64 results found
Keown K, Brown R, Doherty DF, et al., 2020, Airway Inflammation and Host Responses in the Era of CFTR Modulators., Int J Mol Sci, Vol: 21
The arrival of cystic fibrosis transmembrane conductance regulator (CFTR) modulators as a new class of treatment for cystic fibrosis (CF) in 2012 represented a pivotal advance in disease management, as these small molecules directly target the upstream underlying protein defect. Further advancements in the development and scope of these genotype-specific therapies have been transformative for an increasing number of people with CF (PWCF). Despite clear improvements in CFTR function and clinical endpoints such as lung function, body mass index (BMI), and frequency of pulmonary exacerbations, current evidence suggests that CFTR modulators do not prevent continued decline in lung function, halt disease progression, or ameliorate pathogenic organisms in those with established lung disease. Furthermore, it remains unknown whether their restorative effects extend to dysfunctional CFTR expressed in phagocytes and other immune cells, which could modulate airway inflammation. In this review, we explore the effects of CFTR modulators on airway inflammation, infection, and their influence on the impaired pulmonary host defences associated with CF lung disease. We also consider the role of inflammation-directed therapies in light of the widespread clinical use of CFTR modulators and identify key areas for future research.
Markowski M, Cleaver K, Weldon SM, 2020, An integrative review of the factors influencing older nurses' timing of retirement, JOURNAL OF ADVANCED NURSING, Vol: 76, Pages: 2266-2285, ISSN: 0309-2402
Shiels J, Cwiklinski K, Alvarado R, et al., 2020, Schistosoma mansoni immunomodulatory molecule Sm16/SPO-1/SmSLP is a member of the trematode-specific helminth defence molecules (HDMs)., PLoS Negl Trop Dis, Vol: 14
BACKGROUND: Sm16, also known as SPO-1 and SmSLP, is a low molecular weight protein (~16kDa) secreted by the digenean trematode parasite Schistosoma mansoni, one of the main causative agents of human schistosomiasis. The molecule is secreted from the acetabular gland of the cercariae during skin invasion and is believed to perform an immune-suppressive function to protect the invading parasite from innate immune cell attack. METHODOLOGY/PRINCIPAL FINDINGS: We show that Sm16 homologues of the Schistosomatoidea family are phylogenetically related to the helminth defence molecule (HDM) family of immunomodulatory peptides first described in Fasciola hepatica. Interrogation of 69 helminths genomes demonstrates that HDMs are exclusive to trematode species. Structural analyses of Sm16 shows that it consists predominantly of an amphipathic alpha-helix, much like other HDMs. In S. mansoni, Sm16 is highly expressed in the cercariae and eggs but not in adult worms, suggesting that the molecule is of importance not only during skin invasion but also in the pro-inflammatory response to eggs in the liver tissues. Recombinant Sm16 and a synthetic form, Sm16 (34-117), bind to macrophages and are internalised into the endosomal/lysosomal system. Sm16 (34-117) elicited a weak pro-inflammatory response in macrophages in vitro but also suppressed the production of bacterial lipopolysaccharide (LPS)-induced inflammatory cytokines. Evaluation of the transcriptome of human macrophages treated with a synthetic Sm16 (34-117) demonstrates that the peptide exerts significant immunomodulatory effects alone, as well as in the presence of LPS. Pathways most significantly influenced by Sm16 (34-117) were those involving transcription factors peroxisome proliferator-activated receptor (PPAR) and liver X receptors/retinoid X receptor (LXR/RXR) which are intricately involved in regulating the cellular metabolism of macrophages (fatty acid, cholesterol and glucose homeostasis) and are central to infla
Thompson T, Dias S, Poulter D, et al., 2020, Efficacy and acceptability of pharmacological and non-pharmacological interventions for non-specific chronic low back pain: a protocol for a systematic review and network meta-analysis., Syst Rev, Vol: 9
BACKGROUND: Despite the enormous financial and humanistic burden of chronic low back pain (CLBP), there is little consensus on what constitutes the best treatment options from a multitude of competing interventions. The objective of this network meta-analysis (NMA) is to determine the relative efficacy and acceptability of primary care treatments for non-specific CLBP, with the overarching aim of providing a comprehensive evidence base for informing treatment decisions. METHODS: We will perform a systematic search to identify randomised controlled trials of interventions endorsed in primary care guidelines for the treatment of non-specific CLBP in adults. Information sources searched will include major bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO and LILACS) and clinical trial registries. Our primary outcomes will be patient-reported pain ratings and treatment acceptability (all-cause discontinuation), and secondary outcomes