was apparent in all runners POST-marathon, wearing compression socks was shown to reduce fibrinolytic activity, as demonstrated by lower D-Dimer concentrations. Compression may reduce exercise-associated haemostatic activation when completing prolonged exercise.

Enhancing OSCE preparedness with video exemplars in undergraduate nursing students. A mixed method study.

BACKGROUND: Objective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for 'real world' clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations. AIM: To implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course. METHOD: A set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined. FINDINGS: The online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received; but did not impact on performance. CONCLUSION: Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.

ENGAGING STUDENTS IN ACUTE MENTAL HEALTHCARE.

Mental health is an increasing component of the burden of disease worldwide, providing challenges in healthcare and health systems (World Health Organization, 2013); it is widespread, and not limited to dedicated mental health facilities.

Student learning styles in anatomy and physiology courses: Meeting the needs of nursing students.

Anatomy and Physiology is a core course in pre-registration nursing programs, yet many students have difficulty successfully negotiating the large volume of content and the complex concepts in these bioscience courses. Typically students perform poorly in these 'threshold' courses', despite multiple interventions to support student engagement. Investigation of the shortcomings in these courses, based on feedback from students indicated several key areas of difficulty in the course, especially focused around a relative lack of hands-on 'concrete' activities in laboratories and tutorials. To attempt to address this, academic and technical staff developed activities for students that promoted discussion and allowed students to interact easily and repetitively with content. Interactive tables and posters that needed to be labelled or 'filled-in' using pre-prepared Velcro dots, as well as pre-prepared flash cards to promote group work, were some examples of the activities used to enhance student experiences and promote hands-on learning. Over the academic year of 2013 these activities were introduced into the laboratory and tutorial classes for first year Bachelor of Nursing anatomy and physiology students. Staff and student participants positively rated implementation of these new activities on surveys, as they allowed them to explore the difficult aspects of anatomy and physiology, utilising various learning styles that may have been neglected in the past.

Olfactory discrimination predicts cognitive decline among community-dwelling older adults.

The presence of olfactory dysfunction in individuals at higher risk of Alzheimer's disease has significant diagnostic and screening implications for preventive and ameliorative drug trials. Olfactory threshold, discrimination and identification can be reliably recorded in the early stages of neurodegenerative diseases. The current study has examined the ability of various olfactory functions in predicting cognitive decline in a community-dwelling sample. A group of 308 participants, aged 46-86 years old, were recruited for this study. After 3 years of follow-up, participants were divided into cognitively declined and non-declined groups based on their performance on a neuropsychological battery. Assessment of olfactory functions using the Sniffin' Sticks battery indicated that, contrary to previous findings, olfactory discrimination, but not olfactory identification, significantly predicted subsequent cognitive decline (odds ratio = 0.869; P<0.05; 95% confidence interval = 0.764-0.988). The current study findings confirm previously reported associations between olfactory and cognitive functions, and indicate that impairment in olfactory discrimination can predict future cognitive decline. These findings further our current understanding of the association between cognition and olfaction, and support olfactory assessment in screening those at higher risk of dementia.

Effects of anesthetic agents on socially transmitted olfactory memories in mice.

Mice can learn a food preference from odor cues transmitted on the breath of a conspecific, even if the "demonstrator" is anesthetized. To our knowledge there are no studies examining the effect of anesthetizing the "observer" on development of memory for socially transmitted food preferences (STFP). In Experiment 1 we found that 2-4 month-old F2 C57Bl/6x129sv male and female mice demonstrated a STFP after a 5min exposure to an anesthetized demonstrator mouse when tested 24h later. In Experiment 2, observer mice anesthetized with Sagatal (60 mg/kg) prior to the "social interaction" preferentially avoided the cued food when tested 24h later. This aversion was not due to any overt aversive effects of this dose of Sagatal because mice that ate the food and were then anesthetized, or could only smell the food for 5 min while anesthetized, showed no preference or aversion. In a third experiment we found that the Sagatal-induced aversion was not a general property of anesthesia because there were varied results produced by observer mice treated with anesthetic drugs with different mechanisms of action. Vetalar (200mg/kg) and Rompun (10 mg/kg) treated animals ate similar amounts of cued and non-cued food at test, indicating an absence of learning. Hypnorm (0.5 ml/kg) treated animals showed a preference for the cued food whereas those treated with Hypnovel (2.5 ml/kg) showed an aversion to the cued food. These results show that the food aversion observed with Sagatal is not a general property of anesthetic agents, but appears to be restricted to those acting primarily on the GABAergic system. Thus, we have shown that under certain conditions it is possible for an anesthetized observer mouse to learn a preference or aversion of a socially-linked olfactory cue.

Light experience and the development of behavioural lateralization in chicks III. Learning to distinguish pebbles from grains.

