Fostering the Facilitator: Promoting Clinical Educators' Interprofessional Education Facilitation Skills and Socialization Using Exclusively Online Learning.

Health professions educators can benefit from continuing education to more effectively facilitate interprofessional education (IPE) in clinical settings. Online learning formats enable broader participation and overcome barriers to in-person events, though few studies describe the most effective platforms and methods of online continuing education for this purpose. In the context of the COVID-19 pandemic, we developed a 6-week interactive online program implemented via an integrated online educational platform (OEP) to equip participants with knowledge and skills to better facilitate IPE in clinical settings. Program outcomes evaluation involved mixed-methods data analysis from OEP site usage statistics, pre/post-program surveys, pre/post program validated self-assessment surveys, and post-pro¬gram focus group. Twenty-four participants representing 5 professions from inpatient and outpatient clinical settings completed the program. Quantitative findings include statistically significant improvement in all of 11 measures of IPE knowledge and skills developed for this study, 4 of 9 socialization measures, and 7 of 18 facilitation measures. Qualitative findings include participants placing value on multiple modes of instruction, facilitated small group engagement, brief condensed asynchronous content, clear expectations of program time commitment, and detailed understanding of the OEP.

Food is Medicine for HIV: Improved health and hospitalizations in the Changing Health through Food Support (CHEFS-HIV) pragmatic randomized trial.

BACKGROUND: Policy support for "Food is Medicine"-medically tailored meals or groceries to improve health-is rapidly growing. No randomized trials have heretofore investigated the benefits of medically tailored food programs for people living with HIV (PLHIV). METHODS: The CHEFS-HIV pragmatic randomized trial included PLHIV who were clients of Project Open Hand (POH), a San Francisco-based nonprofit food organization. The intervention arm (n = 93) received comprehensive medically tailored meals, groceries, and nutritional education. Control participants (n = 98) received less intensive (POH "standard of care") food services. Health, nutrition, and behavioral outcomes were assessed at baseline and 6 months later. Primary outcomes measured were viral non-suppression and health related quality of life. Mixed models estimated treatment effects as differences-in-differences between arms. RESULTS: The intervention arm had lower odds of hospitalization (odds ratio [OR] = 0.11), food insecurity (OR = 0.23), depressive symptoms (OR = 0.32), antiretroviral therapy adherence <90% (OR = 0.18), and unprotected sex (OR = 0.18), and less fatty food consumption (ß= -0.170 servings/day) over 6 months, compared to the control arm. There was no difference between study arms in viral non-suppression and health-related quality of life over 6 months. CONCLUSIONS: A "Food-is-Medicine" intervention reduced hospitalizations and improved mental and physical health among PLHIV, despite no impact on viral suppression. CLINICAL TRIALS REGISTRATION: NCT03191253.

Collaborative drug therapy modification (CDTM): Facilitators, barriers, and perceptions of individual pharmacist participation in Georgia.

BACKGROUND: Georgia Board of Pharmacy (BOP) regulations permit pharmacists to engage in collaborative drug therapy modification (CDTM) with physicians, allowing them to perform patient assessments, adjust pharmacotherapy, and order laboratory tests. Pharmacist-led CDTM can positively affect health outcomes leading to reduced healthcare expenditures. CDTM is underutilized, with < 1% of Georgia pharmacists holding an active license to practice CDTM. OBJECTIVE(S): The objective of this study was to examine CDTM licensed pharmacists' perceptions of facilitators and barriers in providing CDTM. METHODS: Georgia-licensed CDTM pharmacists were invited to participate in a 60-minute qualitative interview. Interview questions were developed from electronic survey responses. The interview was designed to elicit information regarding perceived benefits and barriers to CDTM implementation. Guided by the Consolidated Framework for Implementation Research, thematic analysis was applied to identify themes using ATLAS.ti software to code. Themes were described qualitatively and prevalence of each was reported. RESULTS: Nine interviews were conducted, and data saturation was achieved at interview 6. After resolution of discrepancies, 100% coding agreement was reached among 2 independent researchers. Nine themes were identified, and each was categorized as a facilitator or barrier to establishing pharmacist-led CDTM in Georgia. Themes associated with facilitating were (prevalence %) (1) practice autonomy (100), (2) personal attributes (100), (3) having support (100), and (4) institutional logistics (88). Barrier themes included issues concerning (5) the Georgia BOP (100), (6) pharmacist autonomy (88), (7) lack of provider status (88), (8) institutional restrictions (75), and (9) personal development (e.g., confidence) (22). CONCLUSION: Facilitators to the establishment of pharmacist-led CDTM exist and pharmacists can capitalize on these to create successful CDTM programs. Barriers are varied, and it may be difficult to systematically address individual barriers such as pharmacist autonomy and personal development. Barriers associated with institutional restrictions, the Georgia BOP, and lack of provider status can likely be removed or addressed by policy.

Translating Clinical Decision-Making Skills From a Critical Care Pharmacy Elective to the Required Curriculum.

