Tim Shaw

Plasma membrane transformation: a common response of uterine epithelial cells during the peri‐implantation period

The plasma membrane of uterine epithelial cells and its changes during early pregnancy are reviewed. The review first examines morphological alterations in rats and mice and laboratory rodents and finds that similar changes in membrane organization accompany the peri‐implantation period: long, thin, regular microvilli are gradually converted into irregular, flattened projections. It is also found however, that in many other species related plasma membrane alterations are seen during early pregnancy. Molecular alterations in the membrane are also examined and although the evidence is so far limited, striking similarities are noted across species. The review also examines some new morphological studies on the alterations in the plasma membrane of uterine epithelial cells during early pregnancy and concludes that a process of plasma membrane transformation may be a common response across species.

Developing a national patient safety education framework for Australia

Background: In 2004, The Australian Council for Safety and Quality in Health Care recognised that the lack of a comprehensive framework describing competencies for patient safety was a barrier to achieving a competent and safe health workforce. This article describes the building of a national patient safety education framework that describes the competencies for healthcare workers. Aim: Develop an educational framework that was patient centred and identified the knowledge, skills and behaviours required by healthcare workers irrespective of their profession, position or location. Methods: The content of the framework was developed using a four-staged approach: literature review, development of learning areas and topics, classification into learning domains and, lastly, converting into a performance-sbased format. An extensive consultation and validation process was also undertaken. Results: A national patient safety education framework was endorsed by The Australian Council for Safety and Quality in Health Care in 2005. The framework is already being used to develop curricula and train the trainer programmes in patient safety. Conclusions: The framework, which draws its educational approach from adult learning principles, was extensively researched and built on the experience of healthcare workers. The next challenge is to test different strategies for implementing the framework.

Online CME: an effective alternative to face-to-face delivery

Background: The Pharmacotherapies Accreditation Course (PAC) is a continuing medical education (CME) course designed to prepare practitioners for accreditation as pharmacotherapies prescribers for opioid dependence. The course incorporates a preparation stage, a workshop stage and a clinical placement component. The PAC continues to be successfully delivered in face-to-face mode since 2001. From 2003 onwards, an online alternative of the PAC was also implemented. Aims: The aim of this study was to evaluate the effectiveness of an online alternative to an existing face-to-face CME workshop in preparing practitioners for accreditation as a pharmacotherapies prescriber for opioid dependence. Methods: Participants were 62 practitioners who undertook the PAC between 2003 and 2006. A pretest/posttest-control group design was used, with outcome measures across the domains of knowledge, skill, and attitudes, together with a course feedback survey for both the online and face-to-face modes of the course. Results: Results demonstrate that the online CME mode was equally as effective as the face-to face mode in preparing participants for their role in the treatment and management of opioid dependence, and was also rated highly by participants. Conclusions: The findings have implications for the effective design and delivery of e-learning environments for professional practice, in terms of equipping participants with requisite clinical knowledge and skills and facilitating the development of attitudes congruent with professional practice.

Pan-cadherin concentrates apically in uterine epithelial cells during uterine closure in the rat.

The ubiquitous cadherin probe, pan-cadherin was used to study changes in the distribution of cadherins in the plasma membrane of rat uterine epithelial cells during early pregnancy when the uterine lumen closes down. A major reorganisation of cadherin expression was observed to occur in uterine epithelial cells between days 1 and 6 of pregnancy with a clear shift in molecular distribution from a basal location on day 1 to a distinctly and almost exclusively apical distribution by day 6 of pregnancy when the blastocyst is attached. We suggest these results indicate participation of this molecule in closure of the uterine lumen, a phenomenon well-known to occur in the rat uterus during early pregnancy and in which apical surfaces of opposing uterine epithelial cells cohere.

Actin-Binding Proteins Undergo Major Alterations During the Plasma Membrane Transformation in Uterine Epithelial Cells

The apical surface of uterine epithelial cells undergoes a dramatic transformation during early pregnancy. Previous studies have shown that cytoskeletal actin microfilaments are associated with this transformation, but little is known of the role played by actin‐binding proteins or which of the many described in other cell types are present in uterine epithelial cells.

Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial

Purpose To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). Methods This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Womens Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance. Results Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging. Conclusion While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.

Leucocyte involvement in lectin-induced deciduomata formation.

