Introducing an obstetric emergency training strategy into a simulated environment

Midwifery educators are challenged to produce registrants who are fit for practice at the point of registration with competence at the heart of this expectation. In addition to achieving expertise in normal pregnancy, it is recognised that students need to have the skills of critical decision making where normal processes become adversely affected.
An evaluation was undertaken with final year direct entry midwifery students using questionnaires and focus group interviews to determine whether simulated learning, such as the Practical Obstetric Multi-Professional Training (PROMPT) package, for emergency obstetric training would enhance self-efficacy and confidence levels in preparation for post-registration practice. The main themes that emerged from the study indicate that this style of learning increased midwifery students’ feelings of self-efficacy; highlighted the importance of a safe learning environment; reduced their anxiety regarding their ability to make decisions in clinical practice and reinforced confidence in their level of knowledge.

Low Fidelity Simulation as a Mechanism to Enhance Midwifery Students’ Confidence in Relation to Emergency Obstetric Training

Simulation offers a safe opportunity for students to practice clinical procedures without exposure and risk of harm to real patients (Partin et al, 2011). Simulation is recognised to increase students’ confidence in their ability to make critical decisions (McCaughey and Traynor, 2010). Within Queen’s University Belfast, simulation for obstetric emergency training based on the ethos of ‘Practical Obstetric Multi-Professional Training[PROMPT]’ (Draycott et al, 2008) has been developed for midwifery students and is now uniquely embedded within the pre-registration curriculum. An important aspect of the PROMPT training is the use of low fidelity simulation as opposed to high tech support (Crofts et al, 2008). Studies have reflected that low fidelity simulation can be an effective tool for promoting student confidence (Tosterud, 2013; Hughes et al, 2013). Students are given the opportunity to experience obstetric emergencies within a safe environment and evaluation has indicated that students feel safe and have an increase in confidence and self-efficacy. The immediacy of the feedback offered by simulated situations encourages an exploration of beliefs and attitudes, particularly with peers, promoting a deeper sense of learning (Stoneham and Feltham, 2009).This paper will discuss why low fidelity simulation can effectively enhance the student experience and promote self-efficacy.

Preparing medical students for normal birth: an interactive workshop by pre-registration midwifery students.

There is an increasing recognition of the need to improve inter professional relationships within clinical practice (DoH, 2001). Evidence supports the assertion that health care 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; Begley, 2008). Providing inter professional 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).
An inter-professional education initiative was developed in Queen’s University Belfast within the Schools of Nursing and Midwifery and Medicine and piloted in 2014. The aim of the collaboration was to introduce concepts of normal labour and birth to fourth year medical students prior to their obstetric and gynaecological placement in hospital. The teaching staff felt this would be an excellent opportunity for final year pre-registration midwifery students to demonstrate their knowledge and understanding on normality in labour and birth by preparing interactive workshops with the medical students. 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 workshops consisted of approximately 4 midwifery students to 12 medical students. Resources such as birthing balls, birth mannequins, dolls and pelvises were available to the students to increase interactivity. Significant emphasis was placed upon the importance of relationship building with women in labour and the concept of being ‘with woman’ was core to all elements of teaching. Midwifery students undertook acting roles such as the labouring woman, partner or a midwife role and acted out mini scenarios such as contacting for advice about early labour; positions for labour or positions for birth. Medical students were prompted to vocalise about their feelings towards labour and birth and encouraged to think about their role within the birth setting.
Preliminary evaluations of the workshops have been extremely positive from both the midwifery students and the medical students. The midwifery students have commented on the enjoyable aspects of team working for preparing for the workshop and also the confidence gained from teaching the medical students. The medical students have evaluated the teaching by the midwifery students positively and felt that it lowered their anxiety 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 this form of inter professional education and have subsequently made a commitment to embed it within each curriculum.

