Search results for: senior nurse

Authors: Bency Ann Massinello, Nancy Day, Janet Fellini

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Background: The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members(nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team…) become essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families. The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exceptions to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company provided shared and assigned mobile devices. Objective: This paper discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, use case expansion, and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device. This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Methods: Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre and post implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (Nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management. Results: Successful implementation of the communication system in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-monthperiod post implementation, we noticed a 14% increase from 7,993 messages in 6 days in December 2020 to 9,116messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre and post implementation staff survey for process evaluation. Conclusion: A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology in our mainstream healthcare.

Keywords: nursing informatics, mobile secure texting, multidisciplinary communication, pediatrics post acute care

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Authors: Zainab Olabisi Tairu

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The human species is facing some of the most challenging issues encountered as civilization and development occurs. The most salient factors threatening all species globally are habitats loss and degradation, overexploitation, competition with unwanted invasive species, pollution, global climate and various individual lifestyles of indigenous species. In order to avoid or minimize the effect of our actions on the environment and to balance employee work life with their private life, Green Human Resource is important and must be practiced in every organization including Higher Learning Institutions. This study addressed Green HRM from an institutional perspective, University systems are involved in numerous and complex social, educational and extra-curricular activities. The University community must be challenged to rethink and re-construct their environmental policies and practices in order to contribute to sustainable development. Many institutions only look at sustainability from the technology improvement aspect and waste management. People are the principal actors for sustainability development at the institutional level. The aim of the study is to explore the concept of Green Human Resource Management at a case site. Divine Word University (DWU) an Institution of Higher Education that embraced the ‘Printing & Paper use Policy’, also commonly referred to as the ‘paperless policy’, the use of solar as an alternative source of energy, water conservation and improvement in internet technology (IT) with the aim of becoming a green institution in effort to help save the environment. This study used Participatory Action Research as the Overarching methodological framework and Egg of sustainability and Wellbeing as the theoretical perspective in analyzing the data, engaging Case study strategy and a mixed method design at DWU. Focus group interview were conducted with three departments at the University, semi-structure interviews with the senior managers, survey questionnaire administered to students and staff with a sample size of 176 participants, in addition, policy documents were also exploited as extra source of data. Waste management including e-waste appeared to be one of the main concerns at DWU. A vast majority of DWU staff and students expressed the need for their institution to do more on sustainability education. The findings revealed that members of the community are not fully integrated like the Egg of sustainability and wellbeing in order to achieve sustainable development goal. The concept of Green Human Resource Management in Universities lies with the idea that Universities must bear profound responsibilities to manage its stakeholders in an environmental friendly way. Human resource management can help local institutions to recognize the need for changes of lifestyle, production, consumption as well as the end product in order to combat or at least reduce human Induced which produce or aggravate it.

Keywords: sustainability, environmental management, higher education institutions, green human resource management

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Authors: Joy Tweed, Jon Pike

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In Thailand, a 4.0 policy has been initiated that is designed to prepare and train an appropriate workforce to support the move to a value-based economy. One aspect of support for this policy is a project to encourage the creation of double degree programmes, specifically between Thai and UK universities. This research into the project, conducted with its key players, explores the factors that can either enable or hinder the development of such programmes. It is an area that has received little research attention to date. Key findings focus on differences in quality assurance requirements, attitudes to benefits, risks, and committed levels of institutional support, thus providing valuable input into future policy making. The Transnational Education (TNE) Development Project was initiated in 2015 by the British Council, in conjunction with the Office for Higher Education Commission (OHEC), Thailand. The purpose of the project was to facilitate opportunities for Thai Universities to partner with UK Universities so as to develop double degree programme models. In this arrangement, the student gains both a UK and a Thai qualification, spending time studying in both countries. Twenty-two partnerships were initiated via the project. Utilizing a qualitative approach, data sources included participation in TNE project workshops, peer reviews, and over 20 semi-structured interviews conducted with key informants within the participating UK and Thai universities. Interviews were recorded, transcribed, and analysed for key themes. The research has revealed that the strength of the relationship between the two partner institutions is critical. Successful partnerships are often built on previous personal contact, have senior-level involvement and are strengthened by partnership on different levels, such as research, student exchange, and other forms of mobility. The support of the British Council was regarded as a key enabler in developing these types of projects for those universities that had not been involved in TNE previously. The involvement of industry is apparent in programmes that have high scientific content but not well developed in other subject areas. Factors that hinder the development of partnership programmes include the approval processes and quality requirements of each institution. Significant differences in fee levels between Thai and UK universities provide a challenge and attempts to bridge them require goodwill on the part of the latter that may be difficult to realise. This research indicates the key factors to which attention needs to be given when developing a TNE programme. Early attention to these factors can reduce the likelihood that the partnership will fail to develop. Representatives in both partner universities need to understand their respective processes of development and approval. The research has important practical implications for policy-makers and planners involved with TNE, not only in relation to the specific TNE project but also more widely in relation to the development of TNE programmes in other countries and other subject areas. Future research will focus on assessing the success of the double degree programmes generated by the TNE Development Project from the perspective of universities, policy makers, and industry partners.

Keywords: double-degree, internationalization, partnerships, Thai-UK

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Authors: Mehwish Jawaad

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Purpose: The concept of GrSCM (Green Supply Chain Management) in the academic and research field is still thought to be in the development stage especially in Asian Emerging Economies. The purpose of this paper is to contribute significantly to the first wave of empirical investigation on GrSCM Practices and Firm Performance measures in Pakistan. The aim of this research is to develop a more holistic approach towards investigating the impact of Green Supply Chain Management Practices (Ecodesign, Internal Environmental Management systems, Green Distribution, Green Purchasing and Cooperation with Customers) on multiple dimensions of Firm Performance Measures (Economic Performance, Environmental Performance and Operational Performance) with a mediating role of Investment Recovery and Competitiveness. This paper also serves as an initiative to identify if the relationship between Investment Recovery and Firm Performance Measures is mediated by Competitiveness. Design/ Methodology/Approach: This study is based on survey Data collected from 272, ISO (14001) Certified Textile Firms Based in Lahore, Faisalabad, and Karachi which are involved in Spinning, Dyeing, Printing or Bleaching. A Theoretical model was developed incorporating the constructs representing Green Activities and Firm Performance Measures of a firm. The data was analyzed using Partial Least Square Structural Equation Modeling. Senior and Mid-level managers provided the data reflecting the degree to which their organizations deal with both internal and external stakeholders to improve the environmental sustainability of their supply chain. Findings: Of the 36 proposed Hypothesis, 20 are considered valid and significant. The statistics result reveal that GrSCM practices positively impact Environmental Performance followed by Economic and Operational Performance. Investment Recovery acts as a strong mediator between Intra organizational Green activities and performance outcomes. The relationship of Reverse Logistics influencing outcomes is significantly mediated by Competitiveness. The pressure originating from customers exert significant positive influence on the firm to adopt Green Practices consequently leading to higher outcomes. Research Contribution/Originality: Underpinning the Resource dependence theory and as a first wave of investigating the impact of Green Supply chain on performance outcomes in Pakistan, this study intends to make a prominent mark in the field of research. Investment and Competitiveness together are tested as a mediator for the first time in this arena. Managerial implications: Practitioner is provided with a framework for assessing the synergistic impact of GrSCM practices on performance. Upgradation of Accreditations and Audit Programs on regular basis are the need of the hour. Making the processes leaner with the sale of excess inventories and scrap helps the firm to work more efficiently and productively.