Chicks searching for food grains against a background of unfamiliar pebbles usually peck pebbles less when using the right eye (RE), or both eyes, than when using the left eye (LE), provided that the embryo's RE has been exposed to light (Li), as is normal. When pecking is fast this right/left difference is mainly due to a heightened ability of RE chicks to inhibit premature pecks (and inappropriate responses in general). Dark incubation (Da) abolishes this ability in RE chicks, and RE and LE chicks show similar frequent pebble pecks. We show now that, under conditions that cause cautious pecking, both Li and Da chicks show a new effect: in both cases LE chicks peck pebbles more than RE chicks, probably because of the novelty of pebbles. Interest in novelty in LE chicks is known to be unaffected by light in incubation. Age-dependent effects are also important. RE and LE chicks, which had either the LE or RE exposed to light before hatching, were tested on days 3, 5, 8 or 12 post-hatching, under conditions giving normal fast pecking. Artificial exposure of the embryo's LE to light reversed the lateralization: in general, chicks using the light-exposed eye performed well at all ages. Irrespective of which eye system had heightened ability to inhibit pebble pecks, RE performance differed from usual on 2 days, whereas LE chicks showed no age-dependent changes. Changes confined to the RE system, therefore, affect behaviour independently of lateralization of the ability to inhibit inappropriate response.

Dehydroepiandosterone and its sulphate enhance memory retention in day-old chicks.

We report the presence of dehydroepiandosterone (DHEA) and DHEA sulphate (DHEA-S) in the day-old-chick brain, and their possible role in memory formation. DHEA and DHEA-S were present in the brain at higher concentrations than in the plasma. Radioimmunoassay examination of the intermediate medial hyperstriatum ventrale 5 or 30 min after training or the lobus parolfactorius 60 or 120 min after training on the passive avoidance task did not show learning-related differences in absolute levels of DHEA or DHEA-S. However, bilateral intracerebral injections of DHEA or DHEA-S before or after training on the weak passive avoidance task enhanced recall 24 h after training. Memory retention was enhanced by administration of DHEA and DHEA-S 15 min before training or 30 and 60 but not 180 min after training. Neurosteroids are present in high concentrations in regions of the chick brain known to be associated with learning and memory for an aversive one-trial task. Our study demonstrates that memory retention for this task is enhanced by administration of the neurosteroids DHEA-S and DHEA. These findings provide additional evidence that these neurosteroids have memory-enhancing properties and, thus, if common to other tasks and species, that DHEA-S and DHEA may constitute potential therapeutic tools for the treatment of cognitive deficits.

PGF(2alpha)-induced nest building and choice behaviour in female domestic pigs.

The domestic pig, Sus scrofa, builds a maternal nest in the day before parturition. A model for porcine nest building has been established, in which exogenously administered prostaglandin (PG)F(2alpha) is used to induce nesting behaviour in cyclic, pseudopregnant and pregnant pigs. This experiment was designed to examine the effect of PGF(2alpha) on the preferences of non-pregnant gilts for pens bedded with straw compared with bare pens. Ten 6-month-old nulliparous female pigs (gilts) were tested in an arena, which consisted of four pens (1.8mx1.7m), a neutral area (1.5mx3.4m) and a start area (1.5mx3.4m). Two of the pens contained 2kg of fresh straw and the remainder of the testing arena was devoid of straw. On the first day of testing half of the pigs were given a control intramuscular injection of 3ml 0.9% saline and the remainder were given an intramuscular injection of 15mg PGF(2alpha) and their behaviour scored for 1h after treatment. On the following day the treatments were reversed, such that each pig was given both treatments (saline or PGF(2alpha)). There was no significant effect of the order of treatment on behaviour. After saline-treatment the pigs spent most of their time in the pens containing straw (59%) and the least amount of time in bare pens (5%). In the straw pens, saline-treatment induced bouts of oronasal contact with straw of a relatively long duration (11-100s), which we interpret as foraging. In the hour after PGF(2alpha)-treatment the pigs also spent most of their time in the pens containing straw (44%) and the least amount of time in bare pens (10%), but they interacted with the straw in a markedly different way. PGF(2alpha)-treated pigs displayed bouts of oronasal contact with straw of a relatively short duration (2-10s) which, together with high frequencies of pawing at straw, lifting and carrying straw in the mouth, we interpret as nest building behaviour. Superimposed on this is the finding that gilts spend more time in the neutral areas after PGF(2alpha)-treatment than they did after saline-treatment. PGF(2alpha)-treated pigs spent most of their time engaged in nesting behaviour within the straw pens but they also gathered and deposited straw in different areas of the test arena (neutral and start areas); behaviours not seen after saline-treatment. We conclude that pigs generally prefer a pen containing straw bedding to a bare pen but that PGF(2alpha) alters the way they interact with straw, inducing behaviour similar to prepartum nest building.