Northern Ireland and ‘The Troubles’, outlining an innovative approach to nursing/midwifery student teaching and module evaluation

This discussion paper outlines an approach to developing and evaluating an educative programme primarily delivered by lay `citizen trainers’ in educating student nurses, and student midwives to the impact of and experience of extended and extensive civil unrest within their communities (`the Troubles’ ). This is drawn from experience within the Northern Ireland `Troubles’ and all of the citizen trainers were directly affected physically/psychologically. The programme was intended to both educate but primarily to help facilitate student nurses and student midwives to better understanding to experience and context and to more effective care delivery to those affected by/damaged by `the Troubles’. Evaluation of the teaching and learning by the students was significantly positive.

Microneedles: an innovative platform for gene delivery

The advent of microneedle (MN) technology has provided a revolutionary platform for the delivery of therapeutic agents, particularly in the field of gene therapy. For over 20 years, the area of gene therapy has undergone intense innovation and progression which has seen advancement of the technology from an experimental concept to a widely acknowledged strategy for the treatment and prevention of numerous disease states. However, the true potential of gene therapy has yet to be achieved due to limitations in formulation and delivery technologies beyond parenteral injection of the DNA. Microneedle-mediated delivery provides a unique platform for the delivery of DNA therapeutics clinically. It provides a means to overcome the skin barriers to gene delivery and deposit the DNA directly into the dermal layers, a key site for delivery of therapeutics to treat a wide range of skin and cutaneous diseases. Additionally, the skin is a tissue rich in immune sentinels, an ideal target for the delivery of a DNA vaccine directly to the desired target cell populations. This review details the advancement of MN-mediated DNA delivery from proof-of-concept to the delivery of DNA encoding clinically relevant proteins and antigens and examines the key considerations for the improvement of the technology and progress into a clinically applicable delivery system.

Sorting out mix-ups. The provenance of tissue sections may be confirmed by PCR using microsatellite markers

Standard identification systems usually ensure that biopsy material is correctly associated with a given patient. Sometimes, as when a tumor is unexpectedly found, the provenance (proof of origin) of a tissue sample may be questioned; the tissue may have been mislabelled or contaminated with tissue from another patient. Techniques used to confirm tissue provenance include comparing either tissue markers of gender or ABO blood groups; however, these methods have weak confirmatory power. Recently, the use of DNA-based polymerase chain reaction (PCR) techniques has been reported. Paired, formalin-fixed, paraffin-embedded, 10 microns tissue sections were selected from 17 patients, 8 of whom had carcinoma, either by dividing a biopsy section, using sequential biopsies, or sequential biopsy and autopsy tissue. The resulting 36 samples were coded before analysis. In two additional cases, 1-mm fragments of tumor from one patient were included in the tissue block of benign tissue from another patient, the tumor fragments were identified on hematoxylin-and-eosin-stained sections, separately scraped off the glass slide, and analyzed. Tissue from two clinical cases, one of suspected mislabelling and one with a suspected carry-over of malignant tissue were also investigated. Short tandem repeat sequences (STR) or microsatellites, are 2-5 base pair repeats that vary in their repeat number between individuals. This variation (polymorphism) can be assessed using a PCR. A panel of markers of 3 STRs; ACPP, INT 2, and CYP 19 (on chromosomes 3, 11, and 15, respectively) were used. DNA was isolated from the samples after xylene deparaffinization and proteinase digestion, and was then amplified in a radioactive PCR using primers selected to give a product size ranging from 136-178 bases. Amplified products were electrophoresed on denaturing polyacrylamide gels, dried, and autoradiographed. DNA segments were successfully extracted from all samples but one, which was fixed in Bouin's fluid. By comparing allele sizes from the panel, all tissue pairs (other than the Bouin's pair) were successfully matched, the 1-mm tumor fragments were correctly assigned, and the two clinical problems were solved. STRs are highly informative and robust markers, well suited to PCR of small portions of tissue sections, and are an effective method to confirm the provenance of benign and malignant biopsy and autopsy material.

Innovative interprofessional teaching session on labour and childbirth for undergraduate medical and midwifery students