Eficacia de la melatonina en insomnio primario en el adulto mayor: revisión sistemática de la literatura

Introducción: La melatonina, una sustancia cronobiótica endógena, es cada vez más empleada para el manejo de los problemas del sueño en adultos mayores por su aparente eficacia y buen perfil de eventos adversos. En este sentido, se intentó evaluar la eficacia de la melatonina en el tratamiento del insomnio primario en el adulto mayor (≥55 años) comparado con benzodiacepinas, zopiclona y placebo a la luz de la evidencia disponible en los últimos cinco años. Métodos: Revisión sistemática de la literatura. Resultados: En comparación con placebo, al parecer la melatonina mejora la calidad y los hábitos de sueño, no así la latencia de inicio de sueño en mediciones subjetivas ni objetivas (polisomnografía); a diferencia de otros medicamentos hipnóticos, no altera la arquitectura del sueño ni genera síntomas diurnos. Conclusiones: No se encontró evidencia que soporte el uso de melatonina en adultos mayores de 55 años para la reducción de la latencia de sueño, aumento del tiempo total de sueño, mejoría de la eficiencia del sueño, disminución de despertares nocturnos o mejoría de la calidad de sueño. Es necesario adelantar más estudios en comparación con placebo y otros medicamentos.

Trombosis asociada a cateter venoso central en pediatría de la Fundación Cardioinfantil julio 2013 a julio 2015

La trombosis relacionada al uso del catéter es un problema que cobra cada vez mayor importancia. Se han descrito factores de riesgo para su presentación en la población pediátrica pero aún no se han realizado estudios en nuestro medio. Objetivo: Determinar los factores de riesgo y la prevalencia de la trombosis asociada a catéter venoso central en los pacientes pediátricos de la Fundación Cardioinfantil hospitalizados durante el periodo comprendido entre Julio 2013 a Julio 2015. Metodología: Se realizó un estudio de corte transversal de asociación. Se incluyeron pacientes clasificados en 4 grupos: trombosis y catéter, trombosis sin catéter, catéter sin trombosis y sin trombosis ni catéter. Se estimaron OR como medidas de asociación utilizando el estadístico mantel haenszel. Resultados: En total se incluyeron 221 pacientes. La prevalencia de la trombosis y uso del catéter fue del 22%. La edad inferior a los 36 meses (OR 2,27 IC95% 1,16-4,44,p<0.001), profilaxis antitrombótica (OR 34,4 IC95% 4,18-282,92, p<0.01), hospitalización en la UCI (OR 3,82, IC95% 1,69-8,65, p<0.001) y el tiempo de hospitalización (OR 16,83 IC95% 7,8-36,27, p<0.001) están asociadas con un mayor riesgo de presentación de la trombosis. Conclusión: La edad, hospitalización en UCI, uso de profilaxis antitrombótica y el tiempo de hospitalización son factores de riesgo que estan relacionados con la presentación de la trombosis en pacientes con cateter.

Perspex machine XI: topology of the transreal numbers

The transreal numbers are a total number system in which even, arithmetical operation is well defined even-where. This has many benefits over the real numbers as a basis for computation and, possibly, for physical theories. We define the topology of the transreal numbers and show that it gives a more coherent interpretation of two's complement arithmetic than the conventional integer model. Trans-two's-complement arithmetic handles the infinities and 0/0 more coherently, and with very much less circuitry, than floating-point arithmetic. This reduction in circuitry is especially beneficial in parallel computers, such as the Perspex machine, and the increase in functionality makes Digital Signal Processing chips better suited to general computation.

