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The use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units.This was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service.Four themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles.This study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.

One of the main challenges in the current pandemic is the detection of coronavirus. Conventional techniques (PT-PCR) have their limitations such as long response time and limited accessibility. On the other hand, X-ray machines are widely available and they are already digitized in the health systems. Thus, their usage is faster and more available. Therefore, in this research, we evaluate how well deep CNNs do when it comes to classifying normal versus pathological chest X-rays. Compared to the previous research, we trained our network on the largest number of images, 103,468 in total, including 5 classes such as COPD signs, COVID, normal, others and Pneumonia. We achieved COVID accuracy of 97% and overall accuracy of 81%. Additionally, we achieved classification accuracy of 84% for categorization into normal (78%) and abnormal (88%).

Background: Critically ill patients in the intensive care environment require an appropriate nursing workforce to improve quality of care and patient outcomes. However, limited information exists as to the relationship between severity of illness and nursing skill mix in the intensive care. Objective: The aim of this study was to describe the variation in nursing skill mix across different hospital types and to determine if this was associated with severity of illness of critically ill patients admitted to adult intensive care units (ICUs) in Australia and New Zealand. Design & Setting: A retrospective cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database (to provide information on patient demographics, severity of illness, and outcome) and the Critical Care Resources Registry (to provide information on annual nursing staffing levels and hospital type) from July 2014 to June 2020. Four hospital types (metropolitan, private, rural/regional, and tertiary) and three patient groups (elective surgical, emergency surgical, and medical) were examined. Main outcome measure: The main outcome measure was the proportion of critical care specialist registered nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total RNs working within each ICU each year, as reported annually to the Critical Care Resources Registry. Results: Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand, the median percentage of registered nursing FTE with a critical care qualification for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9–71.6). The percentage FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6–78.2)] and tertiary ICUs [58.1% (IQR = 51.2–70.2)], followed by metropolitan ICUs [56.0% (IQR = 44.5–68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9–70.0)]. In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher severity of illness, most notably in tertiary and private ICUs. This relationship was persistent across all hospital types when examining subgroups of emergency surgical and medical patients and in multivariable analysis after adjusting for the type of hospital and relative percentage of each diagnostic group. Conclusions: In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing teams with the highest percentage FTE of critical care specialist RNs. The Australian and New Zealand healthcare system has a critical care nursing workforce which scales to meet the acuity of ICU patients across Australia and New Zealand.

Does participation in voluntary environmental initiatives affect firm value? We take a closer look at the Chicago Climate Exchange (CCX) and the Climate Leaders (CL), two US initiatives to curb carbon emissions that were operating during a decisive regulatory event. In 2009 the Waxman-Markey Bill surprisingly passed the House of Representatives and brought the US economy a big step closer to a nationwide CO2 emission trading system. With an event study we assess how the stock market valued membership in the initiatives when the likelihood of CO2 regulation unexpectedly increased. Our findings suggest that only membership in the market-based CCX was considered beneficial for a mandated carbon market. This is consistent with research that equity-based regulation through financial markets can help economies favor clean industries over dirty ones. We interpret the empirical results in a simple model. Adding earlier market reactions to the firms’ membership announcements, the model implies that the market had been betting on a mandatory emission trading system all along., International Economics and Economic Policy, 19 (1), ISSN:1612-4804, ISSN:1612-4812