Keywords: economic performance, environmental performance, green supply chain management practices, operational performance, sustainability, a textile sector of Pakistan

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Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Radhika Ralhan

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With the formalization of 2030, Global Agenda for Sustainable Development nations have instantaneously geared up their efforts towards the implementation of a comprehensive list of global goals. The criticality of Sustainable Development Goals (SDGs) is imperative, as it will define the course and pace of development for the next 15 years. This development will entail transformational shifts towards a green and inclusive growth. Leadership, investments and technology will constitute as key ingredients of this transformational shift and governance will emerge as a one of the most significant driver of the global 2030 agenda. Corporate Governance is viewed as one of the key force to accelerate the momentum of SDGs and initiate these transformational shifts. Many senior level leaders have reinstated their conviction that adopting a triple bottom line approach will play an imperative role in transforming the entire industrial sector. In the Indian context, the above occurrence bears an intriguing facet, as the framing of SDGs in the global scenario coincided with the emergence of mandatory Corporate Social Responsibility (CSR) Rules in India at national level. As one of the leading democracies in the world, India is among few countries to formally mandate companies to spend 2% from their CSR funds under Section 135 of The New Companies Act 2013. The overarching framework of SDGs correlates to the areas of CSR interventions as mentioned in the Schedule VII of Section 135. As one of the legitimate stakeholders, business leaders have expressed their commitments to their respective governments, to reorient the entire fabric of their companies to scale up global priorities. This is explicitly seen in the case of India where leading business entities have converged national government priorities of Clean India, Make in India and Skill India by actively participating in the campaigns and incorporating these programmes within the ambit of their CSR policies. However, the CSR Act has received mixed responses with associated concerns such as the onus of doing what the government has to do, mandatory reporting mechanisms, policy disclosures, personnel handling CSR portfolios etc. The overall objective of the paper, therefore, rests in analyzing the discourse of CSR and the perspectives of Indian Inc. in imbibing the principles of SDGs within their business polices and operations. Through primary and secondary research analysis, the paper attempts to outline the diverse challenges that are being faced by Indian businesses while establishing the business case of sustainable responsibility. Some of the principal questions that paper addresses are: What are the SDG priorities for India Inc. as per their respective industry sectors? How can corporate policies imbibe the SDGs principles? How can the global concerns in form of SDGs align with the national CSR mandate and development issues? What initiatives have been undertaken by the companies to integrate their long term business strategy and sustainability? The paper will also reinstate an approach or a way forward that will enable businesses to proceed beyond compliance and accentuate the principles of responsibility and transparency within their operational framework.

Keywords: corporate social responsibility, CSR, India Inc., section 135, new companies act 2013, sustainable development goals, SDGs, sustainability, corporate governance

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Authors: Kiran Baldavoo, Mishelle Doorasamy

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Universities have a role to play in the preservation of the environment, and the study attempted to evaluate the environmental management accounting (EMA) processes at UKZN. UKZN, a South African university, generates the same direct and indirect environmental impacts as the higher education sector worldwide. This is significant within the context of the South African environment which is constantly plagued by having to effectively manage the already scarce resources of water and energy, evident through the imposition of water and energy restrictions over the recent years. The study’s aim is to increase awareness of having a structured approach to environmental management in order to achieve the strategic environmental goals of the university. The research studied the experiences of key managers within UKZN, with the purpose of exploring the potential factors which influence the decision to adopt and apply EMA within the higher education sector. The study comprised two objectives, namely understanding the current state of accounting practices for managing major environmental costs and identifying factors influencing EMA adoption within the university. The study adopted a case study approach, comprising semi-structured interviews of key personnel involved in Management Accounting, Environmental Management, and Academic Schools within the university. Content analysis was performed on the transcribed interview data. A Theoretical Framework derived from literature was adopted to guide data collection and focus the study. Contingency and Institutional theory was the resultant basis of the derived framework. The findings of the first objective revealed that there was a distinct lack of EMA utilization within the university. There was no distinct policy on EMA, resulting in minimal environmental cost information being brought to the attention of senior management. The university embraced the principles of environmental sustainability; however, efforts to improve internal environmental accountability primarily from an accounting perspective was absent. The findings of the second objective revealed that five key barriers contributed to the lack of EMA utilization within the university. The barriers being attitudinal, informational, institutional, technological, and lack of incentives (financial). The results and findings of this study supported the use and application of EMA within the higher education sector. Participants concurred that EMA was underutilized and if implemented, would realize significant benefits for both the university and environment. Environmental management accounting is being widely acknowledged as a key management tool that can facilitate improved financial and environmental performance via the concept of enhanced environmental accountability. Historically research has been concentrated primarily on the manufacturing industry, due to it generating the greatest proportion of environmental impacts. Service industries are also an integral component of environmental management as they contribute significant environmental impacts, both direct and indirect. Educational institutions such as universities form part of the service sector and directly impact on the environment through the consumption of paper, energy, and water and solid waste generated, with the associated demands.

Keywords: environmental management accounting, environmental impacts, higher education, Southern Africa

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Authors: Alan Walsh, Peter Walker

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Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

Keywords: western consultants in megaprojects, national culture impacts on GCC megaprojects, significant risk factors in megaprojects, professional culture in megaprojects

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Authors: Zhuang Ma, Zihan Zhang, Yu Li

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Environmental concerns from stakeholders (e.g., governments & customers) have pushed firms to integrate environmental management systems into business processes such as R&D, manufacturing, and marketing. Environmental systems include managing environmental risks and pollution control (e.g., air pollution control, waste-water treatment, noise control, energy recycling & solid waste treatment) through raw material management, the elimination and reduction of contaminants, recycling, and reuse in firms' operational processes. Despite increasing studies on firms' proactive adoption of environmental management, their focus is primarily on large corporations operating in developed economies. Investigations in the environmental management efforts of small and medium-sized enterprises (SMEs) are scarce. This is problematic for SMEs because, unlike large corporations, SMEs have limited awareness, resources, capabilities to adapt their operational routines to address environmental impacts. The purpose of this study is to explore how SMEs develop organizational capabilities through interactions with business partners (e.g., environmental management specialists & customers). Drawing on the resource-based view (RBV) and an organizational capabilities perspective, this study investigates the interactively developed capabilities that allow SMEs to adopt environmental management systems. Using an exploratory approach, the study includes 12 semi-structured interviews with senior managers from four SMEs, two environmental management specialists, and two customers in the pharmaceutical sector in Chongqing, China. Findings of this study include four key organizational capabilities: 1) ‘dynamic marketing’ capability, which allows SMEs to recoup the investments in environmental management systems by developing environmentally friendly products to address customers' ever-changing needs; 2) ‘process improvement’ capability, which allows SMEs to select and adopt the latest technologies from biology, chemistry, new material, and new energy sectors into the production system for improved environmental performance and cost-reductions; and 3) ‘relationship management’ capability which allows SMEs to improve corporate image among the public, social media, government agencies, and customers, who in turn help SMEs to overcome their competitive disadvantages. These interactively developed capabilities help SMEs to address larger competitors' foothold in the local market, reduce market constraints, and exploit competitive advantages in other regions (e.g., Guangdong & Jiangsu) of China. These findings extend the RBV and organizational capabilities perspective; that is, SMEs can develop the essential resources and capabilities required for environmental management through interactions with upstream and downstream business partners. While a limited number of studies did highlight the importance of interactions among SMEs, customers, suppliers, NGOs, industrial associations, and consulting firms, they failed to explore the specific capabilities developed through these interactions. Additionally, the findings can explain how a proactive adoption of environmental management systems could help some SMEs to overcome the institutional and market restraints on their products, thereby springboarding into larger, more environmentally demanding, yet more profitable markets compared with their existing market.