will be functional ability, quality of life and patient/physician ratings of overall improvement. A hierarchical Bayesian class-based NMA will be performed to determine the relative effects of different classes of pharmacological (NSAIDs, opioids, paracetamol, anti-depressants, muscle relaxants) and non-pharmacological (exercise, patient education, manual therapies, psychological therapy, multidisciplinary approaches, massage, acupuncture, mindfulness) interventions and individual treatments within a class (e.g. NSAIDs: diclofenac, ibuprofen, naproxen). We will conduct risk of bias assessments and threshold analysis to assess the robustness of the findings to potential bias. We will compute the effect of different interventions relative to placebo/no treatment for both short- and long-term efficacy and acceptability. DISCUSSION: While many factors are important in selecting an appropriate intervention for an individual patient, evidence for the analgesic effects and acceptability of a treatment are key factors in guiding t
Francesca P, Weldon SM, Lomi A, 2020, Lost in translation: Collecting and coding data on social relations from audio-visual recordings, Social Networks, ISSN: 0378-8733
© 2020 The Authors Some of the constitutive features of social relations fade from view when information naturally produced by sequential social interaction is translated into network ties. Building on core concepts and ideas developed within conversation analysis, in this paper we argue that this happens because the sequential, multimodal and embodied character of social relations can be fully understood only with reference to the sequential constrains that are generated by – and at the same time shape the micro-dynamics of social interaction. We suggest that the translation of social interaction into social networks precludes analysis of the multiple interfaces that sustain social relations (multimodality), and the material resources around which social relations are organized (embodiment). We highlight audio-visual recording as a data collection technology that facilitates storage, retrieval, and analysis of complex information on social relations that is typically absent from social network data. An illustrative video-supported case study based on the observation of social and task-related interaction among members of surgical teams provides the empirical context that supports and motivates our general reflection on network data collection strategies and technologies to study social interaction. The analysis highlights the need for social networks research to return to the study of social relations.
Weldon SM, Korkiakangas T, Calzada J, et al., 2019, A surgical team simulation to improve teamwork and communication across two continents: ViSIOT Proof-of-Concept Study, Journal of Surgical Education, Vol: 76, Pages: 1413-1424, ISSN: 1931-7204
BACKGROUND: Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization's Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model [Video-Supported Simulation of Interactions in the Operating Theatre (ViSIOT)]. A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT simulation-training has applicability and acceptability beyond the UK. METHODS: ViSIOT training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction, and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. RESULTS: There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. CONCLUSIONS: Practical developments in the course design, technology, and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice.
Ojo O, Weldon SM, Thompson T, et al., 2019, The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials, NUTRIENTS, Vol: 11
Ojo O, Weldon SM, Thompson T, et al., 2019, The Effect of Vitamin D Supplementation on Glycaemic Control in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 16
Weldon SM, Korkiakangas T, Kneebone R, 2019, How simulation techniques and approaches can be used to compare, contrast and improve care: an immersive simulation of a three-Michelin star restaurant and a day surgery unit, BMJ Simulation & Technology Enhanced Learning, Vol: 6, Pages: 65-66, ISSN: 2056-6697
Imran A, Holden B, Weldon SM, et al., 2019, 'How to help your unwell child': a sequential simulation project, BMJ Simulation and Technology Enhanced Learning, Vol: 6, Pages: 127-128, ISSN: 2056-6697
Weil A, Weldon SM, Kronfli M, et al., 2018, A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: a mixed methods study, Nurse Education Today, Vol: 71, Pages: 26-33, ISSN: 0260-6917
BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. SETTING/PARTICIPANTS: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. METHODS: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. RESULTS: Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. CONCLUSION: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data
Weldon SM, Kelay T, Ako E, et al., 2017, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ Simulation & Technology Enhanced Learning, Vol: 4, Pages: 13-18, ISSN: 2056-6697
Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.