There is an increasing recognition of the need to improve interprofessional relationships within clinical practice (Midwifery 2020, 2010). Evidence supports the assertion that healthcare professionals who are able to communicate and work effectively together and who have a mutual respect and understanding for one another’s roles will provide a higher standard of care (McPherson et al, 2001; Miers et al, 2005; Begley, 2008). The joint Royal College of Obstetrics & Gynaecologists(RCOG) / Royal College of Midwives (RCM) report (2008 Page 8) on clinical learning environment and recruitment recommended that “Inter-professional learning strategies should be introduced and supported at an early stage in the medical and midwifery undergraduate students' experience and continued throughout training.” Providing interprofessional education within a University setting offers an opportunity for a non-threatening learning environment where students can develop confidence and build collaborative working relationships with one another (Saxell et al, 2009).Further research supports the influence of effective team working on increased client satisfaction. Additionally it identifies that the integration of interprofessional learning into a curriculum improves students’ abilities to interact professionally and provides a better understanding of role identification within the workplace than students who have only been exposed to uniprofessional education (Meterko et al, 2004; Pollard and Miers, 2008; Siassakos, et al, 2009; Wilhelmsson et al, 2011; Murray-Davis et al, 2012). An interprofessional education indicative has been developed by teaching staff from the School of Nursing and Midwifery and School of Medicine at Queen’s University Belfast. The aim of the collaboration was to enhance interprofessional learning by providing an opportunity for medical students and midwifery students to interact and communicate prior to medical students undertaking their obstetrics and gynaecology placements. This has improved medical students placement experience by facilitating them to learn about the process of birth and familiarisation of the delivery suite environment and it also has the potential to enhance interprofessional relationships. Midwifery students benefit through the provision of an opportunity to teach and facilitate learning in relation to normal labour and birth and has provided them with an opportunity to build stronger and more positive relationships with another profession. This opportunity also provides a positive, confidence building forum where midwifery students utilise teaching and learning strategies which would be transferable to their professional role as registered midwives. The midwifery students were provided with an outline agenda in relation to content for the workshop, but then were allowed creative licence with regard to delivery of the workshop. The interactive workshops are undertaken within the University’s clinical education centre, utilising low fidelity simulation. The sessions are delivered 6 times per year and precede the medical students’ obstetric/gynaecology placement. All 4th year medical and final year midwifery students have an opportunity to participate. Preliminary evaluations of the workshops have been positive from both midwifery and medical students. The teaching sessions provided both midwifery and medical students with an introduction to inter professional learning and gave them an opportunity to learn about and respect each other’s roles. The midwifery students have commented on the enjoyable aspects of team working for preparing for the workshop and also the confidence gained from teaching medical students. The medical students have evaluated the teaching by midwifery students positively and felt that it lowered their anxiety levels going into the labour setting. A number of midwifery and medical students have subsequently worked with one another within the practice setting which has been recognised as beneficial. Both Schools have recognised the benefits of interprofessional education and have subsequently made a commitment to embed it within each curriculum.

CSFinder: A Cold-Start Friend Finder in Large-Scale Social Networks

Recommending users for a new social network user to follow is a topic of interest at present. The existing approaches rely on using various types of information about the new user to determine recommended users who have similar interests to the new user. However, this presents a problem when a new user joins a social network, who is yet to have any interaction on the social network. In this paper we present a particular type of conversational recommendation approach, critiquing-based recommendation, to solve the cold start problem. We present a critiquing-based recommendation system, called CSFinder, to recommend users for a new user to follow. A traditional critiquing-based recommendation system allows a user to critique a feature of a recommended item at a time and gradually leads the user to the target recommendation. However this may require a lengthy recommendation session. CSFinder aims to reduce the session length by taking a case-based reasoning approach. It selects relevant recommendation sessions of past users that match the recommendation session of the current user to shortcut the current recommendation session. It selects relevant recommendation sessions from a case base that contains the successful recommendation sessions of past users. A past recommendation session can be selected if it contains recommended items and critiques that sufficiently overlap with the ones in the current session. Our experimental results show that CSFinder has significantly shorter sessions than the ones of an Incremental Critiquing system, which is a baseline critiquing-based recommendation system.

Evaluation of 'Dementia Friends' programme for undergraduate nursing students: Innovative practice.

The ‘dementia friends’ programme was launched by the Alzheimer’s Society in the UK two years ago with the purpose of educating members of the public about the things they can do which can enhance the lives of people living with dementia. The aim of this project was to deliver a two-hour ‘Dementia Friendly Community Workshop’ written by the Alzheimer’s Society, to an entire cohort of first-year undergraduate nursing students in one Higher Education Institutions in Northern Ireland. Following delivery of the programme, students were asked to complete a short questionnaire on their knowledge and confidence in relation to dementia care before and after the Dementia Friendly Community programme. A total of 322 undergraduate first-year nursing students took part in the Dementia Friendly Community programme. Of these, 304 returned questionnaires; 31.25% of students stated their perceived improvement in dementia knowledge was ‘good’ while 49.01% stated their perceived improvement in dementia knowledge was ‘very good’ and 13.49% stated their perceived improvement in dementia knowledge was ‘excellent’. In relation to confidence in engaging with people with dementia, 31.91% stated ‘good’ improvement, 40.79% stated ‘very good’ improvement and 11.84% stated ‘excellent’ improvement. The Dementia Friendly Community programme was positively reviewed by the undergraduate students as it enhanced knowledge and confidence in relation to care of someone living with dementia.