Keywords: capabilities, environmental management systems, interactions, SMEs

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Authors: Fouzia Khanam, Belal Hossain, Kaosar Afsana, Mahfuzar Rahman

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Aim: Although cardiovascular diseases (CVD) has already been recognized as a major cause of death in developed countries, its prevalence is rising in developing countries as well, and engendering a challenge for the health sector. Bangladesh has experienced an epidemiological transition from communicable to non-communicable diseases over the last few decades. So, the rising prevalence of CVD and its risk factors are imposing a major problem for the country. We aimed to examine the prevalence of CVDs and socioeconomic and lifestyle factors related to it from a population-based survey. Methods: The data used for this study were collected as a part of a large-scale cross-sectional study conducted to explore the overall health status of children, mothers and senior citizens of Bangladesh. Multistage cluster random sampling procedure was applied by considering unions as clusters and households as the primary sampling unit to select a total of 11,428 households for the base survey. Present analysis encompassed 12338 respondents of ≥ 35 years, selected from both rural areas and urban slums of the country. Socio-economic, demographic and lifestyle information were obtained through individual by a face-to-face interview which was noted in ODK platform. And height, weight, blood pressure and glycosuria were measured using standardized methods. Chi-square test, Univariate modified Poisson regression model, and multivariate modified Poisson regression model were done using STATA software (version 13.0) for analysis. Results: Overall, the prevalence of CVD was 4.51%, of which 1.78% had stroke and 3.17% suffered from heart diseases. Male had higher prevalence of stroke (2.20%) than their counterparts (1.37%). Notably, thirty percent of respondents had high blood pressure and 5% population had diabetes and more than half of the population was pre-hypertensive. Additionally, 20% were overweight, 77% were smoker or consumed smokeless tobacco and 28% of respondents were physically inactive. Eighty-two percent of respondents took extra salt while eating and 29% of respondents had deprived sleep. Furthermore, the prevalence of risk factor of CVD varied according to gender. Women had a higher prevalence of overweight, obesity and diabetes. Women were also less physically active compared to men and took more extra salt. Smoking was lower in women compared to men. Moreover, women slept less compared to their counterpart. After adjusting confounders in modified Poisson regression model, age, gender, occupation, wealth quintile, BMI, extra salt intake, daily sleep, tiredness, diabetes, and hypertension remained as risk factors for CVD. Conclusion: The prevalence of CVD is significant in Bangladesh, and there is an evidence of rising trend for its risk factors such as hypertension, diabetes especially in older population, women and high-income groups. Therefore, in this current epidemiological transition, immediate public health intervention is warranted to address the overwhelming CVD risk.

Keywords: cardiovascular diseases, diabetes, hypertension, stroke

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa, Annabella Habinka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to a lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. We aimed at; i) increase awareness and understanding of teledermatology among prison health workers and ii) improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons. Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prison staff with AD. We conducted five days of training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient-Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: We have the very first iconographic atlas of the main dermatoses in pigmented African skin. We increased; i) the proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80%; ii) the proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year; iii) increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year and iv)Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year. Our study contributes to the use, evaluation, and verification of the use of teledermatology to increase access to specialist dermatology services to the most hard to reach areas and vulnerable populations such as that of prisoners.

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: Saneeya Qureshi

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This paper reports doctoral research into the impact of Special Educational Needs Coordinators (SENCOs) on teachers in England, UK. Since 1994, it has been compulsory for all mainstream schools in the UK to have a SENCO who co-ordinates assessment and provision for supporting pupils with Special Educational Needs (SEN), helping teachers to develop and implement optimal SEN planning and resources. SENCOs’ roles have evolved as various policies continually redefined SEN provision, impacting their positioning within the school hierarchical structure. SENCOs in England are increasingly recognised as key members of school senior management teams. In this paper, It will be argued that despite issues around the transformative ‘professionalisation’ of their role, and subsequent conflict around boundaries and power relations, SENCOs enhance teachers’ abilities in terms of delivering optimal SEN provision. There is a significant international dimension to the issue: a similar role in respect of SEN management already exists in countries such as Ireland, Finland and Singapore, whilst in other countries, such as Italy and India, the introduction of a role similar to that of a SENCO is currently under discussion. The research question addressed is: do SENCOs enhance teachers’ abilities to be effective teachers of children with Special Educational Needs? The theoretical framework of the project is that of interpretivism, as it is acknowledged that there are contexts and realities are social constructions. The study applied a mixed method approach consisting of two phases. The first phase involved a purposive survey (n=42) of 223 primary school SENCOs, which enabled a deeper insight into SENCOs’ perceptions of their roles in relation to teachers. The second phase consisted of semi-structured interviews (n=36) of SENCOs, teachers and head teachers, in addition to school SEN-related documentation scrutiny. ‘Trustworthiness’ was accomplished through data and methodological triangulation, in addition to a rigorous process of coding and thematic analysis. The research was informed by an Ethical Code as per national guidelines. Research findings point to the evolutionary aspect of the SENCO role having engendered a culture of expectations amongst practitioners, as SENCOs transition from being ‘fixers’ to being ‘enablers’ of teachers. Outcomes indicate that SENCOs can empower teaching staff through the dissemination of specialist knowledge. However, there must be resources clearly identified for such dissemination to take place. It is imperative that both SENCOs and teachers alike address the issue of absolution of responsibility that arises when the ownership and accountability for the planning and implementation of SEN provision are not clarified so as to ensure the promotion of a positive school ethos around inclusive practices. Optimal outcomes through effective SEN interventions and teaching practices are positively correlated with the inclusion of teachers in the planning and execution of SEN provisions. An international audience can consider how the key findings are being manifest in a global context, with reference to their own educational settings. Research outcomes can aid the development of specific competencies needed to shape optimal inclusive educational settings in accordance with the official global priorities pertaining to inclusion.

Keywords: inclusion, school professionals, school leadership, special educational needs (SEN), special educational needs coordinators (SENCOs)

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Authors: Ebtehal Qulisy, Geoffrey Dougherty, Kholoud Hothan, Mylene Dandavino

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Background: For more than 200 years, journal clubs (JCs) have been used to teach the fundamentals of critical appraisal and evidence-based practice (EBP). However, JCs curricula face important challenges, including poor sustainability, insufficient time to prepare for and conduct the activities, and lack of trainee skills and self-efficacy with critical appraisal. Andragogy principles and modern technology could help EBP be taught in more relevant, modern, and interactive ways. Method: We propose a fresh educational activity to teach EBP. Educational sessions are designed to encourage collaborative and experiential learning and do not require advanced preparation by the participants. Each session lasts 60 minutes and is adaptable to in-person, virtual, or hybrid contexts. Sessions are structured around a worksheet and include three educational objectives: “1. Identify a Clinical Conundrum”, “2. Compare and Contrast Current Guidelines”, and “3. Choose a Recent Journal Article”. Sessions begin with a short presentation by a facilitator of a clinical scenario highlighting a “grey-zone” in pediatrics. Trainees are placed in groups of two to four (based on the participants’ number) of varied training levels. The first task requires the identification of a clinical conundrum (a situation where there is no clear answer but only a reasonable solution) related to the scenario. For the second task, trainees must identify two or three clinical guidelines. The last task requires trainees to find a journal article published in the last year that reports an update regarding the scenario’s topic. Participants are allowed to use their electronic devices throughout the session. Our university provides full-text access to major journals, which facilitated this exercise. Results: Participants were a convenience sample of trainees in the inpatient services at the Montréal Children’s Hospital, McGill University. Sessions were conducted as a part of an existing weekly academic activity and facilitated by pediatricians with experience in critical appraisal. There were 28 participants in 4 sessions held during Spring 2022. Time was allocated at the end of each session to collect participants’ feedback via a self-administered online survey. There were 22 responses, were 41%(n=9) pediatric residents, 22.7%(n=5) family medicine residents, 31.8%(n=7) medical students, and 4.5%(n=1) nurse practitioner. Four respondents participated in more than one session. The “Satisfied” rates were 94.7% for session format, 100% for topic selection, 89.5% for time allocation, and 84.3% for worksheet structure. 60% of participants felt that including the sessions during the clinical ward rotation was “Feasible.” As per self-efficacy, participants reported being “Confident” for the tasks as follows: 89.5% for the ability to identify a relevant conundrum, 94.8% for the compare and contrast task, and 84.2% for the identification of a published update. The perceived effectiveness to learn EBP was reported as “Agreed” by all participants. All participants would recommend this session for further teaching. Conclusion: We developed a modern approach to teach EBP, enjoyed by all levels of participants, who also felt it was a useful learning experience. Our approach addresses known JCs challenges by being relevant to clinical care, fostering active engagement but not requiring any preparation, using available technology, and being adaptable to hybrid contexts.