ObjectivesThe aim of this study was to test the feasibility and effectiveness of two models (face-to-face vs online teaching) of clinically integrating evidence-based medicine (EBM) teaching in an undergraduate medical school.Design and settingA pilot study of face-to-face versus online EBM teaching.ParticipantsThis study focused on undergraduate medical students who entered the University of Buckingham Medical School MBChB course in 2016 (n=65). Of the 65 students, 45 received face-to-face teaching, while 20 received online teaching.Main outcome measuresFeasibility was assessed by the ability to deliver the content, students’ engagement during teaching and their completion rates in formative assessments—Assessing Competency in EBM (ACE) tool, and educational prescriptions (EPs). Effectiveness of teaching for the two models was compared by evaluating students’ performance in the formative assessments and in the summative final professional examination and final year EBM objective structured clinical examination (OSCE).ResultsWe had similar students’ engagement and completion rates in formative assessments in both models. Students receiving face-to-face teaching performed better in EPs (mean difference=−2.28, 95% CI: −4.31 to –0.26). There was no significant difference in performances in the ACE tool (mean difference=−1.02, 95% CI: −2.20 to 0.16); the written final professional exams (mean difference=−0.11, 95% CI: −0.65 to 0.44) and the EBM OSCE station (mean difference=−0.81, 95% CI: −2.38 to 0.74).ConclusionsIt was feasible to deliver both models of clinically integrated EBM teaching. While students in the face-to-face model scored higher in EPs; there was no significant difference between the two models of teaching as measured by performances in the ACE tool or the summative assessments.

Background Medical students often struggle to understand the relevance of Evidence Based Medicine (EBM) to their clinical practice, yet it is a competence that all students must develop prior to graduation. Objective structured clinical examinations (OSCEs) are a valued assessment tool to assess critical components of EBM competency, particularly different levels of mastery as they progress through the course. This study developed and evaluated EBM based OSCE stations with an aim to establish a spiral approach for EBM OSCE stations for undergraduate medical students. Methods OSCE stations were developed with increasingly complex EBM tasks. OSCE stations were classified according to the classification rubric for EBP assessment tools (CREATE) framework and mapped against the recently published core competencies for evidence-based practice (EBP). Performance data evaluation was undertaken using Classical Test Theory analysing mean scores, pass rates, and station item total correlation (ITC) using SPSS. Results Six EBM based OSCE stations assessing various stages of EBM were created for use in high stakes summative OSCEs for different year groups across the undergraduate medical degree. All OSCE stations, except for one, had excellent correlation coefficients and hence a high reliability, ranging from 0.21–0.49. The domain mean score ranged from 13.33 to 16.83 out of 20. High reliability was demonstrated for the each of the summative OSCE circuits (Cronbach’s alpha = 0.67–0.85). In the CREATE framework these stations assessed knowledge, skills, and behaviour of medical students in asking, searching, appraising, and integrating evidence in practice. The OSCE stations were useful in assessing six core evidence-based practice competencies, which are meant to be practiced with exercises. A spiral model of OSCEs of increasing complexity was proposed to assess EBM competency as students progressed through the MBChB course. Conclusions The use of the OSCEs is a feasible method of authentically assessing leaner EBM performance and behaviour in a high stakes assessment setting. Use of valid and reliable EBM-based OSCE stations provide evidence for continued development of a hierarchy of assessing scaffolded learning and mastery of EBM competency. Further work is needed to assess their predictive validity.

ObjectivesTo systematically review the impact of mindfulness-based interventions (MBIs) on the academic performance of undergraduate medicine, nursing and allied health students.MethodsRandomised controlled trials that examined the effects of MBIs in medicine, nursing and allied health students on academic performance were eligible for inclusion. Electronic database searches were conducted across Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), PsycINFO and ERIC databases. Two authors independently reviewed citations, extracted data and assessed the quality of evidence using the Cochrane Collaboration’s risk of bias tool. A descriptive analysis of included studies and a meta-analysis using a random-effects model of standardised mean difference were performed.ResultsA total of 267 studies were returned from the search, of which 2 met the inclusion criteria. The overall risk of bias was assessed as unclear risk of bias for one study and high risk of bias for second included study. A meta-analysis of MBIs on student academic performance as measured by marks in written examination indicated no statistical difference between interventions (Standardised Mean Difference (SMD)=0.43, 95% CI −1.77 to 2.62, I2=96%).DiscussionOur systematic review highlights a lack of evidence to either support, or refute, the use of mindfulness interventions on the academic performance of undergraduate medical students. We encourage that future randomised controlled trials pay heed to the dosing of mindfulness and include a measurement of mindfulness to enable us to draw a clearer causal relationship.

