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Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.

IntroductionHyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP.MethodsA consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact.ResultsPopulation interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline (‘business as usual’ scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy weight was most effective in reducing HIP incidence (28.8% reduction by 2030; incidence=11.5, 95% CI 11.2 to 11.8). Scenarios exploring the effect of childhood weight status on entry to adulthood demonstrated significant impact in the selected outcome measure for glycemic regulation, insulin sensitivity in the short term and HIP in the long term.DiscussionPopulation-level weight reduction interventions will be necessary to ‘turn the tide’ on HIP. Weight reduction interventions targeting high-risk individuals, while beneficial for those individuals, did not significantly impact forecasted HIP incidence rates. The importance of maintaining interventions promoting healthy weight in childhood was demonstrated.

The Resuscitation Council (UK), the British Cardiovascular Society (including the British Heart Rhythm Society and the British Society for Heart Failure) and the National Council for Palliative Care recognise the importance of providing clear and consistent guidance on management of cardiovascular implanted electronic devices (CIEDs) towards the end of life, during cardiorespiratory arrest and after death. This document has been developed to provide guidance for the full range of healthcare professionals who may encounter people with CIEDs in the situations described and for healthcare managers and commissioners. The authors recognise that some patients and people close to patients may also wish to refer to this document. It is intended as an initial step to help to ensure that people who have CIEDs, or are considering implantation of one, receive explanation of and understand the practical implications and decisions that this entails; to promote a good standard of care and service provision for people in the UK with CIEDs in the circumstances described; to offer relevant ethical and legal guidance on this topic; to offer guidance on the delivery of services in relation to deactivation of CIEDs where appropriate; to offer guidance on whether any special measures are needed when a person with a CIED receives cardiopulmonary resuscitation; and to offer guidance on the actions needed when a person with a CIED dies.

Over 40% of adults in the United States are classified as obese. American adults with severe obesity experience symptoms of depression at double the rate of normal-weight people. Bariatric surgery (BS) is a safe and effective treatment for severe obesity that results in long-term weight loss. The estimated 19% of BS patients who suffer from depression after surgery exhibit a lower-than-average percentage of excess weight loss (%EWL) over time. These BS patients also do not attend follow-up appointments, which makes treating their symptoms of depression difficult for healthcare providers. This study examined the relationship between depression, %EWL, and follow-up attendance to ascertain if depression influenced whether BS patients achieved their %EWL goal as well as attended their 12- and 24-month follow-up appointments. Non-identifiable data in 212 electronic medical records were examined of adults aged 18-64 who had their first BS from 2012 to 2020 at an academic medical center. The BS patients were sorted into two depression status groups per their pre-surgical BDI-II score for statistical analysis. This categorization resulted in 44% of the BS patients in the with depression group (mean BDI-II score 21 ± 9 points) and 56% in the without depression group (mean BDI-II score 8 ± 5 points). A repeated measures mixed model found no statistically significant decrease in %EWL between or within the depression status groups at 12- and 24-months post-BS – even when controlling for patient characteristics (age, sex, race, insurance type, marital status, education level, employment status, and antidepressant medication). A generalized linear mixed model found a statistically significant decrease in the follow-up attendance from 12 to 24 months within both depression status groups (with depression p < .001; without depression p = .003) when controlling for the same patient characteristics except race. However, when controlling for patient characteristics, no statistically significant decrease in follow-up attendance was found between the depression status groups at 12 months (p = .887) or 24 months (p = .229). The results of this study were inconclusive regarding whether depression influenced BS outcomes since BS patients were only assessed for symptoms of depression before surgery and not at each follow-up appointment after surgery. A prospective study with a mixed-methods design is needed to determine if surgical outcomes are associated with depression and why BS patients do not attend follow-up appointments. Follow-up attendance is essential for treating BS patients over time, so they can successfully achieve and maintain their weight loss goals.

This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of practice teaching.

Background: The call for interprofessional nursing and social work education in the United Kingdom has led to the development of a singularly integrated nursing and social work degree. Although evidence exists to highlight the impact of this degree in practice, details of the experience of interprofessional nursing and social work education have not been studied in equal depth.Methods and Findings: Guided by the tenets of interpretive phenomenological analysis, six students who had recently completed the first year of a nursing and social work degree were asked to describe their experiences of interprofessional education. The dominant theme that emerged from analysis highlighted the importance of providing students with a bespoke curriculum, which could communicate their full and inclusive integration. Where this was not achieved, students explained that they could become confused by increased workloads and a sense of separatism.Conclusions: When combining nursing and social work into a single degree, pedagogic strategies must be confidently prepared to deliver a specific interprofessional nursing and social work curriculum. Above all, this curriculum must demonstrate an integrated philosophy and distinctive orientation to inclusive interprofessional education.

Background There is a lack of significant literature on provision of Supportive and Palliative care (SPC) for Lung transplant patients pre and post surgery. Aims A baseline audit of patients was undertaken to identify SPC access in the last year of life. Data collection Patients who died in 2010 on the lung transplant waiting list or had lung or heart and lung transplants were audited retrospectively. Patient demographics and end of life data were collected. Results In 2010 50% of post lung transplant patients who died were in Harefield Hospital. Most had SPC involvement but often late. One died in a hospice and none were known to die at home. Patients sometimes refused SPC referrals until very late. Communication to GPs rarely mentioned SPC. Most patients on the waiting list died in local hospitals. Limitations of Data collection There was a dearth of information for patients who died outside HH, and with one exception, there was no SPC data. This highlighted the difficulty of following the patient's journey through the healthcare system. The NHS spine data only includes date of death. Staff report anecdotally that conversations about advance care planning are often not documented. Future audits Contact GPs to collect data. Outcomes Action planning following this audit includes: 1) Weekly meetings between Transplant and SPC to discuss patients who are cause for concern with audited outcomes. 2) All patients on the waiting list will have access to Supportive care. 3) Place of death has now been included on hospital systems. 4) Improving access to SPC will increase support and services available to patients; families; carers and staff. Other specialist centres managing complex patients with organ failure face similar challenges and may consider a similar approach.

After considering complaints of boredom as a significant factor in our classrooms, the second part of this article analyzes the responses of thirty-two first-year writing students to questions about boredom.

Presents and discusses a study of 129 first-year composition students that identifies both their expectations and frustrations. Focuses on how such results demonstrate students’ ambivalence about classes and educators as well as their ability to function as effective writers.

This manuscript demonstrates and presents the program evaluation of one basic writing program. Based on a two-year study that targets 685 basic writing students, we hypothesize that these students achieve similar or higher retention rates than those of regularly-admitted students. The authors, who studied four variables which are nominally rated — retention rate, current classification, grade point average, and writing course sequence completed — discuss how each contributes to the successful retention rate of these basic writing students.