Keywords: medical education, journal clubs, post-graduate teaching, andragogy, experiential learning, evidence-based practice

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Authors: Nick Toossi, Joseph Hartland

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Background: Malawi is an example of a low resource setting which faces a chronic shortage of doctors and other medical staff. This shortfall is made up for by clinical officers (COs), who are para-medicals trained for 4 years. The literature suggests to improve outcomes surgical skills training specifically should be promoted for COs in district and mission hospitals. Accordingly, the primary author was tasked with developing a basic surgical skills teaching package for COs of Mulanje Mission Hospital (MMH), Malawi, as part of a 4th year medical student External Student Selected Component field trip. MMH is a hospital based in the South of Malawi near the base of Mulanje Mountain and works in an extremely isolated environment with some of the poorest communities in the country. Traveling to Malawi the medical student author performed an educational needs assessment to develop and deliver a bespoke basic surgical skills teaching package. Methodology: An initial needs assessment identified the following domains: basic surgical skills (instrument naming & handling, knot tying, suturing principles and suturing techniques) and perineal repair. Five COs took part in a teaching package involving an interactive group simulation session, overseen by senior clinical officers and surgical trainees from the UK. Non-organic and animal models were used for simulation practice. This included the use of surgical skills boards to practice knot tying and ox tongue to simulate perineal repair. All participants spoke and read English. The impact of the session was analysed in two different ways. The first was via a pre and post Single Best Answer test and the second a questionnaire including likert’s scales and free text response questions. Results: There was a positive trend in pre and post test scores on competition of the course. There was increase in the mean confidence of learners before and after the delivery of teaching in basic surgical skills and simulated perineal repair, especially in ‘instrument naming and handling’. Whilst positively received it was discovered that learners desire more frequent surgical skills teaching sessions in order to improve and revise skills. Feedback suggests that the learners were not confident in retaining the skills without regular input. Discussion: Skills and confidence were improved as a result of the teaching provided. Learner's written feedback suggested there was an overall appetite for regular surgical skills teaching in the clinical environment and further opportunities to allow for deliberate self-practice. Surgical mentorship schemes facilitating supervised theatre time among trainees and lead surgeons along with improving access to surgical models/textbooks were some of the simple suggestions to improve surgical skills and confidence among COs. Although, this study is limited by population size it is reflective of the small, isolated and low resource environment in which this healthcare is delivered. This project does suggest that current surgical skills packages used in the UK could be adapted for employment in low resource settings, but it is consistency and sustainability that staff seek above all in their on-going education.

Keywords: clinical officers, education, Malawi, surgical skills

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Authors: Jo Mitchell, Daniel Johnson

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MindMax is a digital community and learning platform built to maximise the wellbeing and resilience of AFL Players and Australian men. The MindMax application engages men, via their existing connection with sport and video games, in a range of wellbeing ideas, stories and actions, because we believe fit minds, kick goals. MindMax is an AFL Players Association led project, supported by a Movember Foundation grant, to improve the mental health of Australian males aged between 16-35 years. The key engagement and delivery strategy for the project was digital technology, sport (AFL) and video games, underpinned by evidenced based wellbeing science. The project commenced April 2015, and the expected completion date is March 2017. This paper describes the conceptual model underpinning product development, including progress, key learnings and challenges, as well as the research agenda. Evaluation of the MindMax project is a multi-pronged approach of qualitative and quantitative methods, including participatory design workshops, online reference groups, longitudinal survey methods, a naturalistic efficacy trial and evaluation of the social and economic return on investment. MindMax is focused on the wellness pathway and maximising our mind's capacity for fitness by sharing and promoting evidence-based actions that support this. A range of these ideas (from ACT, mindfulness and positive psychology) are already being implemented in AFL programs and services, mostly in face-to-face formats, with strong engagement by players. Player's experience features strongly as part of the product content. Wellbeing science is a discipline of psychology that explores what helps individuals and communities to flourish in life. Rather than ask questions about illness and poor functioning, wellbeing scientists and practitioners ask questions about wellness and optimal functioning. While illness and wellness are related, they operate as separate constructs and as such can be influenced through different pathways. The essential idea was to take the evidence-based wellbeing science around building psychological fitness to the places and spaces that men already frequent, namely sport and video games. There are 800 current senior AFL players, 5000+ past players, and 11 million boys and men that are interested in the lives of AFL Players; what they think and do to be their best both on and off field. AFL Players are also keen video gamers – using games as one way to de-stress, connect and build wellbeing. There are 9.5 million active gamers in Australia with 93% of households having a device for playing games. Video games in MindMax will be used as an engagement and learning tool. Gamers (including AFL players) can also share their personal experience of how games help build their mental fitness. Currently available games (i.e., we are not in the game creation business) will also be used to motivate and connect MindMax participants. The MindMax model is built with replication by other sport codes (e.g., Cricket) in mind. It is intended to not only support our current crop of athletes but also the community that surrounds them, so they can maximise their capacity for health and wellbeing.

Keywords: Australian football league, digital application, positive psychology, wellbeing

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Authors: Siti Rahayu, Khairulniza Mohd Puat, Kesavan R., Mohammad Harris A., Jalila, Kunalan G., Fazir Mohamad

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The greatest challenge has been in establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively for managing wound, where they can continue to build expertise and skills. In addition, there is a growing incidence of chronic wounds and recognition of the complexity involved in caring for these patients. We would like to share 4 cases with different techniques of wound management. 1st case, 39 years old gentleman with underlying rheumatoid arthritis with chronic periprosthetic joint infection of right total knee replacement presented with persistent drainage over right knee. Patient was consulted for two stage revision total knee replacement. However, patient only agreed for debridement and retention of implant. After debridement, large medial and lateral wound was treated with Instillation Negative Pressure Wound Therapy Dressings. After several cycle, the wound size reduced, and conventional dressing was applied. 2nd case, 58 years old gentleman with underlying diabetes presented with right foot necrotizing fasciitis with gangrene of 5th toe. He underwent extensive debridement of foot with rays’ amputation of 5th toe. Post debridement patient was started on Instillation Negative Pressure Wound Therapy Dressings. After several cycle of VAC, the wound bed was prepared, and he underwent split skin graft over right foot. 3 rd case, 60 years old gentleman with underlying diabetes mellitus presented with right foot necrotizing soft tissue infection. He underwent rays’ amputation and extensive wound debridement. Upon stabilization of general condition, patient was discharge with regular wound dressing by same nurse and doctor during each visit to clinic follow up. After 6 months of follow up, the wound healed well. 4th case, 38-year-old gentleman had alleged motor vehicle accident and sustained closed fracture right tibial plateau. Open reduction and proximal tibial locking plate were done. At 2 weeks post-surgery, the patient presented with warm, erythematous leg and pus discharge from the surgical site. Empirical antibiotic was started, and wound debridement was done. Intraoperatively, 50cc pus was evacuated, unhealthy muscle and tissue debrided. No loosening of the implant. Patient underwent multiple wound debridement. At 2 weeks post debridement wound healed well, but the proximal aspect was unable to close immediately. This left the proximal part of the implant to be exposed. Patient was then put on VAC dressing for 3 weeks until healthy granulation tissue closes the implant. Meanwhile, antibiotic was change according to culture and sensitivity. At 6 weeks post the first debridement, the wound was completely close, and patient was discharge home well. At 3 months post operatively, patient wound and fracture healed uneventfully and able to ambulate independently. Complex wounds are too serious to be dealt with. Team managing complex wound need continuous support through the provision of educational tools to support their professional development, engagement with local and international expert, as well as highquality products that increase efficiencies in services