Every choice we make in health professions education has a cost, whether it be financial or otherwise; by choosing one action (e.g., integrating more simulation, studying more for a summative examination) we lose the opportunity to take an alternative action (e.g., freeing up time for other teaching, leisure time). Economics significantly shapes the way we behave and think as educators and learners and so there is increasing interest in using economic ways of thinking and approaches to examine and understand how choices are made, the influence of constraints and boundaries in educational decision making, and how costs are felt. Thus, in this article, we provide a brief historical overview of modern economics, to illustrate how the core concepts of economics-scarcity (and desirability), rationality, and optimization-developed over time. We explain the important concept of bounded rationality, which explains how individual, meso-factors and contextual factors influence decision making. We then consider the opportunities that these concepts afford for health professions education and research. We conclude by proposing that embracing economic thinking opens up new questions and new ways of approaching old questions which can add knowledge about how choice is enacted in contemporary health professions education.

Background Journal clubs are an educational activity in which individuals meet to critique and discuss research articles. They are an established part of the medical education system and are considered to be a practical way to improve the content knowledge of health professionals. Aims To determine the effectiveness of journal clubs for increasing health professionals’ competency in EBM. Methods A systematic review of randomized controlled trials (RCTs) was performed. Electronic searches were conducted in October 2019 across MEDLINE, ERIC and Scopus databases. Two authors independently reviewed articles, and extracted data. A risk-of-bias tool, based on the Cochrane Collaboration's tool for assessing risk of bias in RCTs, was used to assess internal validity. Results A total of 151 citations were returned, from which five studies (n = 378 individuals) were included in the final review. No overall statistical difference in knowledge scores was observed between health professionals participating in journal clubs compared to other professional education modes (SMD 0.15, 95% CI –0.09, 0.39). Similarly, no significant difference in attitudes or implementation of evidence-based medicine practices was observed across studies. Conclusions There is insufficient evidence to support the effectiveness of journal clubs in improving the knowledge, attitudes, and implementation of evidence-based skills by health professionals in clinical practice. Further research is needed to test the effectiveness of other interventions to increase uptake of EBM in real world settings. Such interventions may include interactive components with auditing and feedback to facilitate more effective learning.

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Introduction. The flow of endodontic sealer (ES) is the property that characterizes its velocity along the certain surface and depends on the friction force. The aim of this research was to measure the flow rate of three zinc oxide eugenol based ES?s in various consistencies exposed to the load of 2 kg. Material and methods. The experimental group included prepared samples of sealers protocoled by ADA specification No. 57 A) Endomethasone N in liquid:powder ratio of 1:5, 1:6, 1:7 (standard), 1:8 and 1:9 according to the manufacturer brochure depending on the clinical situation; B) Roth 801 as 1:7 (standard) and 1:8 mixtures C) Tubliseal EWT as standard preparation (base-catalyst 1:1). A volume of 0.05 ml sealer was spread on the glass plate and upon applying the load of 2 kg the diameter of sealer was measured. In the control group the sealer samples were loaded only by the weight of glass plate (0.1kg). Results. Based on measured diameters of sealers, all of them satisfied ADA requirements for the flow (d>20mm) (Endomethasone - 20.7-27.8 mm; Roth 801- 29.6-30.0 mm; Tubliseal -39.9 mm). The thin consistency of sealers (1:5, 1:6) showed significantly higher flow than standard mixture (1:7) (p < 0.05). Conclusion. Tubliseal EWT sealer showed the highest flow rate, significantly different than standard mixtures (1:7) of Endomethasone N and Roth 801.

The global online education sector has been rising rapidly, particularly during and after the events of 2020, and is becoming mainstream much sooner than expected. Despite this, research studies report higher levels of perceived isolation, difficulties with engagement, and higher attrition rates in online compared to equivalent on-campus programs. Reasons include restrictions to the type of institutional support accessible by online students, and the lack of comprehensiveness of orientation resources. This paper describes the collaborative efforts by a cross-faculty academic team, supported by a community of practice, to create a university-wide online orientation resource—the Monash Online Learning Hub (MOLH). The development of the MOLH involved multiple phases, including an analysis of current practice, resource design and content creation, formative evaluation by staff and students, and successful integration into the university’s mainstream student orientation platform for widescale implementation. The methods adopted were varied, and involved generating both qualitative and quantitative data across multiple phases of development from online education experts at the University, that culminated in the gradual building and refinement of the MOLH. Final outcomes, implications and lessons learned are also discussed in this paper.

