87 results found
Scott A, Weldon S, Taggart CC, 2022, The Serpin-tine Search for Factors Associated with COVID-19 Severity in Patients with Chronic Obstructive Pulmonary Disease., Am J Respir Crit Care Med, Vol: 206, Pages: 657-658
Essex R, Weldon SM, 2022, The justification for strike action in healthcare: A systematic critical interpretive synthesis., Nurs Ethics, Vol: 29, Pages: 1152-1173
Strike action in healthcare has been a common global phenomenon. As such action is designed to be disruptive, it creates substantial ethical tension, the most cited of which relates to patient harm, that is, a strike may not only disrupt an employer, but it could also have serious implications for the delivery of care. This article systematically reviewed the literature on strike action in healthcare with the aim of providing an overview of the major justifications for strike action, identifying relative strengths and shortcomings of this literature and providing direction for future discussions, and theoretical and empirical research. Three major themes emerged related to (1) the relationship between healthcare workers, patients and society; (2) the consequences of strike action; and (3) the conduct of strike action. Those who argue against strike action generally cite the harms of such action, particularly as it relates to patients. Many also argue that healthcare workers, because of their skills and position in society, have a special obligation to their patients and society more generally. Those who see this action as not only permissible but also, in some cases, necessary have advanced several points in response, arguing that healthcare workers do not necessarily have any special obligation to their patients or society, and even if so, this obligation is not absolute. Overwhelmingly, when talking about the potential risks of strike action, authors have focused on patient welfare and the impact that a strike could have. Several directions for future work are identified, including greater explorations into how structural and systemic issues impact strike action, the need for greater consideration about the contextual factors that influence the risks and characteristics of strike action and finally the need to tie this literature to existing empirical evidence.
Essex R, Weldon SM, Thompson T, et al., 2022, The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies., Health Serv Res
OBJECTIVE: This study sought to evaluate the impact of health care strike action on patient mortality. DATA SOURCES: EMBASE, PubMed CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, and grey literature were searched up to December 2021. STUDY DESIGN: A systematic review and meta-analysis were utilized. DATA COLLECTION/EXTRACTION: Random-effects meta-analysis was used to compare mortality rate during strike versus pre- or post-strike, with meta-regression employed to identify factors that might influence the potential impact of strike action. Studies were included if they were observational studies that examined in-hospital/clinic or population mortality during a strike period compared with a control period where there was no strike action. PRINCIPAL FINDINGS: Seventeen studies examined mortality: 14 examined in-hospital mortality and three examined population mortality. In-hospital studies represented 768,918 admissions and 7191 deaths during strike action and 1,034,437 admissions and 12,676 deaths during control periods. The pooled relative risk (RR) of in-hospital mortality did not significantly differ during strike action versus non-strike periods (RR = 0.91, 95% confidence interval 0.63, 1.31, p = 0.598). Meta-regression also showed that mortality RR was not significantly impacted by country (p = 0.98), profession on strike (p = 0.32 for multiple professions, p = 0.80 for nurses), the duration of the strike (p = 0.26), or whether multiple facilities were on strike (p = 0.55). Only three studies that examined population mortality met the inclusion criteria; therefore, further analysis was not conducted. However, it is noteworthy that none of these studies reported a significant increase in population mortality attributable to strike action. CONCLUSIONS: Based on the data available, this review did not find any evidence that strike action has any significant impact on in-hospital patient mortality
Francesca P, Weldon SM, Lomi A, 2022, Lost in translation: Collecting and coding data on social relations from audio-visual recordings, Social Networks, Vol: 69, Pages: 102-112, ISSN: 0378-8733
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.