Intra‐uterine injection of the lectin Concanavalin A (ConA) on day 5 of PSP induced a rapid and persistent infiltration of leucocytes into the rat uterine stroma. Although the infiltration of leucocytes was witnessed along the entire length of the uterine horn, areas of stromal oedema, indicative of decidualisation (as indicated by the positive Pontamine Sky Blue reaction), were only associated with regions in which the movement of leucocytes across the uterine epithelium was evident. Epithelial disruption and trauma was frequently noted within these regions. We believe that ConA may initiate decidualisation through indirectly causing epithelial trauma.

Impact of a novel online learning module on specialist palliative care nurses’ pain assessment competencies and patients’ reports of pain: Results from a quasi-experimental pilot study

Background: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain. Aim: To test the impact of an online pain assessment learning module on specialist palliative care nurses’ pain assessment competencies, and to determine whether this education impacted positively on palliative care patients’ reported pain ratings. Design: A quasi-experimental pain assessment education pilot study utilising ‘Qstream©’, an online methodology to deliver 11 case-based pain assessment learning scenarios, developed by an interdisciplinary expert panel and delivered to participants’ work emails over a 28-day period in mid-2012. The ‘Self-Perceived Pain Assessment Competencies’ survey and chart audit data, including patient-reported pain intensity ratings, were collected pre-intervention (T1) and post-intervention (T2) and analysed using inferential statistics to determine key outcomes. Setting/participants: Nurses working at two Australian inpatient specialist palliative care services in 2012. Results: The results reported conform to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines. Participants who completed the education intervention (n = 34) increased their pain assessment knowledge, assessment tool knowledge and confidence to undertake a pain assessment (p < 0.001). Participants were more likely to document pain intensity scores in patients’ medical records than non-participants (95% confidence interval = 7.3%–22.7%, p = 0.021). There was also a significant reduction in the mean patient-reported pain ratings between the admission and audit date at post-test of 1.5 (95% confidence interval = 0.7–2.3) units in pain score. Conclusion: This pilot confers confidence of the education interventions capacity to improve specialist palliative care nurses’ pain assessment practices and to reduce patient-rated pain intensity scores.

What is eHealth (6)? Development of a Conceptual Model for eHealth: Qualitative Study with Key Informants

Background Despite rapid growth in eHealth research, there remains a lack of consistency in defining and using terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalize eHealth and enable its implementation in health care practice, research, education, and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalization and hypothesis testing. Objective This study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts. Methods We conducted semistructured interviews with key informants (N=25) from organizations involved in health care delivery, research, education, practice, governance, and policy to explore their perspectives on and experiences with eHealth. We used purposeful sampling for maximum diversity. Interviews were coded and thematically analyzed for emergent domains. Results Thematic analyses revealed 3 prominent but overlapping domains of eHealth: (1) health in our hands (using eHealth technologies to monitor, track, and inform health), (2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients), and (3) data enabling health (collecting, managing, and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains. Conclusions This model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that are lacking in previous research. On the basis of this model, we suggest that eHealth initiatives that are most impactful would include elements from all 3 domains.

How does tele-learning compare with other forms of education delivery? A systematic review of tele-learning educational outcomes for health professionals

UNLABELLED Telecommuniciation technologies, including audio and videoconferencing facilities, afford geographically dispersed health professionals the opportunity to connect and collaborate with others. Recognised for enabling tele-consultations and tele-collaborations between teams of health care professionals and their patients, these technologies are also well suited to the delivery of distance learning programs, known as tele-learning. AIM To determine whether tele-learning delivery methods achieve equivalent learning outcomes when compared with traditional face-to-face education delivery methods. METHODS A systematic literature review was commissioned by the NSW Ministry of Health to identify results relevant to programs applying tele-learning delivery methods in the provision of education to health professionals. RESULTS The review found few studies that rigorously compared tele-learning with traditional formats. There was some evidence, however, to support the premise that tele-learning models achieve comparable learning outcomes and that participants are generally satisfied with and accepting of this delivery method. CONCLUSION The review illustrated that tele-learning technologies not only enable distance learning opportunities, but achieve comparable learning outcomes to traditional face-to-face models. More rigorous evidence is required to strengthen these findings and should be the focus of future tele-learning research.