Perspex machine VII: The universal perspex machine

The perspex machine arose from the unification of projective geometry with the Turing machine. It uses a total arithmetic, called transreal arithmetic, that contains real arithmetic and allows division by zero. Transreal arithmetic is redefined here. The new arithmetic has both a positive and a negative infinity which lie at the extremes of the number line, and a number nullity that lies off the number line. We prove that nullity, 0/0, is a number. Hence a number may have one of four signs: negative, zero, positive, or nullity. It is, therefore, impossible to encode the sign of a number in one bit, as floating-, point arithmetic attempts to do, resulting in the difficulty of having both positive and negative zeros and NaNs. Transrational arithmetic is consistent with Cantor arithmetic. In an extension to real arithmetic, the product of zero, an infinity, or nullity with its reciprocal is nullity, not unity. This avoids the usual contradictions that follow from allowing division by zero. Transreal arithmetic has a fixed algebraic structure and does not admit options as IEEE, floating-point arithmetic does. Most significantly, nullity has a simple semantics that is related to zero. Zero means "no value" and nullity means "no information." We argue that nullity is as useful to a manufactured computer as zero is to a human computer. The perspex machine is intended to offer one solution to the mind-body problem by showing how the computable aspects of mind and. perhaps, the whole of mind relates to the geometrical aspects of body and, perhaps, the whole of body. We review some of Turing's writings and show that he held the view that his machine has spatial properties. In particular, that it has the property of being a 7D lattice of compact spaces. Thus, we read Turing as believing that his machine relates computation to geometrical bodies. We simplify the perspex machine by substituting an augmented Euclidean geometry for projective geometry. This leads to a general-linear perspex-machine which is very much easier to pro-ram than the original perspex-machine. We then show how to map the whole of perspex space into a unit cube. This allows us to construct a fractal of perspex machines with the cardinality of a real-numbered line or space. This fractal is the universal perspex machine. It can solve, in unit time, the halting problem for itself and for all perspex machines instantiated in real-numbered space, including all Turing machines. We cite an experiment that has been proposed to test the physical reality of the perspex machine's model of time, but we make no claim that the physical universe works this way or that it has the cardinality of the perspex machine. We leave it that the perspex machine provides an upper bound on the computational properties of physical things, including manufactured computers and biological organisms, that have a cardinality no greater than the real-number line.

Perspex machine IX: transreal analysis

We introduce transreal analysis as a generalisation of real analysis. We find that the generalisation of the real exponential and logarithmic functions is well defined for all transreal numbers. Hence, we derive well defined values of all transreal powers of all non-negative transreal numbers. In particular, we find a well defined value for zero to the power of zero. We also note that the computation of products via the transreal logarithm is identical to the transreal product, as expected. We then generalise all of the common, real, trigonometric functions to transreal functions and show that transreal (sin x)/x is well defined everywhere. This raises the possibility that transreal analysis is total, in other words, that every function and every limit is everywhere well defined. If so, transreal analysis should be an adequate mathematical basis for analysing the perspex machine - a theoretical, super-Turing machine that operates on a total geometry. We go on to dispel all of the standard counter "proofs" that purport to show that division by zero is impossible. This is done simply by carrying the proof through in transreal arithmetic or transreal analysis. We find that either the supposed counter proof has no content or else that it supports the contention that division by zero is possible. The supposed counter proofs rely on extending the standard systems in arbitrary and inconsistent ways and then showing, tautologously, that the chosen extensions are not consistent. This shows only that the chosen extensions are inconsistent and does not bear on the question of whether division by zero is logically possible. By contrast, transreal arithmetic is total and consistent so it defeats any possible "straw man" argument. Finally, we show how to arrange that a function has finite or else unmeasurable (nullity) values, but no infinite values. This arithmetical arrangement might prove useful in mathematical physics because it outlaws naked singularities in all equations.

Perspex machine VIII: axioms of transreal arithmetic

Transreal arithmetic is a total arithmetic that contains real arithmetic, but which has no arithmetical exceptions. It allows the specification of the Universal Perspex Machine which unifies geometry with the Turing Machine. Here we axiomatise the algebraic structure of transreal arithmetic so that it provides a total arithmetic on any appropriate set of numbers. This opens up the possibility of specifying a version of floating-point arithmetic that does not have any arithmetical exceptions and in which every number is a first-class citizen. We find that literal numbers in the axioms are distinct. In other words, the axiomatisation does not require special axioms to force non-triviality. It follows that transreal arithmetic must be defined on a set of numbers that contains{-8,-1,0,1,8,&pphi;} as a proper subset. We note that the axioms have been shown to be consistent by machine proof.