Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.
A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.
Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p
The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.
The objective of this study is to evaluate the impact of the COVID-19 outbreak on mental health and burn-out syndrome in Spanish internists and the factors that could be related to its appearance.
We performed an observational, cross-sectional, descriptive study for which we designed a survey that was distributed in May 2020.
We included internists who worked in Spain during the COVID-19 outbreak.
A total of 1015 internists responded to the survey. Of those 62.9% were women.
Of 1015 people, 58.3% presented with high emotional exhaustion, 61.5% had a high level of depersonalisation and 67.6% reported low personal fulfilment. 40.1% presented with the 3 criteria described, and therefore burn-out syndrome.
Burn-out syndrome was independently related to the management of patients with SARS-CoV-2 (HR: 2.26; 95% CI 1.15 to 4.45), the lack of availability of personal protective equipment (HR: 1.41; 95% CI 1.05 to 1.91), increased responsibility (HR: 2.13; 95% CI 1.51 to 3.01), not having received financial compensation for overtime work (HR: 0.43; 95% CI 0.31 to 0.62), not having rested after 24-hour shifts (HR: 1.61; 95% CI 1.09 to 2.38), not having had holidays in the previous 6 months (HR: 1.36; 95% CI 1.01 to 1.84), consumption of sleeping pills (HR: 1.83; 95% CI 1.28 to 2.63) and higher alcohol intake (HR: 1.95; 95% CI 1.39 to 2.73).
During the COVID-19 outbreak, 40.1% of Internal Medicine physicians in Spain presented with burn-out syndrome, which was independently related to the assistance of patients with SARS-CoV-2, overworking without any compensation and the fear of being contagious to their relatives. Therefore, it is imperative to initiate programmes to prevent and treat burn-out in front-line physicians during the COVID-19 outbreak.
Intestinal microbiota is arising as a new element in the physiopathology of cardiovascular diseases. A healthy microbiota includes a balanced representation of bacteria with health promotion functions (symbiotes). The aim of this study is to analyse the relationship between intestinal microbiota composition and arterial stiffness.
An observational case—control study will be developed. Cases will be defined by the presence of at least one of the following: carotid-femoral pulse wave velocity (cf-PWV), Cardio-Ankle Vascular Index (CAVI), brachial ankle pulse wave velocity (ba or ba-PWV) above the 90th percentile, for age and sex, of the reference population. Controls will be selected from the same population as cases. The study will be developed in Primary Healthcare Centres. We will select 500 subjects (250 cases and 250 controls), between 45 and 74 years of age. Cases will be selected from a database that combines data from EVA study (Spain) and Guimarães/Vizela study (Portugal). Measurements: cf-PWV will be measured using the SphygmoCor system, CAVI, ba-PWV and Ankle-Brachial Index will be determined using VaSera device. Gut microbiome composition in faecal samples will be determined by 16S ribosomal RNA sequencing. Lifestyle will be assessed by food frequency questionnaire, adherence to the Mediterranean diet and IPAQ (International Physical Activity Questionnaire). Body composition will be evaluated by bioimpedance.
The study has been approved by ‘Committee of ethics of research with medicines of the health area of Salamanca’ on 14 December 2018 (cod. 2018-11-136) and the ’Ethics committee for health of Guimaraes’ (Portugal) on 15 October 2019 (ref: 67/2019). All study participants will sign an informed consent form agreeing to participate in the study, in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow a better description of gut microbiota in patients with arterial stiffness.
ClinicalTrials.gov, identifier NCT03900338
The treatment of burns is one of the earliest medical activities on record, probably because of the powerful impact of their physical consequences among other sequelae. The aim of the present paper is to perform an epidemiological study of burn patients. The data were obtained by reviewing the medical histories of all those patients admitted or treated in the Outpatients Department of the Burn Unit of our hospital between 2013 and 2017. A sample was gathered of 1401 patients, made up of 716 males (51.11%) and 685 females (48.89%), in a ratio of males to females of 1.05, with a mean age of 40.74 years old. The burns were mainly suffered in a domestic setting (60.96%), mostly as a result of contact with hot liquids. Most of the burns were second degree superficial burns (60.03%), and affected a mean total body surface area (TBSA) of 4.61%. They were most often produced on the hands. It was found that the frequency of burns increased during the summer and during the main mealtimes of the day. These data may be used to make specific plans of prevention, and as a basis for new studies and databases to be made.