ObjectiveTo review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints).Eligibility criteria for study selectionObservational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality.Main outcome measuresThe main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality.Data synthesisDerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran’s Q test and the I2 metrics, with two tailed P values.Results72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a “package of interventions.” Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively.ConclusionsThis systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination.Systematic review registrationPROSPERO CRD42020178692.

OBJECTIVES: To determine the prognostic utility of reporting neuroendocrine staining at prostate cancer diagnosis, we performed a systematic review and meta-analysis. Specifically, we aimed to understand the variability in reporting of neuroendocrine staining, and determine whether different reporting approaches impact the correlation between staining and patient outcome. METHODS: Medical databases were searched to identify studies where adenocarcinoma specimens were stained with any of four neuroendocrine markers: Chromogranin A (CgA), Neuron Specific Enolase (NSE), synaptophysin and CD56. Prevalence of neuroendocrine staining and correlation to patient outcomes were analysed using a random-effects model. All statistical tests were two-sided. RESULTS: Sixty-two studies spanning 7,616 patients were analysed. The pooled prevalence for the most common marker, CgA (41%), was similar to NSE (39%) and higher than synaptophysin (31%). Prevalence of CgA staining was significantly influenced by reporting criteria, where objective thresholds reduced the variation in prevalence to 26%. No correlation was found between CgA prevalence and tumour grade. Patients positive for CgA staining using objective criteria had more rapid biochemical progression (hazard ratio 1.98 (95% CI = 1.49 to 2.65)) and poorer prostate cancer-specific survival (hazard ratio: 7.03 (95% CI = 2.55 to 19.39)) compared to negative patients, even among those with low risk cancers. CONCLUSION: Discrepancies in the reported prevalence of neuroendocrine cells in adenocarcinoma are driven by the inconsistent scoring criteria. This study unequivocally demonstrates that when neuroendocrine cell staining is assessed with objective criteria it identifies patients with poor clinical outcomes. Future studies need to determine the exact quantifiable thresholds to report neuroendocrine cell staining, to identify patients at higher risk of progression.

BackgroundThere is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice.ObjectiveTo identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course.DesignMixed methods study utilizing a retrospective cohort and a qualitative study.SettingMonash University, Melbourne, Australia.ParticipantsLongitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed.MethodsRetrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed.ResultsMore than two-thirds of the students were aged 18–20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance.ConclusionsA supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

Context High-quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. Methods We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5-year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. Results A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n = 43). The profession most commonly referred to was that of the physician (n = 46). The mean ± standard deviation (SD) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost-related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. Conclusions The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time.

Background Despite epidemiological studies worldwide have documented erectile dysfunction (ED) as a major complication of type 2 diabetes Mellitus (T2DM) in men, only limited research reported on determinants of ED in this population. The study aimed at examining the association of ED with dyslipidaemia in T2DM patients. Methods The study enrolled 813 consecutive eligible adult male T2DM patients attending the endocrinology departments of a tertiary teaching hospital in Bangladesh. Sexual function was assessed using modified International Index of Erectile Function (IIEF) in face-to-face interview and collected along with sociodemographic information. Diabetes and lipid profile and treatment history were collected from patient's treatment records. Association of ED with dyslipidaemia was assessed using multivariable logistic regression adjusting for potential confounders. Result Prevalence of ED among the T2DM patients was very high (72.7%), of which around half had moderated-to-severe ED. Odds of having dyslipidaemia among T2DM patients with ED is 2.3 times higher than those without. The odds increased by approximately 3 fold for an abnormal High Density Lipoprotein level and by 2.7 fold for abnormal Low Density Lipoprotein. Conclusion Dyslipidaemia was associated with increased ED risk among T2DM. Abnormal lipoprotein level particularly were found to pose greater risk.