Essex R, Milligan W, Williams G, et al., 2022, The impact of strike action on patient morbidity: A systematic literature review., Int J Health Plann Manage, Vol: 37, Pages: 1311-1326
Strike action in healthcare has been common over the last several decades. The overarching aim of this systematic review was to synthesise and analyse the empirical literature that examines the impact of strike action on patient morbidity, that is, all patient outcomes except mortality. After conducting a search and apply eligibility criteria, 15 studies were included in this review. These articles included a variety of outcomes from hypertension control to rates of chlamydia. Strikes ranged from 13 to 118 days, with a mean strike length of 56 days. A textual narrative synthesis was employed to arrange studies by whether they had a positive, mixed or neutral or negative impact on patient morbidity. Results suggest that strike action has little impact on patient morbidity. The majority of studies reported that strike action had a neutral or mixed impact of strike action on patient morbidity. One study reported positive outcomes and three studies reported negative outcomes, however in both cases, the impact that the strike had was marginal.
McKelvey MC, Abladey AA, Small DM, et al., 2022, Cathepsin S Contributes to Lung Inflammation in Acute Respiratory Distress Syndrome, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 205, Pages: 769-782, ISSN: 1073-449X
Harvey C, Weldon S, Elborn S, et al., 2022, The Effect of CFTR Modulators on Airway Infection in Cystic Fibrosis., Int J Mol Sci, Vol: 23
The advent of Cystic fibrosis transmembrane receptor (CFTR) modulators in 2012 was a critical event in the history of cystic fibrosis (CF) treatment. Unlike traditional therapies that target downstream effects of CFTR dysfunction, CFTR modulators aim to correct the underlying defect at the protein level. These genotype-specific therapies are now available for an increasing number of CF patients, transforming the way we view the condition from a life-limiting disease to one that can be effectively managed. Several studies have demonstrated the vast improvement CFTR modulators have on normalization of sweat chloride, CFTR function, clinical endpoints, and frequency of pulmonary exacerbation. However, their impact on other aspects of the disease, such as pathogenic burden and airway infection, remain under explored. Frequent airway infections as a result of increased susceptibility and impaired innate immune response are a serious problem within CF, often leading to accelerated decline in lung function and disease progression. Current evidence suggests that CFTR modulators are unable to eradicate pathogenic organisms in those with already established lung disease. However, this may not be the case for those with relatively low levels of disease progression and conserved microbial diversity, such as young patients. Furthermore, it remains unknown whether the restorative effects exerted by CFTR modulators extend to immune cells, such as phagocytes, which have the potential to modulate the response of people with CF (pwCF) to infection. Throughout this review, we look at the potential impact of CFTR modulators on airway infection in CF and their ability to shape impaired pulmonary defences to pathogens.
Imran A, Mpofu S, Weldon SM, 2022, Clinical research nurses perspective on recruitment challenges and lessons learnt from a large multi-site observational study, Journal of Research in Nursing, ISSN: 1744-9871
Background: Recruitment of large numbers of study participants within a designated time frame for multi-site clinical research studies is a significant challenge faced by researchers. If a study does not manage to recruit targeted number of participants, it could have a significant impact on the statistical significance of the research. Purpose: This paper highlights the challenges of recruitment for a large multi-site UK-based tuberculosis observational study ‘PREDICT’. Methods: It uses a case study analysis from the research nurses perspective, and descriptive information retrieved from non-recruitment log forms to understand reasons for potential recruits not participating. Results: Some of the main challenges to recruitment included patients not attending their clinic appointments, time required to obtain site-specific permissions and courier timings for blood sample collection. This paper also outlines key reasons for potential recruits who did not participate. Some of the common barriers to participation for non-recruited participants were work and family commitments, additional blood tests and language barriers. Conclusion: Successful strategies which were implemented to overcome some of the challenges during the study are presented. This paper, therefore, aims to present the challenges faced, lessons learnt and successful strategies implemented to inform the planning of similar longitudinal studies of this scale in future.
Guo-Parke H, Linden D, Weldon S, et al., 2022, Deciphering Respiratory-Virus-Associated Interferon Signaling in COPD Airway Epithelium, MEDICINA-LITHUANIA, Vol: 58, ISSN: 1010-660X
Essex R, Weldon SM, Markowski M, et al., 2022, A Systematic Mapping Literature Review of Ethics in Healthcare Simulation and its Methodological Feasibility, Clinical Simulation in Nursing, ISSN: 1876-1399
Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardized practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred four papers were included and analyzed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilized simulation overwhelmingly in an educational context.