Las personas trans* denuncian frecuentemente actitudes de prejuicio/transfobia por parte de los profesionales de la salud. Objetivo: Evaluar los prejuicios-transfobia explícitos de los estudiantes de salud y profesionales, y compararlos con la población general de Tenerife. Metodología: Se llevó a cabo un estudio transversal descriptivo utilizando como elementos de medición la Escala de Genderismo y Transfobia, y la Escala de Actitudes Negativas hacia Personas Trans*. Un total de 602 participantes completaron los cuestionarios autoadministrados. Resultados: Mostraron un nivel muy bajo de prejuicio/transfobia explícitos. Tanto los hombres como las mujeres eran menos transfóbicos con personas trans* cuyas identidades coinciden con las suyas. Los profesionales de la salud y de otras profesiones muestran un nivel igualmente bajo de transfobia explícita. Conclusión principal: Las barreras percibidas por las personas trans* pueden no ser un problema de prejuicios, sino de falta de formación específica de los profesionales de la salud.
All doctoral students strive for the day—after years of often all-consuming study—that their thesis is ready to submit. For both doctoral students and supervisors there is often trepidation about whether the thesis will meet the criteria to merit the award of a Doctor of Philosophy (PhD). As anxieties increase, doctoral students often ask what makes a good PhD, something we explored in a recent ‘Research Made Simple’ article,
Traditionally, a PhD involves 3 to 4 years of full-time study (or a longer part-time programme), which is assessed by the student submitting the work they have undertaken as a thesis or—less commonly—a portfolio of published papers and an associated narrative (sometimes...
To examine the relationship between the dimensions of evidence‐based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units.
A cross‐sectional design.
Data were collected between February–April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence‐based practice and therapeutic relationship. Questionnaires were completed by 198 nurses.
Higher levels of evidence‐based practice were a significant predictor of a higher‐quality therapeutic relationship (β: 2.276; 95% CI: 1.30–3.25). The evidence‐based practice factor which most influenced an improved therapeutic relationship was the nurses’ attitude (β: 2.047; 95% CI: 0.88–3.21). The therapeutic relationship dimension which was most conditioned by evidence‐based practice dimensions was agreement on tasks, which was most favourable with a better attitude (β: 0.625; 95% CI: 0.09–1.16) and greater knowledge and skills for evidence‐based practice (β: 0.500; 95% CI: 0.08–0.93).
In mental health settings, the therapeutic nurse–patient relationship is positively enhanced by evidenced‐based practice and the nurse's level of experience, with a great influence on shared decision‐making.
This research sought to examine the relationship between the evidence‐based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence‐based practices of mental health nurses increases shared decision‐making with patients, which is a basic requirement for person‐centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.
El objetivo en este trabajo es contar la historia de una madre ante la muerte de su hija, la cual nació de forma prematura. Para ello, realizamos una entrevista semiestructurada y a partir de la información recabada se realizó un breve relato en forma de narrativa clínica partiendo de los datos obtenidos. Este relato da voz a una madre, a su historia antes y después del nacimiento de su hija y de cómo finalmente debió de enfrentarse a su muerte. A pesar de ser la historia de una mujer en concreto, estas líneas plasman la realidad a la que tienen que hacer frente muchas familias cuando se produce la muerte de un hijo prematuro.
Esta narrativa pretende describir el trabajo realizado en una unidad hospitalaria de nueva creación (Unidad de Innovación), en la que Enfermería, además de realizar una función asistencial con cuidados altamente individualizados como elemento humanizador, desempeña una función investigadora mediante la realización de programas y proyectos propios. La narrativa propiamente dicha enlaza la experiencia de una enfermera, que se enfrenta al cambio desde su antiguo lugar de trabajo a la nueva unidad, con el caso clínico de uno de los primeros pacientes ingresados en la misma, tomándolo como muestra de la aplicación de cuidados integrales e individualizados.
by Hien Lau, Nicole Corrales, Samuel Rodriguez, Colleen Luong, Mohammadreza Mohammadi, Veria Khosrawipour, Shiri Li, Michael Alexander, Paul de Vos, Jonathan R. T. LakeyPrevious studies have shown that necrostatin-1 (Nec-1) supplementation improved the viability of murine islets following exposure to nitric oxide, increased the survival of human islets during hypoxic culture, and augmented the maturation of pre-weaned porcine islets (PPIs) after 7 days of tissue culture. A limitation of these studies is that only one concentration of Nec-1 was used, and no studies have determined the optimal dose of Nec-1 for PPIs. Thus, the present study examined the effects of Nec-1 on PPIs at four different doses—0, 25, 50, 100, and 200 μM—after 7 days of tissue culture when supplemented on day 3. PPIs were isolated from pancreata of pre-weaned Yorkshire piglets (8–15 days old) and cultured in a specific islet maturation media added with Nec-1 on day 3 of tissue culture at 4 different doses—0, 25, 50, 100, and 200 μM (n = 6 for each dose). After 7 days of tissue culture, islets were assessed for recovery, viability, endocrine cellular content, GLUT2 expression in beta cells, and insulin secretion after glucose challenge. Nec-1 did not affect the viability of both intact islets and dissociated islets cells during tissue culture regardless of doses. Islets cultured in media supplemented with Nec-1 at 100 μM, but not 25, 50, or 200 μM, had a significantly higher recovery, composition of endocrine cells, GLUT2 expression in beta cells, and insulin secretion capacity than control islets cultured in media without Nec-1 supplementation. Moreover, culturing islets in 200 μM Nec-1 supplemented media not only failed to improve the insulin release but resulted in a lower glucose-induced insulin stimulation index compared to islets cultured in media added with 100 μM Nec-1. Xenotransplantation using porcine islets continues to demonstrate scientific advances to justify this area of research. Our findings indicate that Nec-1 supplementation at 100 μM was most effective to enhance the in vitro maturation of PPIs during tissue culture.