Introduction. Calcium silicate (CS) dental cements have numerous clinical indications in dentistry including pulp capping, root end surgery, perforation repair and apexification/apexogenesis treatment. Materials and methods. Novel CS based dental cement with incorporation of SrCO3 radiopacifier named ALBO-DENT was used as an experimental cement material while Portland cement (Aalborg, Denmark) and ProRoot MTA (Tulsa Dental, USA) were used as controls. The radiopacity evaluation was performed using digital Trophy Radiographic system with an intention to precisely determine the minimum of radiopaque agent needed to confer to ISO radiopacity requirement. Thereafter, biocompatibility of material was tested in in vitro conditions in mouse fibrosarcoma L929 cell culture treated with materials? extracts. Cell morphology was observed using phase-contrast microscopy, while cell viability was measured using crystal violet (CV) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assays. Results. Radiopacity evaluation revealed that 30%wt addition of SrCO3 was necessary to achieve satisfactory radiopacity (3.45 mm Al). Cytotoxicity analysis using CV and MTT assays revealed that pure extracts of ALBO-DENT presented superior biocompatibility when compared to PC and MTA controls while serial dilutions of experimental cements? extracts as well as that of PC and MTA did not influence L929 cell viability. Conclusions. Novel formulation of CS cement - ALBO-DENT presented satisfactory radiopacity and adequate biocompatibility.

Growing demand for accountability, transparency, and efficiency in health professions education is expected to drive increased demand for, and use of, cost and value analyses. In this AMEE Guide, we introduce key concepts, methods, and literature that will enable novices in economics to conduct simple cost and value analyses, hold informed discussions with economic specialists, and undertake further learning on more advanced economic topics. The practical structure for conducting analyses provided in this guide will enable researchers to produce robust results that are meaningful and useful for improving educational practice. Key steps include defining the economic research question, identifying an appropriate economic study design, carefully identifying cost ingredients, quantifying, and pricing the ingredients consumed, and conducting sensitivity analyses to explore uncertainties in the results.

Background Clinically integrated Evidence Based Medicine (EBM) teaching promotes higher order application of knowledge, skills, and behaviours. There is, however, limited evidence on the most efficient model for clinically integrating EBM teaching. The aim of this study was to test the feasibility of integrating EBM teaching into clinical placements in an undergraduate medical school and compare the effectiveness of two different methods of EBM teaching - active teaching and passive teaching. Methods Active teaching involved blended learning methods and facilitated small group discussions. Passive teaching involved self-directed small group discussions and a remote live telecast taught session. Students’ EBM competencies were assessed using the Assessing Competency in EBM (ACE tool) and Educational Prescriptions (EP) and in summative final professional written and clinical examinations.Results Education was delivered to 65 students, of whom 45 received active teaching, while 20 received passive teaching. Students receiving active teaching performed better in EPs (MD=-2.28, -4.31, -0.26). There was no significant difference in performances in the ACE tool (MD=-1.02, -2.20, 0.16); the written final professional exams (MD=-0.11, -0.65, 0.44) and the EBM OSCE stations (MD=-0.81, -2.38, 0.74). Conclusions It was feasible to integrate EBM teaching into clinical placements in an undergraduate medical school. Both active and passive methods were effective in delivering EBM teaching. While students in the active teaching model scored higher in EPs; there was no significant difference in performances in the ACE tool or the summative assessments. Scaffolding student learning or a spiral approach to EBM teaching model provides a great example of continually shifting the zone of proximal development.

Background Due to the complex nature of healthcare professionals’ roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus. Methods The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches. Discussion The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.