Essex R, Weldon SM, Thompson T, et al., 2021, Impact of healthcare strikes on patient mortality: A protocol for a systematic review and meta-analysis of observational studies, BMJ Open, Vol: 11
Introduction A strike is a collective, temporary and calculated action, which involves a temporary stoppage of work. For healthcare professionals strike action poses a unique dilemma. Perhaps most fundamentally, as strike action is designed to be disruptive it has the potential to impact the delivery of care and place patient well-being in jeopardy. The objective of this study is therefore to evaluate the impact of healthcare strike action on patient mortality outcomes globally using meta-analysis in order to provide a comprehensive evidence base that can advise healthcare professionals, governments and regulatory bodies on the impact that strike action has on patients. Methods and analysis A comprehensive literature search of major electronic databases (EMBASE, MEDLINE, CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, OPEN GREY and SIGMA REPOSITORY) will be undertaken to identify observational studies of strike action among healthcare professionals where in-hospital/clinic and population/community mortality is examined, prestrike, during and poststrike. Meta-analysis will be performed to estimate in-hospital/clinic and population/community mortality during periods of strike action. The quality of evidence will be assessed using the National Institute of Health quality assessment tool for observational cohort and cross-sectional studies. Risk of bias will be assessed using the Cochrane Risk Of Bias In Non-Randomized Studies - of Interventions tool. Ethics and dissemination This study does not require ethical approval. Findings will be submitted to an appropriate peer-reviewed journal. Trial registration number CRD42021238879.
Thompson T, Ahmed B, Weldon SM, et al., 2021, Relative effectiveness of non-surgical interventions for pain management in knee osteoarthritis: a protocol for a component network meta-analysis of randomised controlled trials., BMJ Open, Vol: 11
INTRODUCTION: Knee osteoarthritis is a chronic degenerative disease associated with significant chronic pain, disability and impaired quality of life and is the most common form of osteoarthritis. There is no cure for knee osteoarthritis, and the main therapeutic goals are pain management and improving quality of life. The objective of this study is to evaluate the relative efficacy and acceptability of available interventions using network meta-analysis (NMA) to provide a comprehensive evidence base to inform future treatment guidelines. METHODS AND ANALYSIS: A comprehensive literature search of major electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) and clinical trial registries will identify randomised control trials (RCTs) of interventions listed in NICE guidelines for the treatment of knee osteoarthritis in adults. We will perform an NMA to estimate relative intervention effects across the whole treatment network. If any studies use multicomponent intervention packages, we will employ a component NMA model to estimate the contribution of individual components. The quality of evidence will be assessed using the Confidence in Network Meta-Analysis approach, which is based on the traditional GRADE framework adapted for NMA. Risk of bias (RoB) will be assessed using the revised Cochrane RoB 2.0 tool for RCTs. ETHICS AND DISSEMINATION: This study does not require ethical approval. Findings will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020184192.
Essex R, Weldon SM, 2021, Health Care Worker Strikes and the Covid Pandemic. Reply., N Engl J Med, Vol: 385
Creane SE, Carlile SR, Downey D, et al., 2021, The Impact of Lung Proteases on Snake-Derived Antimicrobial Peptides., Biomolecules, Vol: 11
Respiratory infections are a leading cause of global morbidity and mortality and are of significant concern for individuals with chronic inflammatory lung diseases. There is an urgent need for novel antimicrobials. Antimicrobial peptides (AMPs) are naturally occurring innate immune response peptides with therapeutic potential. However, therapeutic development has been hindered by issues with stability and cytotoxicity. Availing of direct drug delivery to the affected site, for example the lung, can reduce unwanted systemic side effects and lower the required dose. As cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) lungs typically exhibit elevated protease levels, the aim of this study was to assess their impact on snake-derived AMPs. Peptide cleavage was determined using SDS-PAGE and antimicrobial and anti-inflammatory activities of neutrophil elastase (NE)-incubated peptides were assessed using a radial diffusion assay (RDA) and an in vitro LPS-induced inflammation model, respectively. Although the snake-derived AMPs were found to be susceptible to cleavage by lung proteases including NE, several retained their function following NE-incubation. This facilitated the design of novel truncated derivatives that retained functionality following NE incubation. Snake-derived AMPs are tractable candidate treatments for use in environments that feature elevated NE levels, such as the CF airways.