To analyse nursing students’ perception of the Magnet hospital attributes of the work environment at the hospitals where they perform their clinical placement and the relationship of this factor to their clinical learning environment and supervision, satisfaction and intention to stay in those hospitals once graduated.
This study had a cross‐sectional, correlational, design.
Data were collected using self‐reported questionnaires from 180 nursing students at a university in southeast Spain between September–October 2018. Nursing work environment and clinical learning environment were measured using the Practice Environment Scale of the Nursing Work Index and Clinical Learning Environment, Supervision and Nurse Teacher scale, respectively. Students’ satisfaction with the work environment and with the clinical learning process were measured using a four‐point Likert scale developed by the researchers. Percentages, frequencies, mean, standard deviation, χ2 test, Mann–Whitney U test, Spearman and phi correlation were used to analyse the data.
Nursing students’ perception of greater Magnet‐like features at work environment was associated with better clinical learning environment (Spearman rs = |0.22–0.54|; p < .01) and satisfaction with the work environment (Spearman rs = 0.18; p = .01) and with their learning process (Spearman rs = 0.21; p < .01). Greater intention to stay working in the hospital after graduation was significantly associated with greater satisfaction with the learning process (phi = 0.31; p < .01) and the work environment (phi = 0.23; p = .02).
Magnet‐like features at the work environment lead to superior clinical learning environment and higher students’ satisfaction, two factors that play a decisive role in their decision to stay at hospitals where they performed clinicals after graduation.
In the face of a global nurse shortage, nursing managers and faculty leaders should consider the improvement of nursing workplaces as a strategic alliance to promote satisfactory clinical learning experience and aid recruitment of nurses.
In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL.
The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised.
The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL.
Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
Objetivos: conocer el registro en las historias clínicas electrónicas sobre la sexualidad en personas con lesión medular traumática y las variables que influyen en el mismo. Material y métodos: estudio observacional, descriptivo, transversal. La población estuvo compuesta por las historias clínicas electrónicas de personas con lesión medular traumática de entre 18 y 65 años ingresadas en el Hospital Universitario de Asturias del 2005 al 2015. Se han registrado variables: sociodemográficas, relacionadas con la lesión, relacionadas con las complicaciones secundarias, la hospitalización y el registro sobre sexualidad por parte de los profesionales. Resultados: en el 50,6% de las historias clínicas aparecen registros sobre sexualidad. El tipo de lesión según afectación de miembros (p=0,007), según extensión (p=0,036) y según nivel neurológico (p=0,017) se encuentran estadísticamente relacionadas con el registro sobre sexualidad. Existe una relación estadísticamente significativa entre el tiempo en unidad de hospitalización (p<0,001) y el tiempo total de ingreso (p=0,001) con el registro sobre sexualidad. Los temas que se anotan con mayor frecuencia son las alteraciones ginecológicas en mujeres y la disfunción eréctil y su tratamiento en hombres. Conclusiones: el registro sobre la sexualidad por parte de los profesionales sanitarios en las personas con lesión medular es escaso y centrado sobre todo en la erección y las alteraciones del aparato genital. Para unos cuidados de calidad, es necesaria la valoración sistemática de la sexualidad tras una lesión medular y la apertura de concepto, desde lo genital a lo integral.