Weldon S, 2017, Changing the simulation horizon: Let there be light, Annual Physician Associate Educators' Conference
Bezemer J, Cope A, Korkiakangas T, et al., 2016, Microanalysis of video from the operating room: an underused approach to patient safety research, BMJ Quality & Safety, Vol: 26, Pages: 583-587, ISSN: 2044-5423
Huddy JR, Weldon SM, Ralhan S, et al., 2016, Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics., BMJ Open, Vol: 6, Pages: e011043-e011043, ISSN: 2044-6055
OBJECTIVES: Public and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer. SETTING: Three 3-hour workshops in central London. PARTICIPANTS: 38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway. INTERVENTIONS: Clinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS. PRIMARY AND SECONDARY OUTCOME MEASURES: Evaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings. RESULTS: 38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended. CONCLUSIONS: SqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the inv
Weldon S, Kneebone R, Bello F, 2016, Collaborative healthcare remodelling through Sequential Simulation (SqS): a patient and front-line staff perspective, BMJ Simulation & Technology Enhanced Learning, Vol: 2, Pages: 78-86, ISSN: 2056-6697
Background The Department of health funded an initiative to pioneer new approaches that would create a more integrated form of care.Local problem In order to receive funding, local Clinical Commissioning Groups were required to engage a range of stakeholders in a practical approach that generated the development of an integrated model of care.Intervention Two sequential simulation (SqS) workshops comprising 65 and 93 participants, respectively, were designed using real patient scenarios from the locality, covering areas of general practice, community health and adult social care. Workshops were attended by a diverse group of stakeholders. The first workshop addressed current care pathways and the second modelled ideal care pathways generated from the data obtained at the first workshop.Methods Discussions were captured through video recording, field-notes and pre and post questionnaires. Data was collated, transcribed and analysed through a combination of descriptive statistics and thematic analysis.Results The questionnaires revealed that attendees strongly agreed that they had had an opportunity to contribute to all discussions and raise questions, concerns and ideas (100%). Pre and post knowledge of current and new models of care was vastly improved. The opportunity to share information and to network was valued, with the SqS approach seen as breaking professional barriers (100%).Conclusions Simulation can be used as a tool to engage stakeholders in designing integrated models of care. The systematic data collection from the diverse ideas generated also allows for a much-needed ‘ear’ to those providing the solutions, as well as a legitimate and balanced perspective.
Objectives: To develop an intervention for educating pharmacists(community and hospital) about integrated care and their role in implementingit.Methods: We developed a sequential simulation derived from a patient’sjourney, the key scenario featuring a community pharmacist. The scenarioswere designed with input from pharmacists and patients, and emphasized theeffect operating in silos can have on the patient.Evaluation: Evaluation was by questionnaire, field notes and analysis ofvideo material. 21/37 (56.7%) participants responded to the questionnaire.19/21 expressed that they felt the event was a good or excellent educationalexperience, and had improved their confidence in their capability to improvepatient care. 19/21 said their knowledge and understanding of integrated carehad been enhanced. The sequential simulation was appreciated as a way ofvisualizing integrated care, with 19/21 describing it as good or excellent.Further themes were identified through video-analysis and field note analysis.Conclusion: Sequential Simulation is a novel and practical approach topresent current care pathways, aiming to generate a mutual focus, createparticipant empathy and bring the conventionalities of integrated care to life.We consider this approach helpful in preparing frontline staff to participate in integrated care.
Kneebone R, Weldon S-M, Bello F, 2016, Engaging patients and clinicians through simulation: rebalancing the dynamics of care, Advances in Simulation, Vol: 1, ISSN: 2059-0628
This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.