Keywords: VAC (Vacuum Assisted Closure), empirical- initial antibiotics, NPWT- negative pressure wound therapy, NF- necrotizing fasciitis, gangrene- blackish discoloration due to poor blood supply

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Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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Authors: Lourenco Camnahas, Eileen Willis, Greg Fisher, Jessie Gunson, Pascale Dettwiller, Charlene Thornton

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Stock-out of pharmaceuticals is a common issue at all level of health services in Timor-Leste, a small post-conflict country. This lead to the research questions: what are the current methods used to quantify pharmaceutical supplies; what factors contribute to the on-going pharmaceutical stock-out? The study examined factors that influence the pharmaceutical supply chain system. Methodology: Privett and Goncalvez dependency model has been adopted for the design of the qualitative interviews. The model examines pharmaceutical supply chain management at three management levels: management of individual pharmaceutical items, health facilities, and health systems. The interviews were conducted in order to collect information on inventory management, logistics management information system (LMIS) and the provision of pharmaceuticals. Andersen' behavioural model for healthcare utilization also informed the interview schedule, specifically factors linked to environment (healthcare system and external environment) and the population (enabling factors). Forty health professionals (bureaucrats, clinicians) and six senior officers from a United Nations Agency, a global multilateral agency and a local non-governmental organization were interviewed on their perceptions of factors (healthcare system/supply chain and wider environment) impacting on stock out. Additionally, policy documents for the entire healthcare system, along with population data were collected. Findings: An analysis using Pozzebon’s critical interpretation identified a range of difficulties within the system from poor coordination to failure to adhere to policy guidelines along with major difficulties with inventory management, quantification, forecasting, and budgetary constraints. Weak logistics management information system, lack of capacity in inventory management, monitoring and supervision are additional organizational factors that also contributed to the issue. There were various methods of quantification of pharmaceuticals applied in the government sector, and non-governmental organizations. Lack of reliable data is one of the major problems in the pharmaceutical provision. Global Fund has the best quantification methods fed by consumption data and malaria cases. There are other issues that worsen stock-out: political intervention, work ethic and basic infrastructure such as unreliable internet connectivity. Major issues impacting on pharmaceutical quantification have been identified. However, current data collection identified limitations within the Andersen model; specifically, a failure to take account of predictors in the healthcare system and the environment (culture/politics/social. The next step is to (a) compare models used by three non-governmental agencies with the government model; (b) to run the Andersen explanatory model for pharmaceutical expenditure for 2 to 5 drug items used by these three development partners in order to see how it correlates with the present model in terms of quantification and forecasting the needs; (c) to repeat objectives (a) and (b) using the government model; (d) to draw a conclusion about the strength.

Keywords: inventory management, pharmaceutical forecasting and quantification, pharmaceutical stock-out, pharmaceutical supply chain management

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Authors: Michelle Mansfield

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Introduction: This paper uses the work of Deleuze and Guattari to consider the street art practice of youth in the Indonesian city of Yogyakarta, a hub of arts and culture in Central Java. Around the world young people have taken to city streets to populate the new informal exhibition spaces outside the galleries of official art institutions. However, rarely is the focus outside the urban metropolis of the ‘Global North.' This paper looks at these practices in a ‘Global South’ Asian context. Space and place are concepts central to understanding youth cultural expression as it emerges on the streets. Deleuze and Guattari’s notion of assemblage enriches understanding of this complex spatial and creative relationship. Yogyakarta street art combines global patterns and motifs with local meanings, symbolism, and language to express local youth voices that convey a unique sense of place on the world stage. Street art has developed as a global urban youth art movement and is theorised as a way in which marginalised young people reclaim urban space for themselves. Methodologies: This study utilised a variety of qualitative methodologies to collect and analyse data. This project took a multi-method approach to data collection, incorporating the qualitative social research methods of ethnography, nongkrong (deep hanging out), participatory action research, online research, in-depth interviews and focus group discussions. Both interviews and focus groups employed photo-elicitation methodology to stimulate rich data gathering. To analyse collected data, rhizoanalytic approaches incorporating discourse analysis and visual analysis were utilised. Street art practice is a fluid and shifting phenomenon, adding to the complexity of inquiry sites. A qualitative approach to data collection and analysis was the most appropriate way to map the components of the street art assemblage and to draw out complexities of this youth cultural practice in Yogyakarta. Major Findings: The rhizoanalytic approach devised for this study proved a useful way of examining in the street art assemblage. It illustrated the ways in which the street art assemblage is constructed. Especially the interaction of inspiration, materials, creative techniques, audiences, and spaces operate in the creations of artworks. The study also exposed the generational tensions between the senior arts practitioners, the established art world, and the young artists. Conclusion: In summary, within the spatial processes of the city, street art is inextricably linked with its audience, its striving artistic community and everyday life in the smooth rather than the striated worlds of the state and the official art world. In this way, the anarchic rhizomatic art practice of nomadic urban street crews can be described not only as ‘becoming-artist’ but as constituting ‘nomos’, a way of arranging elements which are not dependent on a structured, hierarchical organisation practice. The site, streets, crews, neighbourhood and the passers by can all be examined with the concept of assemblage. The assemblage effectively brings into focus the complexity, dynamism, and flows of desire that is a feature of street art practice by young people in Yogyakarta.

Keywords: assemblage, Indonesia, street art, youth

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Authors: Sithandazile Masuku

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Introduction: Public health approaches to offender mental health are driven by international policies and frameworks in response to the disproportionately large representation of people with mental health problems within the offender pathway compared to the general population. Public health service innovations include mental health courts in the US, restorative models in Singapore and, liaison and diversion services in Australia, the UK, and some other European countries. Mental health nurses are at the forefront of offender health service innovations. In the U.K. context, police custody has been identified as an early point within the offender pathway where nurses can improve outcomes by offering assessments and share information with criminal justice partners. This scope of nursing practice has introduced challenges related to skills and support required for nurses working at the interface of health and the criminal justice system. Parallel literature exploring experiences of nurses working in forensic settings suggests the presence of compassion fatigue, burnout and vicarious trauma that may impede risk harm to the nurses in these settings. Published research explores mainly service-level outcomes including monitoring of figures indicative of a reduction in offending behavior. There is minimal research exploring the experiences of liaison and diversion nurses who are situated away from a supportive clinical environment and engaged in complex autonomous decision-making. Aim: This paper will share qualitative findings (in progress) from a PhD study that aims to explore the experiences of liaison and diversion nurses in one service in the U.K. Methodology: This is a qualitative interview study conducted using an Interpretative Phenomenological Analysis to gain an in-depth analysis of lived experiences. Methods: A purposive sampling technique was used to recruit n=8 mental health nurses registered with the UK professional body, Nursing and Midwifery Council, from one UK Liaison and Diversion service. All participants were interviewed online via video call using semi-structured interview topic guide. Data were recorded and transcribed verbatim. Data were analysed using the seven steps of the Interpretative Phenomenological Analysis data analysis method. Emerging Findings Analysis to date has identified pertinent themes: • Difficulties of meaning-making for nurses because of the complexity of their boundary spanning role. • Emotional burden experienced in a highly emotive and fast-changing environment. • Stress and difficulties with role identity impacting on individual nurses’ ability to be resilient. • Challenges to wellbeing related to a sense of isolation when making complex decisions. Conclusion Emerging findings have highlighted the lived experiences of nurses working in liaison and diversion as challenging. The nature of the custody environment has an impact on role identity and decision making. Nurses left feeling isolated and unsupported are less resilient and may go on to experience compassion fatigue. The findings from this study thus far point to a need to connect nurses working in these boundary spanning roles with a supportive infrastructure where the complexity of their role is acknowledged, and they can be connected with a health agenda. In doing this, the nurses would be protected from harm and the likelihood of sustained positive outcomes for service users is optimised.