Objectives: to analyse the records about sexuality in the electronic medical reports for patients with traumatic spinal cord injury and the variables that influence these records. Material and methods: observational, descriptive, cross-sectional study. The population was made up of electronic medical records of patients with traumatic spinal cord injuries between the age of 18 and 65 admitted to the University Hospital of Asturias from 2005 to 2015. Variables have been recorded considering the following factors: sociodemographic, related to the injury, related to secondary complications, hospitalization and registration on sexuality by professionals. Results: in 50.6% of the medical records there were reports on sexuality. The type of injury according to limb involvement (p = 0.007), according to extent (p = 0.036) and according to neurological level (p = 0.017) are statistically related to the records on sexuality. There is a statistically significant relationship between the time in the hospitalization unit (p <0.001) and the total time of admission (p = 0.001) with the record on sexuality. The most frequently noted issues are gynaecological disorders in women and erectile dysfunction and its treatment in men. Conclusions: the record on sexuality by health professionals in patients with spinal cord injury is scarce and it is focused mainly on erection and alterations in the genital apparatus. For quality care, a systematic assessment of sexuality after a spinal cord injury and an open concept is necessary, from the genital to the integral.
About 25% of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) associated with a high release of pro-inflammatory cytokines such as interleukin-6 (IL-6). The aim of the SARICOR study is to demonstrate that early administration of sarilumab (an IL-6 receptor inhibitor) in hospitalised patients with COVID-19, pulmonary infiltrates and a high IL-6 or D-dimer serum level could reduce the progression of ARDS requiring high-flow nasal oxygen or mechanical ventilation (non-invasive or invasive).
Phase II, open-label, randomised, multicentre, controlled clinical trial to study the efficacy and safety of the administration of two doses of sarilumab (200 and 400 mg) plus best available therapy (BAT) in hospitalised adults with COVID-19 presenting cytokine release syndrome. This strategy will be compared with a BAT control group. The efficacy and safety will be monitored up to 28 days postadministration. A total of 120 patients will be recruited (40 patients in each arm).
The clinical trial has been approved by the Research Ethics Committee of the coordinating centre and authorised by the Spanish Agency of Medicines and Medical Products. If the hypothesis is verified, the dissemination of the results could change clinical practice by increasing early administration of sarilumab in adult patients with COVID-19 presenting cytokine release syndrome, thus reducing intensive care unit admissions.
In 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status.
A systematic mixed studies review using a data-based convergent design will be conducted. Medline, Embase, Scopus, CINAHL and the Cochrane Library will be searched on 25 March 2020. Screening and critical appraisal will be conducted independently by the first author. Authors 3–5 will act as second reviewers, each independently conducting 33% of the screening and appraisal. Quantitative data will be transformed to qualitative data and be synthesised using thematic analysis. The Mixed Methods Appraisal Tool will be used for quality assessment. An advisory committee, composed of four migrant PLWH, will be involved in screening and appraising 5% of articles to build knowledge and experience with systematic reviews. They will also be involved in analysis and dissemination.
Ethics approval was obtained from the McGill University Health Centre (15-188-MUHC, 2016-1697, eReviews 4688). Publications arising from this study will be open-access.
by Luis-Gerardo Rodríguez-Lobato, Alexandra Martínez-Roca, Sandra Castaño-Díez, Alicia Palomino-Mosquera, Gonzalo Gutiérrez-García, Alexandra Pedraza, María Suárez-Lledó, Montserrat Rovira, Carmen Martínez, Carlos Fernández de Larrea, María-Teresa Cibeira, Laura Rosiñol, Ester Lozano, Pedro Marín, Joan Cid, Miquel Lozano, Ana Belén Moreno-Castaño, Marta Palomo, Maribel Díaz-Ricart, Cristina Gallego, Adelina Hernando, Susana Segura, Enric Carreras, Álvaro Urbano-Ispizua, Joan Bladé, Francesc Fernández-AvilésBackground
Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT.Methods
Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT.Results
The incidence of NF among the groups was reduced (64%, 44%, and 24%; PP = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; PP = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05).Conclusions
G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.
To explore the emotional impact and experiences of geriatric nurses working in nursing homes and caring for patients with coronavirus 2019 disease (COVID‐19).
This is a qualitative study with phenomenological method and data were gathered through in‐depth interview.
The experiences and expectations that nurses are facing during their care duties were explored via video conference, using a semi‐structured interview guide. We have followed the Consolidated criteria for reporting qualitative research COREQ.
Interviews (N=24) were conducted with nurses from four countries (Spain, Italy, Peru, and Mexico) during April 2020. Three main categories were extracted: fear of the pandemic situation, the sense of duty and professional commitment, and emotional exhaustion.
Regardless of the country and situation, in the face of the pandemic, dramatic situations have been experienced in nursing homes worldwide, with nursing staff feeling exhausted and overwhelmed, and reflection is urged on a global level to consider the most appropriate model of care in nursing homes.
This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers.
Randomized controlled clinical trial.
The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8–10 people where caregivers were trained in the Antecedent‐Behavior‐Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC).
An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann–Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES‐D) (U = −2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = −4.10; p < 0.01; Cohen d = 0.98).
The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver.
To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.
A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research. The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.
Central to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity...