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• The health education systems incorporated (HESI) exit test helps to quickly identify students at risk of failure for early remediation interventions • Advanced Fundamentals course was the most prominent in predicting composite HESI scores • Close and ongoing assessment of student scores throughout the Advanced Fundamentals course. The purpose of this study was to determine how students' individual grades in BSN courses associated with their medical surgical, fundamentals, and pharmacology raw HESI scores. The average of three HESI scores were calculated and recursive partitioning and regression trees were used to identify associations between course grades and the composite HESI score. The model results provide insight into assessing student progression and can help in implementing tailored remediation strategies. [ABSTRACT FROM AUTHOR]

In Canada, the British Columbia College of Nurses and Midwives requires baccalaureate registered nurse education programs to deliver a generalist curriculum meeting entry-level competencies. To fulfill this requirement, nursing programs ensure the provision of practice opportunities for hands-on experience with patients of all ages through practicum. Current literature suggests the limited availability of clinical placement opportunities in pediatric settings. This may reduce the opportunity for nursing students to become acquainted with the unique needs of infants, children, and adolescents as part of their nursing education. This study aimed to explore students' and new graduates' experiences of acute and community pediatric clinical practicum as part of their British Columbia nursing education program. This study utilized a qualitative descriptive approach. Fifteen online semi-structured interviews were conducted with thirteen undergraduate nursing students and two recent graduates. Participants in this study were distributed across the province of British Columbia, representing the North, the Interior, and the Lower Mainland. Data were analyzed using thematic analysis. The key themes of relational practice and exposure to lived experiences (and their related subthemes) are explored in detail. Both themes encapsulate the importance that nursing students ascribe to the pediatric practicum experience as part of their nursing education. The result of this study deduced that the pediatric practicum experience provided nursing students with learning opportunities they may not get elsewhere such as: building relationships with children, adolescents, and their families within the context of care and developing awareness of the lived experiences of health and illness with each patient encounters. This unique perspective of nursing students may prove valuable for the planning and delivery of clinical learning in nursing education programs. • Pediatric practicum experiences support the development of generalist practice competencies. • Caring for patients in the context of family-centered care promotes relationship building. • Learning from the lived experiences of children, adolescents, and their families is incomparable. [ABSTRACT FROM AUTHOR]

We investigated the role of commensals at the peak of infection with the colonic mouse pathogen Citrobacter rodentium. Bioluminescent and kanamycin (Kan)-resistant C. rodentium persisted avirulently in the cecal lumen of mice continuously treated with Kan. A single Kan treatment was sufficient to displace C. rodentium from the colonic mucosa, a phenomenon not observed following treatment with vancomycin (Van) or metronidazole (Met). Kan, Van, and Met induce distinct dysbiosis, suggesting C. rodentium relies on specific commensals for colonic colonization. Expression of the master virulence regulator ler is induced in germ-free mice, yet C. rodentium is only seen in the cecal lumen. Moreover, in conventional mice, a single Kan treatment was sufficient to displace C. rodentium constitutively expressing Ler from the colonic mucosa. These results show that expression of virulence genes is not sufficient for colonization of the colonic mucosa and that commensals are essential for a physiological infection course. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the factors which influence student nurses' ability to urethrally catheterise children in their care. This aimed to inform current pre-registration clinical skill training and education. Methodology: A mixed method study using focus groups and written questionnaires. Results: The students identified that being able to competently carry out urethral catheterisation was influenced by a lack of exposure to the clinical skill and a need for specific paediatric focused training. Evaluation of current catheterisation training highlighted that, even after training, only a small proportion of the student nurses (24%, n = 12) felt confident to catheterise children in practice. Conclusion: Student nurses infrequently witnessed paediatric urethral catheterisation in clinical placements which impacted on their ability to consolidate their learning and build competency in this clinical skill. Limited exposure to some clinical skills in practice, may mean that student nurses' education should focus on skills they are more likely to witness in order to optimise their learning opportunities. [ABSTRACT FROM AUTHOR]

Abstract: UK health policy dictates that Advance Care Planning (ACP), including the use of living wills, promotes choice and quality regarding end of life care for those with chronic and life-threatening conditions and it has been incorporated in self-management training. This paper reports a qualitative evaluation based on in-depth interviews with 31 respondents who had completed a UK-based lay-led self-management course (The Expert Patients Programme), and 12 respondents who had completed the same course adapted for people who are HIV positive. We draw upon previous social research on ‘death awareness’ and the biographical context of illness experience and management in examining the impact of incorporating this subject within a self-management intervention. The analysis demonstrates that many participants were unprepared to face issues raised in the session with material represented as disrupting some aspects of illness adaptation and existing views about death and dying. Positioning educational material on death and dying alongside that on ‘positive’ self-management of illness highlights the complexities and sensitivities of planning for end of life care with implications for future educational interventions of this type. [Copyright &y& Elsevier]

Abstract: Aim: To determine whether the use of a novel dressing removal technique resulted in shorter removal times, reduced the child''s experience of pain and/or reduced parental anxiety when compared to a standard approach. Methods: This prospective unblinded randomized controlled trial of 53 consecutive boys undergoing primary hypospadias repair was powered using data from a prior feasibility study. Children were randomized to a standard control dressing (A) or standard dressing plus Cavilon™ (B) group. Removal was by (A) soaking the child and dressing in the bath or (B) application of an adhesive remover to the dressing. The primary outcome measure was dressing removal time. Secondary measures were: child pain scores on a visual analogue scale measured by the parent and nurse, and parental anxiety using the self-evaluative state anxiety measure. Data are expressed as median (range); P <0.05 is significant. Results: Dressing B was significantly quicker to remove than A: B 30min (5–86min) vs A 40min (17–105min), P =0.01, Mann–Whitney. No differences in parent/nurse pain scores between the two groups were seen. There was a strong correlation between parent and nurse reporting of pain scores at the time of dressing removal (Spearman 0.79, P <0.000). No significant differences in pre- and post-dressing removal parental anxiety scores were seen (P =0.159, Mann–Whitney). Several parents had high anxiety levels at both times. Conclusion: The novel dressing removal approach (B) was significantly shorter than the standard one (A). There were no significant differences in child''s pain or parental anxiety score between the two approaches. [Copyright &y& Elsevier]

PURPOSE: To report the impact and tolerability of PTNS and the effect on the child''s reported quality of life. MATERIAL AND METHODS: Prospective data from 8 children (M:F 1:7; mean age 12 years 3 months) with OAB demonstrated on urodynamics. PTNS was performed weekly for 30 minutes over 12 weeks. Symptoms (voiding diary, dry pie chart) objective measures (uriflow, post void residual (PVR), needle pain score, urge score, PinQ score) and child''s thoughts about the experience were recorded. RESULTS: The number of days per week of incontinence ranged from 2-7 (mean 4 days) two had nocturnal enuresis (NE), one sporadic NE, none had faecal incontinence. Seven had urge/frequency and 2 had a history of symptomatic UTI within last 6 months. Four of the eight children with incontinence became dry, 1 significantly improved. Three children had no improvement 2/3 had recurrent UTI. Noninvasive uriflow and PVR were not statistically significant before and after treatment. Pre-treatment patient age, sex and frequency of wetting were not predictive of outcome. PinQ score changed demonstrating an improvement in QoL. Pain scores were low or absent in all children. Qualitative themes included improved confidence and positive fun experiences. There were no reported side effects or adverse events. CONCLUSIONS: PTNS for children that have failed previous standard treatments is safe and well tolerated. It is not reported as painful and improvement in continence was reflected in QoL score for most children. Weekly treatments impact on family life and some families had difficulties meeting this commitment. Long term outcome data collection is in progress. [Copyright &y& Elsevier]

PURPOSE: To explore and understand parents'' experiences of their child''s genital abiguity and reconstructive genital surgeries. MATERIAL AND METHODS: Narrative inquiry was chosen and data were collected through eighteen in-depth narrative interviews with a purposive non-random sample of fifteen parents of 11 children (aged 0-11 years). Narrative analysis resulted in three keystone stories which contained aggregate stories and foundational stories. The three keystone story themes were parents’ stories about their child, about being a parent of a child with AG and about healthcare professionals. RESULTS: Interpretation and synthesis of the three keystone stories revealed three core elements fundamental to parents’ stories; shock, protection and anxiety. The synthesis reveals how even though parents had to cope with shock, protect their child whilst experiencing anxiety they were able to achieve a sense of harmony about their child. When parents were supported by healthcare staff who they trusted, they were able to develop new skills at an earlier stage in their journey. Information and control over the disclosure of information to others was important for parents. Parents believed that reconstructive surgeries were necessary to enable them to protect their child and some felt that the surgeries were necessary to bond with their child. None of the parents kept the AG surgeries secret from their child although they did not all share information openly with family or friends. Harmony is a concept that brought consistency and agreement together resulting in parents embracing their experiences holistically and giving their experiences meaning. CONCLUSIONS: Parents overcame the tensions inherent in their experience of their child''s AG and found a sense of harmony. Harmony has not previously been described in the literature. [Copyright &y& Elsevier]

The internet is increasingly being used as a source of health advice and information by individuals with long term conditions (LTCs). Specifically, online forums allow people to interact with others with similar conditions. However, it is not clear how online health information is assessed by those with LTCs. This study aims to address this gap by exploring how individuals with contested and uncontested LTCs utilise internet forums. Semi-structured interviews were conducted with 20 participants with ME/CFS and 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. The findings indicate that the use of online forums was a complex and nuanced process and was influenced by a number of individual and illness-specific factors. Participants trusted those with similar experiences and perspectives as themselves, while also valuing conventional biomedical information and advice. By accessing support online, forum users were able to draw on a personalised form of support based on the lived experiences of their peers. However, the role of digital literacy in developing and maintaining online relationships must be acknowledged. [ABSTRACT FROM AUTHOR]

Abstract: The health professions are engaged in an ongoing and dynamic process involving reflection and adaptation, with factors such as socio-economic and cultural developments and technological innovations compelling professions to respond to changed circumstances. This paper concerns English community pharmacy, where recent reforms provide financial incentives to deliver interventions, which have the potential for pharmacists to promote their knowledge and skills, as part of a professionalising strategy. The paper, drawing on interviews with 49 pharmacists, describes how responses to reforms are not necessarily in accordance with either national policy goals or enhancement of professional status. Debates about professional status and role extension have often focused on health professions’ subordination to medicine. This paper highlights the importance and interplay of other factors which help explain the inability to capitalise fully on the potential contribution to professional status, which reforms to extend professional roles afford. [Copyright &y& Elsevier]

Abstract: Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved demand management. However, the processes and imputed relationship between self-management education skills and health service contact are poorly understood. This paper reports on data from an embedded qualitative study which ran alongside a randomised controlled trial in England designed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation. Drawing on concepts from the sociology of chronic illness, analyses suggest that the biographical and social context relevant to individuals’ experience of living with a long-term condition, history of health service utilisation, and relationships with health professionals are relevant to understanding the impact of self-management education and related policies aimed at bringing about changes in service use. Our study suggests that future health policy assumptions about utilisation in the context of chronic disease management and self-care support polices may benefit by acknowledging the complex, contextual and recursive nature of health service utilisation operating in the life worlds of patients’ experience of living with a long-term condition. [Copyright &y& Elsevier]

• C. rodentium infection has advanced our understanding of mucosal immunity. • T3SS effectors form robust and flexible networks in intestinal epithelial cells. • Effector networks can undergo significant contraction while maintaining virulence. • Different effector repertoires induce distinct immune signatures. • Artificial intelligence models can allow prediction of infection outcomes in vivo. Citrobacter rodentium , a natural mouse pathogen which colonises the colon of immuno-competent mice, provides a robust model for interrogating host-pathogen-microbiota interactions in vivo. This model has been key to providing new insights into local host responses to enteric infection, including changes in intestinal epithelial cell immunometabolism and mucosal immunity. C. rodentium injects 31 bacterial effectors into epithelial cells via a type III secretion system (T3SS). Recently, these effectors were shown to be able to form multiple intracellular subnetworks which can withstand significant contractions whilst maintaining virulence. Here we highlight recent advances in understanding gut mucosal responses to infection and effector biology, as well as potential uses for artificial intelligence (AI) in understanding infectious disease and speculate on the role of T3SS effector networks in host adaption. [ABSTRACT FROM AUTHOR]

Abstract: People with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; ‘direct’, ‘embedded’, and ‘oblique’. Both settings provided interactional ‘slots’ for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated ‘oblique’ formats. We suggest that the attenuation of the ‘oblique’ format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns. [Copyright &y& Elsevier]

Context: Uremic pruritus, or itch, is common in people with chronic kidney disease (CKD) and has a negative impact on their lives and well-being. However, for reasons currently unknown, itch often remains unreported and therefore untreated.Objectives: To explore reasons for underreporting of itch to provide pointers for improving itch reporting and management in people with CKD.Methods: We interviewed adult patients with CKD who self-reported experiencing itching in the last three years (n = 25), nephrologists (n = 10), and nurses (n = 12) from three kidney services in the U.K. Topic guides were informed by previous studies and a theoretical model of self-regulation. We conducted a thematic analysis of verbatim transcripts using framework analysis.Results: We identified the following three main themes reflecting factors that may influence whether itch is reported: knowledge on causes and treatment of itch (lack of awareness of the relationship between itch and CKD, and lack of knowledge of treatment options); attitudes toward importance of itch as a health issue (patients' and clinicians' attitudes); and prompts for itch assessment during consultations (routine practice, itch as a marker, and itch severity).Conclusion: Underreporting of itch is related to patients being unaware of its causes, accepting it as something to live with, prioritizing other health issues, and the length and timing of consultations. Health care professionals' assessment and management of itch vary widely and are not necessarily evidence-based. Better patient information, development of clinical practice guidelines, and incorporation of routine symptom assessments into care may improve itch reporting and management in people with CKD. [ABSTRACT FROM AUTHOR]