McKelvey MC, Brown R, Ryan S, et al., 2021, Proteases, Mucus, and Mucosal Immunity in Chronic Lung Disease, INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, Vol: 22
Essex R, Weldon SM, 2021, Health Care Worker Strikes and the Covid Pandemic, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 384, Pages: E93-E93, ISSN: 0028-4793
Cleaver K, Essex R, Malamateniou C, et al., 2021, A Systematic Scoping Review and Textual Narrative Synthesis of Undergraduate Pediatric Nursing Simulations: What, Why, and How?, Clinical Simulation in Nursing, Vol: 53, Pages: 10-31, ISSN: 1876-1399
Background: Simulation is increasingly being used to train health care professionals; however, there is limited knowledge on how pediatric simulation is being used to train undergraduate nurses. This article systematically scopes the literature on the types of undergraduate pediatric nursing simulations taking place, their value, the research methods used, and areas of research focused on. Methods: A systematic scoping literature review, combined descriptive synthesis, and textual narrative synthesis were conducted. Results: A total of 139 articles were identified by the search strategy. Of these, 32 articles were included for appraisal and synthesis. Seventeen articles were quantitative, five articles were qualitative, and eight articles were mixed-methods. The research took place in six different geographical locations. The total participant sample was 2,039. Articles were categorized according to their aims and objectives and simulation types. Conclusions: This review revealed the heterogeneity of studies on this subject. Ultimately, studies were small and confined to single institutions or geographical locations. Studies that described or explored simulation as an intervention provided more interesting insights than those that evaluated or tested effectiveness. The variety of simulation types was wide, and the fidelity of the simulations being described was frequently noted; however, no reference was made as to how this was determined. Future studies would benefit from detailing the low, medium, or high technological, psychological, or environmental aspects of simulation.
Brown R, Small DM, Doherty DF, et al., 2021, Therapeutic Inhibition of Cathepsin S Reduces Inflammation and Mucus Plugging in Adult beta ENaC-Tg Mice, MEDIATORS OF INFLAMMATION, Vol: 2021, ISSN: 0962-9351
Kneebone R, Korkiakangas T, Weldon S, 2021, “Let me take care of you”: What can healthcare learn from a high-end restaurant to improve patient experience?, Journal of Communication in Healthcare, Vol: 14, Pages: 225-240, ISSN: 1753-8068
BackgroundThe patient experience is associated with patient satisfaction and health outcomes, presenting a key challenge in healthcare. The objective of the study was to explore the principles of care in and beyond healthcare, namely in a three Michelin-starred restaurant, and consider what, if any, principles of care from the diners’ experience could be transferrable to healthcare.MethodThe principles of care were first explored as part of observational fieldwork in a healthcare day surgery unit and the restaurant respectively, focusing on communication between the professionals and the patients or the diners. Care was subsequently explored in a series of public engagement events across the UK. The events used immersive simulation to recreate the healthcare and the dining experiences for the general public, and to stimulate discussion.ResultsA thematic analysis of the engagement discussions identified overarching themes in how care was experienced in and through communication; ‘informed, not bombarded’, ‘conversation, not interrogation’, ‘environment is communication’, and ‘being met as a person’. The themes suggested how the participants in simulation felt about the care they received in real time and provided recommendations for improved clinical practice.
Brown R, McKelvey MC, Ryan S, et al., 2020, The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview, FRONTIERS IN MEDICINE, Vol: 7
Keown K, Brown R, Doherty DF, et al., 2020, Airway Inflammation and Host Responses in the Era of CFTR Modulators, INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, Vol: 21
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 NEGLECTED TROPICAL DISEASES, Vol: 14, ISSN: 1935-2735
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
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
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