Keywords: liaison and diversion, nurse experiences, offender health, staff wellbeing

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Authors: Sun-Hee Lee, Amanda Kraley

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The “MeToo” movement is a social movement against sexual abuse and harassment. Though the hashtag went viral in 2017 following different cultural flashpoints in different countries, the initial response was quiet in South Korea. This radically changed in January 2018, when a high-ranking senior prosecutor, Seo Ji-hyun, gave a televised interview discussing being sexually assaulted by a colleague. Acknowledging public anger, particularly among women, on the long-existing problems of sexual harassment and abuse, the South Korean media have focused on several high-profile cases. Analyzing the media representation of these cases is a window into the evolving South Korean discourse around “MeToo.” This study presents a linguistic analysis of “MeToo” discourse in South Korea by utilizing a corpus-based approach. The term corpus (pl. corpora) is used to refer to electronic language data, that is, any collection of recorded instances of spoken or written language. A “MeToo” corpus has been collected by extracting newspaper articles containing the keyword “MeToo” from BIGKinds, big data analysis, and service and Nexis Uni, an online academic database search engine, to conduct this language analysis. The corpus analysis explores how Korean media represent accusers and the accused, victims and perpetrators. The extracted data includes 5,885 articles from four broadsheet newspapers (Chosun, JoongAng, Hangyore, and Kyunghyang) and 88 articles from two Korea-based English newspapers (Korea Times and Korea Herald) between January 2017 and November 2020. The information includes basic data analysis with respect to keyword frequency and network analysis and adds refined examinations of select corpus samples through naming strategies, semantic relations, and pragmatic properties. Along with the exponential increase of the number of articles containing the keyword “MeToo” from 104 articles in 2017 to 3,546 articles in 2018, the network and keyword analysis highlights ‘US,’ ‘Harvey Weinstein’, and ‘Hollywood,’ as keywords for 2017, with articles in 2018 highlighting ‘Seo Ji-Hyun, ‘politics,’ ‘President Moon,’ ‘An Ui-Jeong, ‘Lee Yoon-taek’ (the names of perpetrators), and ‘(Korean) society.’ This outcome demonstrates the shift of media focus from international affairs to domestic cases. Another crucial finding is that word ‘defamation’ is widely distributed in the “MeToo” corpus. This relates to the South Korean legal system, in which a person who defames another by publicly alleging information detrimental to their reputation—factual or fabricated—is punishable by law (Article 307 of the Criminal Act of Korea). If the defamation occurs on the internet, it is subject to aggravated punishment under the Act on Promotion of Information and Communications Network Utilization and Information Protection. These laws, in particular, have been used against accusers who have publicly come forward in the wake of “MeToo” in South Korea, adding an extra dimension of risk. This corpus analysis of “MeToo” newspaper articles contributes to the analysis of the media representation of the “MeToo” movement and sheds light on the shifting landscape of gender relations in the public sphere in South Korea.

Keywords: corpus linguistics, MeToo, newspapers, South Korea

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Authors: J. S. M. Yang, G. E. T. Chua

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Diploma in Optometry (OPT) course is a three-year program offered by Ngee Ann Polytechnic (NP) to train students to provide primary eye care. Students are equipped with foundational conceptual knowledge and practical skills in the first three semesters before clinical modules in fourth to six semesters. In the clinical modules, students typically have difficulties in integrating the acquired knowledge and skills from the past semesters to perform general eye examinations on public patients at NP Optometry Centre (NPOC). To help the students overcome the challenge, a web-based game Virtual Optometrist (VO) was developed to help students apply their skills and knowledge through scenario-based learning. It consisted of two interfaces, Optical Practice Counter (OPC) and Optometric Consultation Room (OCR), to provide two simulated settings for authentic learning experiences. In OPC, students would recommend and provide appropriate frame and lens selection based on virtual patient’s case history. In OCR, students would diagnose and manage virtual patients with common ocular conditions. Simulated scenarios provided real-world clinical situations that required contextual application of integrated knowledge from relevant modules. The stages in OPC and OCR are of increasing complexity to align to expected students’ clinical competency as they progress to more senior semesters. This prevented gameplay fatigue as VO was used over the semesters to achieve different learning outcomes. Numerous feedback opportunities were provided to students based on their decisions to allow individualized learning to take place. The game-based learning element in VO was achieved through the scoreboard and leader board to enhance students' motivation to perform. Scores were based on the speed and accuracy of students’ responses to the questions posed in the simulated scenarios, preparing the students to perform accurately and effectively under time pressure in a realistic optometric environment. Learning analytics was generated in VO’s backend office based on students’ responses, offering real-time data on distinctive and observable learners’ behavior to monitor students’ engagement and learning progress. The backend office allowed versatility to add, edit, and delete scenarios for different intended learning outcomes. Likert Scale was used to measure students’ learning experience with VO for OPT Year 2 and 3 students. The survey results highlighted the learning benefits of implementing VO in the different modules, such as enhancing recall and reinforcement of clinical knowledge for contextual application to develop higher-order thinking skills, increasing efficiency in clinical decision-making, facilitating learning through immediate feedback and second attempts, providing exposure to common and significant ocular conditions, and training effective communication skills. The results showed that VO has been useful in reinforcing optometry students’ learning and supporting the development of higher-order thinking, increasing efficiency in clinical decision-making, and allowing students to learn from their mistakes with immediate feedback and second attempts. VO also exposed the students to diverse ocular conditions through simulated real-world clinical scenarios, which may otherwise not be encountered in NPOC, and promoted effective communication skills.

Keywords: authentic learning, game-based learning, scenario-based learning, simulated clinical scenarios

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Authors: O. O. Oku, K. S. Jerry-Alagbaoso

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It is universally acknowledged that the primary function of universities is the generation and dissemination of knowledge. This mission is pursued through the research component of the university programme especially at the post-graduate level. The senior academic staff teach, supervise and provide general academic leadership to post-graduate students who are expected to carry out research leading to the presentation of dissertation as requirement for the award of doctoral degree in their various disciplines. Carrying out the research enterprises involves a lot of corroboration among individuals and communities. The need to safeguard the interest of everyone involved in the enterprise makes the development of ethical standard in research imperative. Ensuring the development and effective application of such ethical standard falls within the leadership role of the vice –chancellors, Deans of post-graduate schools/ faculties, Heads of Departments and supervisors. It is the relevance and application of such ethical standard in Nigerian university research efforts that this study discussed. The study adopted the descriptive research design. A researcher-made 4 point rating scale was used to elicit information from the post-graduate dissertation supervisors sampled from one university each from the six geo-political zones in Nigeria using the purposive sampling technique. The data collected was analysed using the mean score and standard deviation. The findings of the study include among others that there are several cases of unethical practices by Ph.D dissertation students in Nigerian universities. Prominent among these include duplicating research topics, making unauthorized copies of data paper or computer programme, failing to acknowledge contributions of relevant people and authors, rigging an experiment to prempt the result among others. Some of the causes of the unethical practices according to the respondents include inadequate funding of universities resulting in inadequate remuneration for university teachers, inadequacy of equipment and infrastructures, poor supervision of Ph.D students,’ poverty on the side of the student researchers and non-application of sanctions on violators. Improved funding of the Nigerian universities system with emphasis on both staff and student research efforts, admitting academic oriented students into the Ph.D programme and ensuring the application of appropriate sanctions in cases of unethical conduct in research featured prominently in the needed leadership imperatives. Based on the findings of the study, the researchers recommend the development of university research policies that is closely tied to each university’s strategic plan. Such plan should explain the research focus that will attract more funding and direct students interest towards it without violating the principle of academic freedom. The plan should also incorporate the establishment of a research administration office to provide the necessary link between the students and funding agencies and also organise training for supervisors on leadership activities expected of them while educating students on the processes involved in carrying out a qualitative and acceptable research study. Such exercise should include the ethical principles and guidelines that comprise all parts of research from research topic through the literature review to the design and the truthful reporting of results.