CONTEXT The design of selection methods must balance, amongst a range of factors, the desire to select the best possible future doctors with the reality of our resource-constrained environment. Examining the cost of selection processes enables us to identify areas in which efficiencies may be gained. METHODS A cost description study was conducted based on selection for 2018 entry into medical school directly from secondary school. The perspectives of applicants, volunteer interviewers and the admitting institution were considered. Costs were modelled based on the Monash University (Australia) selection process, which uses a combination of secondary school matriculation score, aptitude test score (Undergraduate Medicine and Health Sciences Admission Test) and multiple mini-interview score. A variety of data sources were utilised, including bespoke surveys, audit data and existing literature. All costs are expressed in 2018 Australian dollars (AU$). Applicant behaviours in preparing for selection tests were also evaluated. RESULTS A total of 381 of 383 applicants returned the survey. Over 70% of applicants had utilised commercial preparation materials. The median total cost to applicants was AU$2586 (interquartile range [IQR] AU$1574-3999), including costs to both prepare for and attend selection tests. Of 217 volunteer interviewers, 108 returned the survey. These were primarily health professional clinicians at a mid-career stage. The median total cost to interviewers was AU$452 (IQR AU$252-715) for participation in a half-day interview session, largely due to the loss of income. The cost to the admitting institution was AU$269 per applicant, accounted for by the costs of equipment and consumables (52%), personnel (34%) and facilities (14%). CONCLUSIONS The costs of student selection for medical school are substantial. Understanding costs facilitates achievement of the objective of selecting the desired future medical workforce within the constraints of the resources available. Opportunities for change may arise from changes in applicant preparation behaviours, opportunities for economies of scale, and efficiencies driven by technological solutions.

Objectives The objective of this study was to explore how social media is used by a population of injured professional athletes, by comparing the content and frequency of posts on social media, pre and post-injury. Design A retrospective mixed methods design was utilised. Methods Professional Australian Football League (AFL) players, injured during the 2015 season, were included in the study. Publicly accessible social media profiles for these players were identified on Twitter and Instagram. All posts published on verified profiles, from four weeks prior to injury until return to play, were extracted. Thematic analysis was used to investigate the content of these posts, while univariate and multivariate linear regression was used to investigate the frequency of posts during this time period. Results Two reoccurring themes were identified exclusively post-injury; ‘supporting team from the sideline’ and ‘sharing information about injury and rehabilitation’. The frequency of total posts did not differ significantly pre and post-injury, but the frequency of injury related posts increased in the immediate post-injury phase, then decreased between 4–8 weeks and 8–12 weeks post-injury. The frequency of injury related posts was higher with more severe injuries. Conclusions The findings of this study suggest that injured players use social media to seek social support from their followers, especially in the immediate post-injury period and after sustaining a severe injury. The role of social media in injury rehabilitation may warrant further investigation, to determine if it could be used to facilitate return to play.

Immigrant groups that are marginalized in their host countries are disproportionately more likely to have their citizenship applications rejected. It is not readily obvious whether this disparity is due to prejudice on the part of decisionmakers or due to applicant differences in meeting naturalization standards. To address this question, I develop a simple model of a council deciding whether to grant applicants citizenship. The model implies an empirical test for prejudice using average applicant group rejection rates. Using Switzerland as a case study, I apply the test to newly collected data from six large municipalities. In five municipalities, the test cannot reject the hypothesis of no prejudice with respect to country of origin. The rejection pattern of the sixth municipality is consistent with prejudice. The model illustrates some general points about the underlying mechanism in the decisionmaking process which have bearing on the inference of prejudice in naturalizations from observational data.

Objective The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. Methods Seven focus groups were conducted with 47 participants, representing three stakeholder groups − men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis. Results Knowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation. Conclusion GPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice. Practice implications A feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.

Background: Student failure creates additional economic costs. Knowing the cost of failure helps to frame its economic burden relative to other educational issues, providing an evidence-base to guide priority setting and allocation of resources. The Ingredients Method is a cost-analysis approach which has been previously applied to health professions education research. In this study, the Ingredients Method is introduced, and applied to a case study, investigating the cost of pre-clinical student failure. Methods: The four step Ingredients Method was introduced and applied: (1) identify and specify resource items, (2) measure volume of resources in natural units, (3) assign monetary prices to resource items, and (4) analyze and report costs. Calculations were based on a physiotherapy program at an Australian university. Results: The cost of failure was £5991 per failing student, distributed across students (70%), the government (21%), and the university (8%). If the cost of failure and attrition is distributed among the remaining continuing cohort, the cost per continuing student educated increases from £9923 to £11,391 per semester. Conclusions: The economics of health professions education is complex. Researchers should consider both accuracy and feasibility in their costing approach, toward the goal of better informing cost-conscious decision-making.

The majority of studies to date have focused on the effects of work stress in the nursing environment, with the effect of personal stress in nursing being less explored. This study sought to determine whether personal stress is a more significant predictor of burnout, job satisfaction and general health than work stress. Of the 1200 nurses randomly selected to participate in the study, 895 agreed to complete six questionnaires over 3 weeks. Data was analysed using hierarchical multiple linear regression. Findings revealed that personal stress is a better predictor of burnout and general health than job satisfaction, which is better predicted by work stress. The findings of this study could inform potential solutions to reduce the impact of personal and work stress on burnout, job satisfaction and general health. Coping strategies and staffing strategies need to be evaluated within developing contexts such as South Africa to ascertain their effectiveness.

Objective To determine the effects of laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP) compared with open radical prostatectomy (ORP) in men with localized prostate cancer. Materials and Methods We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings, with no restrictions on the language of publication or publication status, up until 9 June 2017. We included all randomized or pseudo-randomized controlled trials that directly compared LRP and RARP with ORP. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. Results We included two unique studies in a total of 446 randomized participants with clinically localized prostate cancer. All available outcome data were short-term (up to 3 months). We found no study that addressed the outcome of prostate cancer-specific survival. Based on one trial, RARP probably results in little to no difference in urinary quality of life (mean difference [MD] −1.30, 95% confidence interval [CI] −4.65 to 2.05; moderate quality of evidence) and sexual quality of life (MD 3.90, 95% CI: −1.84 to 9.64; moderate quality of evidence). No study addressed the outcomes of biochemical recurrence-free survival or overall survival. Based on one trial, RARP may result in little to no difference in overall surgical complications (risk ratio [RR] 0.41, 95% CI: 0.16−1.04; low quality of evidence) or serious postoperative complications (RR 0.16, 95% CI: 0.02–1.32; low quality of evidence). Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at 1 day (MD −1.05, 95% CI: −1.42 to −0.68; low quality of evidence) and up to 1 week (MD −0.78, 95% CI: −1.40 to −0.17; low quality of evidence). Based on one study, RARP probably results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI: −0.32 to 0.34; moderate quality of evidence). Based on one study, RARP probably reduces the length of hospital stay (MD −1.72, 95% CI: −2.19 to −1.25; moderate quality of evidence). Based on two studies, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI: 0.12–0.46; low quality of evidence). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1,000 men (95% CI: 78–48 fewer). Conclusions There is no evidence to inform the comparative effectiveness of LRP or RARP compared with ORP for oncological outcomes. Urinary and sexual quality of life appear similar. Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions.

To explore the experiences of family members of patients treated with extracorporeal membrane oxygenation.Sudden onset of an unexpected and severe illness is associated with an increased stress experience of family members. Only one study to date has explored the experience of family members of patients who are at high risk of dying and treated with extracorporeal membrane oxygenation.A qualitative descriptive research design was used.A total of 10 family members of patients treated with extracorporeal membrane oxygenation were recruited through a convenient sampling approach. Data were collected using open-ended semi-structured interviews. A six-step process was applied to analyse the data thematically. Four criteria were employed to evaluate methodological rigour.Family members of extracorporeal membrane oxygenation patients experienced psychological distress and strain during and after admission. Five main themes (Going Downhill, Intensive Care Unit Stress and Stressors, Carousel of Roles, Today and Advice) were identified. These themes were explored from the four roles of the Carousel of Roles theme (decision-maker, carer, manager and recorder) that participants experienced.Nurses and other staff involved in the care of extracorporeal membrane oxygenation patients must pay attention to individual needs of the family and activate all available support systems to help them cope with stress and strain.An information and recommendation guide for families and staff caring for extracorporeal membrane oxygenation patients was developed and needs to be applied cautiously to the individual clinical setting.