Ralhan S, Weldon S, Kneebone R, et al., 2016, Sequential Simulation Workshops: An Innovative Approach to Working Together (engaging front-line staff, patients and publics) to Develop New Integrated Models of Care, Trainees in the Association for the Study of Medical Education
Weldon S, Korkiakangas T, 2016, Video-Supported Simulation for Interactions in the Operating Theatre (ViSIOTTM), The Society in Europe for Simulation Applied to Medicine
Korkiakangas T, Weldon S, 2016, ViSIOT: Evidence-based training for improving interactions in the operating room, AORN Surgical Conference & Expo
Weldon S, Korkiakangas T, 2016, Music in the Operating Room, AORN Surgical Conference & Expo
Korkiakangas T, Weldon S, 2016, Mobilizing a team for the Surgical Safety Checklist: Interactional analysis, AORN Surgical Conference & Expo
Sadideen H, Weldon S-M, Saadeddin M, et al., 2015, A Video Analysis of Intra- and Interprofessional Leadership Behaviors Within "The Burns Suite": Identifying Key Leadership Models, Journal of Surgical Education, Vol: 73, Pages: 31-39, ISSN: 1931-7204
ObjectiveLeadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS.MethodsA total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos.ResultsAll 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence &l
Bezemer J, Korkiakangas T, Weldon S, et al., 2015, Unsettled teamwork: Communication and learning in the operating theatres of an urban hospital, Journal of Advanced Nursing, Vol: 72, Pages: 361-372, ISSN: 0309-2402
AimTo explore the unsettling effects of increased mobility of nurses, surgeons and other healthcare professionals on communication and learning in the operating theatre.BackgroundIncreasingly, healthcare professionals step in and out of newly formed transient teams and work with colleagues they have not met before, unsettling previously relatively stable team work based on shared, local knowledge accumulated over significant periods of close collaboration.DesignAn ethnographic case study was conducted of the operating theatre department of a major teaching hospital in London.MethodVideo recordings were made of 20 operations, involving different teams. The recordings were systematically reviewed and coded. Instances where difficulties arose in the communication between scrub nurse and surgeons were identified and subjected to detailed, interactional analysis.FindingsInstrument requests frequently prompted clarification from the scrub nurse (e.g. ‘Sorry, what did you want?’). Such requests were either followed by a relatively elaborate clarification, designed to maximize learning opportunities, or a by a relatively minimal clarification, designed to achieve the immediate task at hand.ConclusionsSignificant variation exists in the degree of support given to scrub nurses requesting clarification. Some surgeons experience such requests as disruptions, while others treat them as opportunities to build shared knowledge.
Korkiakangas T, Weldon S, Bezemer J, et al., 2015, “Coming Up!”: Why verbal acknowledgement matters in the operating theatre, Publisher: Equinox
Kneebone RL, Weldon SM, Ralham S, et al., 2015, Sequential Simulation (SqS): an innovative approach to educating GP receptionists about integrated care via a patient journey – a mixed methods approach, BMC Family Practice, Vol: 16, ISSN: 1471-2296
BackgroundAn evaluation of an effective and engaging intervention for educating general practice (GP) receptionists about integrated care and the importance of their role within the whole system was conducted.MethodsWorkshops took place in North West London, one of England’s 14 ‘Integrated Care Pioneers.’ Three training days featuring Sequential Simulations (SqS) were held. Forty GP receptionists attended on each day, as well as 5–6 patients and 8–9 healthcare professionals. The SqS developed was from a collection of patient stories, the key scene of which featured a GP receptionist. The scenes were designed to show the consequences for the patient of professionals working in silos. This provided the focus for facilitated table discussions. The discussants suggested ways in which an unfortunate series of events could have been dealt with differently. These suggestions were then incorporated in a re-designed SqS. Evaluation was conducted through questionnaires, field notes and analysis of video material. Descriptive statistics and thematic analysis were applied.ResultsNinety three participants responded to the questionnaire out of 131 attendees. All (93/93) respondents reported that the event was a powerful learning experience and that they had gained confidence in improving patient care. 98 % (91/93) reported that their knowledge of integrated care had improved. The simulation was rated highly as a learning experience [60 % (57/93) - excellent, 39 % (37/93) good]. Further evidence of educational benefit was expressed through comments such as: ‘The simulations really got me thinking about the patient as a human with many problems and situations.’ConclusionSqS is an innovative and practical way of presenting current care pathways and health care scenarios in order to create a shared focus, engage the emotions of the participants and bring the principles of integrated care to life. Facilitated table discussions are an opportuni
Huddy J, Weldon S-M, Ralhan S, et al., 2015, Sequential simulation of clinical pathways: a tool for public and patient involvement in diagnostic research, UK Diagnostic Forum
Weldon S, Korkiakangas T, Bezemer J, et al., Music and communication in the operating theatre, Journal of Advanced Nursing, ISSN: 1365-2648
Paice L, Weldon S, Ralhan S, et al., 2015, Sequential simulation (SqS) of a patient journey: an intervention to engage GP receptionists in integrated care, 15th International Conference on Integrated Care, Publisher: Ubiquity Press, ISSN: 1568-4156
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