Keywords: academic leadership, ethical standards, research stakeholders, research enterprise

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Authors: Sanaz Moayer, Fang Huang, Scott Gardner

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In the highly leveraged business world of today, an organisation’s success depends on how it can manage and organize its traditional and intangible assets. In the knowledge-based economy, knowledge as a valuable asset gives enduring capability to firms competing in rapidly shifting global markets. It can be argued that ability to create unique knowledge assets by configuring ICT and human capabilities, will be a defining factor for international competitive advantage in the mid-21st century. The concept of KM is recognized in the strategy literature, and increasingly by senior decision-makers (particularly in large firms which can achieve scalable benefits), as an important vehicle for stimulating innovation and organisational performance in the knowledge economy. This thinking has been evident in professional services and other knowledge intensive industries for over a decade. It highlights the importance of social capital and the value of the intellectual capital embedded in social and professional networks, complementing the traditional focus on creation of intellectual property assets. Despite the growing interest in KM within professional services there has been limited discussion in relation to multinational resource based industries such as mining and petroleum where the focus has been principally on global portfolio optimization with economies of scale, process efficiencies and cost reduction. The Australian minerals and metals mining industry, although traditionally viewed as capital intensive, employs a significant number of knowledge workers notably- engineers, geologists, highly skilled technicians, legal, finance, accounting, ICT and contracts specialists working in projects or functions, representing potential knowledge silos within the organisation. This silo effect arguably inhibits knowledge sharing and retention by disaggregating corporate memory, with increased operational and project continuity risk. It also may limit the potential for process, product, and service innovation. In this paper the strategic application of knowledge management incorporating contemporary ICT platforms and data mining practices is explored as an important enabler for knowledge discovery, reduction of risk, and retention of corporate knowledge in resource based industries. With reference to the relevant strategy, management, and information systems literature, this paper highlights possible connections (currently undergoing empirical testing), between an Strategic Knowledge Management (SKM) framework incorporating supportive Data Mining (DM) practices and competitive advantage for multinational firms operating within the Australian resource sector. We also propose based on a review of the relevant literature that more effective management of soft and hard systems knowledge is crucial for major Australian firms in all sectors seeking to improve organisational performance through the human and technological capability captured in organisational networks.

Keywords: competitive advantage, data mining, mining organisation, strategic knowledge management

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Authors: Jessica Kate Simonds

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The last successful hijacking perpetrated by Somali pirates in 2012 represented a critical turning point for the identity and brand of Indian Ocean (IO) insecurity, coined in this paper as the era of the post-piratical. This paper explores the broadening of the PMSC business model to account and contribute to the design of a new IO security environment that prioritises foreign and insurgency drone activity and Houthi rebel operations as the main threat to merchant shipping in the post-2012 era. This study is situated within a longer history of analysing maritime insecurity and also contributes a bespoke conceptual framework that understands the sea as a space that is produced and reproduced relative to existing and emerging threats to merchant shipping based on bespoke models of information sharing and intelligence acquisition. This paper also makes a prominent empirical contribution by drawing on a post-positivist methodology, data drawn from original semi-structured interviews with senior maritime insurers and active merchant seafarers that is triangulated with industry-produced guidance such as the BMP series as primary data sources. Each set is analysed through qualitative discourse and content analysis and supported by the quantitative data sets provided by the IMB Piracy Reporting center and intelligence networks. This analysis reveals that mechanisms such as the IGP&I Maritime Security Committee and intelligence divisions of PMSC’s have driven the exchanges of knowledge between land and sea and thus the reproduction of the maritime security environment through new regulations and guidance to account dones, rebels and bombs as the key challenges in the IO, beyond piracy. A contribution of this paper is the argument that experts who may not be in the highest-profile jobs are the architects of maritime insecurity based on their detailed knowledge and connections to vessels in transit. This paper shares the original insights of those who have served in critical decision making spaces to demonstrate that the development and refinement of industry produced deterrence guidance that has been accredited to the mitigation of piracy, have shaped new editions such as BMP 5 that now serve to frame a new security environment that prioritises the mitigation of risks from drones and WBEID’s from both state and insurgency risk groups. By highlighting the experiences and perspectives of key players on both land and at sea, the key finding of this paper is outlining that as pirates experienced a financial boom by profiteering from their bespoke business model during the peak of successful hijackings, the private security market encountered a similar level of financial success and guaranteed risk environment in which to prospect business. Thus, the reproduction of the Indian Ocean as a maritime security environment reflects a new found purpose for PMSC’s as part of the broader conglomerate of maritime insurers, regulators, shipowners and managers who continue to redirect the security consciousness and IO brand of insecurity.

Keywords: maritime security, private security, risk intelligence, political geography, international relations, political economy, maritime law, security studies

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Authors: Marie-Helena Docherty, Sion Edryd Williams

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The prevalence of diabetes mellitus is increasing worldwide. In Sub-Saharan Africa, type 2 diabetes represents over 90% of all types of diabetes with the number of diabetic patients expected to rise. This represents a huge economic burden in an area already contending with high rates of other significant diseases, including the highest worldwide prevalence of HIV. Diabetic complications considerably impact on morbidity and mortality. The epidemiological data for the region quotes high rates of retinopathy (7-63%), neuropathy (27-66%) and microalbuminuria (10-83%). It is therefore imperative that diabetic screening programmes are established. It is recognised that in many parts of the developing world the implementation and management of such programmes is limited by a lack of available resources. The International Diabetes Federation produced guidelines in 2012 taking these limitations into account suggesting that all diabetic patients should have access to basic screening. These guidelines are consistent with the national diabetic guidelines produced by the Lesotho Medical Council. However, diabetic care in Lesotho is delivered at the local level, with variable levels of quality. A cross sectional study was performed in the outpatient department of Maluti Hospital in Mapoteng, Lesotho, a busy rural hospital in the Berea district. Demographic data on gender, age and modality of treatment were collected over a six-week time period. Information regarding 3 basic screening parameters was obtained. These parameters included eye screening (defined as a documented ophthalmology review within the last 12 months), foot screening (defined as a documented foot health assessment by any health care professional within the last 12 months) and secondary prevention (defined as a documented blood pressure and lipid profile reading within the last 12 months). These parameters were selected on the basis of the absolute minimum level of resources in Maluti Hospital. Renal screening was excluded, as the hospital does not have access to reliable renal profile checks or urinalysis. There is however a fully functioning on-site ophthalmology department run by a senior ophthalmologist with the ability to provide retinal photography, retinal surgery and photocoagulation therapy. Data was collected on 183 type 2 diabetics. 112 patients were male and 71 were female. The average age was 43 years. 4 patients were diet controlled, 140 patients were on oral hypoglycaemic agents (metformin and/or glibenclamide), and 39 patients were on a combination of insulin and oral hypoglycaemics. In the preceding 12 months, 5 patients had undergone eye screening (3%), 24 patients had undergone foot screening (13%), and 31 patients had lipid profile testing (17%). All patients had a documented blood pressure reading (100%). Our results show that screening is poorly performed in the basic indicators suggested by the IDF and the Lesotho Medical Council. On the basis of these results, a screening programme was developed using the mnemonic SaFE; secondary prevention, foot and eye care. This is simple, memorable and transferable between healthcare professionals. In the future, the expectation would be to expand upon this current programme to include renal screening, and to further develop screening pertaining to secondary prevention.

Keywords: Africa, complications, rural, screening

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Authors: Yael Rieder, Yael Gilboa, S. O. Adva, Efrat Halevi, Ronnie Tepper

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Background: Operation of ultrasound equipment is a core skill for many clinical specialties. As part of the training program at -Simultech- a simulation center for Ob\Gyn at the Meir Medical Center, Israel, teaching how to operate ultrasound equipment requires dealing with misunderstandings of spatial and 3D orientation, failure of the operator to hold a transducer correctly, and limited ability to evaluate the data on the screen. We have developed a platform intended to endow physicians and sonographers with clinical and operational skills of obstetric ultrasound. Simultech's simulations are focused on medical knowledge, risk management, technology operations and physician-patient communication. The simulations encompass extreme work conditions. Setup: Between eight and ten of the eight hundred and fifty physicians and sonographers of the Clalit health services from seven hospitals and eight community centers across Israel, participate in individual Ob/Gyn training sessions each week. These include Ob/Gyn specialists, experts, interns, and sonographers. Innovative teaching and training methodologies: The six-hour training program includes: (1) An educational computer program that challenges trainees to deal with medical questions based upon ultrasound pictures and films. (2) Sophisticated hands-on simulators that challenge the trainees to practice correct grip of the transducer, elucidate pathology, and practice daily tasks such as biometric measurements and analysis of sonographic data. (3) Participation in a video-taped simulation which focuses on physician-patient communications. In the simulation, the physician is required to diagnose the clinical condition of a hired actress based on the data she provides and by evaluating the assigned ultrasound films accordingly. Giving ‘bad news’ to the patient may put the physician in a stressful situation that must be properly managed. (4) Feedback at the end of each phase is provided by a designated trainer, not a physician, who is specially qualified by Ob\Gyn senior specialists. (5) A group exercise in which the trainer presents a medico-legal case in order to encourage the participants to use their own experience and knowledge to conduct a productive ‘brainstorming’ session. Medical cases are presented and analyzed by the participants together with the trainer's feedback. Findings: (1) The training methods and content that Simultech provides allows trainees to review their medical and communications skills. (2) Simultech training sessions expose physicians to both basic and new, up-to-date cases, refreshing and expanding the trainee's knowledge. (3) Practicing on advanced simulators enables trainees to understand the sonographic space and to implement the basic principles of ultrasound. (4) Communications simulations were found to be beneficial for trainees who were unaware of their interpersonal skills. The trainer feedback, supported by the recorded simulation, allows the trainee to draw conclusions about his performance. Conclusion: Simultech was found to contribute to physicians at all levels of clinical expertise who deal with ultrasound. A break in daily routine together with attendance at a neutral educational center can vastly improve performance and outlook.

Keywords: medical training, simulations, ultrasound, Simultech

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Authors: Lauren B. Birney

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The BOP-CCERS (Billion Oyster Project- Curriculum and Community Enterprise for Restoration Science) Near-Peer Mentoring Program provides the long-term (five-year) support network to motivate and guide students toward restoration science-based CTE pathways. Students are selected from middle schools with actively participating BOP-CCERS teachers. Teachers will nominate students from grades 6-8 to join cohorts of between 10 and 15 students each. Cohorts are comprised primarily of students from the same school in order to facilitate mentors' travel logistics as well as to sustain connections with students and their families. Each cohort is matched with an exceptional undergraduate or graduate student, either a BOP research associate or STEM mentor recruited from collaborating City University of New York (CUNY) partner programs. In rare cases, an exceptional high school junior or senior may be matched with a cohort in addition to a research associate or graduate student. In no case is a high school student or minor be placed individually with a cohort. Mentors meet with students at least once per month and provide at least one offsite field visit per month, either to a local STEM Hub or research lab. Keeping with its five-year trajectory, the near-peer mentoring program will seek to retain students in the same cohort with the same mentor for the full duration of middle school and for at least two additional years of high school. Upon reaching the final quarter of 8th grade, the mentor will develop a meeting plan for each individual mentee. The mentee and the mentor will be required to meet individually or in small groups once per month. Once per quarter, individual meetings will be substituted for full cohort professional outings. The mentor will organize the entire cohort on a field visit or educational workshop with a museum or aquarium partner. In addition to the mentor-mentee relationship, each participating student will also be asked to conduct and present his or her own BOP field research. This research is ideally carried out with the support of the students’ regular high school STEM subject teacher; however, in cases where the teacher or school does not permit independent study, the student will be asked to conduct the research on an extracurricular basis. Near-peer mentoring affects students’ social identities and helps them to connect to role models from similar groups, ultimately giving them a sense of belonging. Qualitative and quantitative analytics were performed throughout the study. Interviews and focus groups also ensued. Additionally, an external evaluator was utilized to ensure project efficacy, efficiency, and effectiveness throughout the entire project. The BOP-CCERS Near Peer Mentoring program is a peer support network in which high school students with interest or experience in BOP (Billion Oyster Project) topics and activities (such as classroom oyster tanks, STEM Hubs, or digital platform research) provide mentorship and support for middle school or high school freshmen mentees. Peer mentoring not only empowers those students being taught but also increases the content knowledge and engagement of mentors. This support provides the necessary resources, structure, and tools to assist students in finding success.

Keywords: STEM education, environmental science, citizen science, near peer mentoring

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Authors: Jan C. Droste, Justine Burns, Nithin Narayan

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Introduction: Life-threatening detrimental effects of inappropriate adrenaline (epinephrine) administration, e.g., by giving the wrong dose, in the context of anaphylaxis management is well documented in the medical literature. Half of the fatal anaphylactic reactions in the UK are iatrogenic, and the median time to a cardio-respiratory arrest can be as short as 5 minutes. It is therefore imperative that hospital doctors of all grades have active and accurate knowledge of the correct route, site, and dosage of administration of adrenaline. Given this time constraint and the potential fatal outcome with inappropriate management of anaphylaxis, it is alarming that surveys over the last 15 years have repeatedly shown only a minority of doctors to have accurate knowledge of adrenaline administration as recommended by the UK Resuscitation Council guidelines (2008 updated 2012). This comparison of survey results of the medical workforce over several years in a small NHS District General Hospital was conducted in order to establish the effect of the employment of multiple educational methods regarding adrenaline administration in anaphylaxis in adults. Methods: Between 2010 and 2017, several education methods and tools were used to repeatedly inform the medical workforce (doctors and advanced clinical practitioners) in a single district general hospital regarding the treatment of anaphylaxis in adults. Whilst the senior staff remained largely the same cohort, junior staff had changed fully in every survey. Examples included: (i) Formal teaching -in Grand Rounds; during the junior doctors’ induction process; advanced life support courses (ii) In-situ simulation training performed by the clinical skills simulation team –several ad hoc sessions and one 3-day event in 2017 visiting 16 separate clinical areas performing an acute anaphylaxis scenario using actors- around 100 individuals from multi-disciplinary teams were involved (iii) Hospital-wide distribution of the simulation event via the Trust’s Simulation Newsletter (iv) Laminated algorithms were attached to the 'crash trolleys' (v) A short email 'alert' was sent to all medical staff 3 weeks prior to the survey detailing the emergency treatment of anaphylaxis (vi) In addition, the performance of the surveys themselves represented a teaching opportunity when gaps in knowledge could be addressed. Face to face surveys were carried out in 2010 ('pre-intervention), 2015, and 2017, in the latter two occasions including advanced clinical practitioners (ACP). All surveys consisted of convenience samples. If verbal consent to conduct the survey was obtained, the medical practitioners' answers were recorded immediately on a data collection sheet. Results: There was a sustained improvement in the knowledge of the medical workforce from 2010 to 2017: Answers improved regarding correct drug by 11% (84%, 95%, and 95%); the correct route by 20% (76%, 90%, and 96%); correct site by 40% (43%, 83%, and 83%) and the correct dose by 45% (27%, 54%, and 72%). Overall, knowledge of all components -correct drug, route, site, and dose-improved from 13% in 2010 to 62% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be considerably improved by employing a variety of educational methods.

Keywords: adrenaline, anaphylaxis, epinephrine, medical education, patient safety

Procedia PDF Downloads 128