OBJECTIVE: To examine the impact of a critical care pharmacy elective (CCPE) on student performance in other courses in the Doctor of Pharmacy curriculum that emphasize clinical reasoning and decision making. METHODS: This is a retrospective, cohort study including all students from the 2019-2021 graduating classes enrolled in required courses, Pharmacotherapy and Integrated Patient Cases (IPCs). Students were divided for comparison based on completion of the CCPE. The primary outcome was outstanding performance, defined by a final course grade ≥90%, in Pharmacotherapy and IPC. Baseline characteristics and outcomes were analyzed using descriptive statistics and the χ2 test or two-sided t test for categorical and continuous variables, respectively. Binary logistic regression models were constructed to identify variables associated with the primary outcome. RESULTS: Of 377 students included, 129 (34%) completed the CCPE. Baseline characteristics were similar between both groups, except more females completed the CCPE. Students that completed the CCPE were not more likely to demonstrate outstanding performance in Pharmacotherapy III (20% vs 30%) or Pharmacotherapy IV (27% vs 24%), but were more likely in IPC (34% vs 23%). In the adjusted analysis, CCPE students were almost twice as likely to exhibit outstanding performance in IPC. CONCLUSION: Students that completed the CCPE were more likely to demonstrate outstanding performance in IPC, but not in either of the Pharmacotherapy courses. Students may benefit from practicing clinical reasoning earlier in the curriculum to build-up to effective and efficient clinical decision-making. Implications of course structure on student performance should be further explored.

Many Cooks in the Kitchen: Iterating a Qualitative Analysis Process Across Multiple Countries, Sites, and Teams.

Establishing and proving methodological rigor has long been a challenge for qualitative researchers where quantitative methods prevail, but much published literature on qualitative analysis assumes a relatively small number of researchers working in relative proximity. This is particularly true for research conducted with a grounded theory approach. Different versions of grounded theory are commonly used, but this methodology was originally developed for a single researcher collecting and analyzing data in isolation. Although grounded theory has evolved since its development, little has been done to reconcile this approach with the changing nature and composition of international research teams. Advances in technology and an increased emphasis on transnational collaboration have facilitated a shift wherein qualitative datasets have been getting larger and the teams collecting and analyzing them more diverse and diffuse. New processes and systems are therefore required to respond to these conditions. Data for this article are drawn from the experiences of the Innovations for Choice and Autonomy (ICAN) Research Consortium. ICAN aims to understand how self-injectable contraceptives can be implemented in ways that best meet women's needs in Kenya, Uganda, Malawi, and Nigeria. We found that taking a structured approach to analysis was important for maintaining consistency and making the process more manageable across countries. However, it was equally important to allow for flexibility within this structured approach so that teams could adapt more easily to local conditions, making data collection and accompanying analysis more feasible. Meaningfully including all interested researchers in the analysis process and providing support for learning also increased rigor. However, competing priorities in a complex study made it difficult to adhere to planned timelines. We conclude with recommendations for both funders and study teams to design and conduct global health studies that ensure more equitable contributions to analysis while remaining logistically feasible and methodologically sound.

Benefits of an Online Interactive Educational Program Over Traditional Textbooks.

BACKGROUND: Technology has become increasingly prominent in nursing education. Online learning platforms may be more useful than traditional textbooks in promoting active learning, engagement, and satisfaction. PURPOSE: The purpose was to evaluate a new online interactive education program (OIEP) that replaces traditional textbooks and to understand student and faculty satisfaction, perceived efficacy of the program, student engagement, and whether the OIEP can help NCLEX preparation and reduce burnout. METHOD: This retrospective study assessed student and faculty perceptions of the constructs using quantitative and qualitative measures. Perceptions were measured at 2 time points each: halfway through the semester and again at its conclusion. RESULTS: Mean efficacy scores of groups were high at both time points. Students showed significant increases in content constructs, which were supported by faculty perceptions of students. Students agreed that using the OIEP throughout their program would significantly increase preparedness for NCLEX. CONCLUSION: The OIEP may better support nursing students throughout school and on NCLEX than traditional textbooks.

It Is Up to Faculty: An Exploration of Registered Nurse-to-Bachelor of Science in Nursing Student Intent for Faculty Role.

AIM: The aim of this study was to explore registered nurse (RN)-to-bachelor of science in nursing (BSN) students' intent to pursue a faculty role. BACKGROUND: The nursing faculty shortage is predicted to worsen as faculty reach retirement age. The shortage affects enrollment into nursing programs because of lack of qualified faculty. Increasing the number of faculty available is critical to maintain nurses needed to care for citizens. METHOD: Using a qualitative descriptive approach, RN-to-BSN students were asked about their intent to become faculty later in their career. RESULTS: Eight RNs pursuing their BSN were interviewed. Five themes emerged from interviews: modeling the role, positive and negative; planting the seed; perceiving rather than knowing; seeing the light bulb go on; and weighing the pros and cons. CONCLUSION: Nursing faculty can influence RN-to-BSN students' intent to become faculty and can attract students to the role by conveying enthusiasm, being collegial, and maintaining clinical relevance.

"Factor structure and utility of the Behavior Rating Inventory of Executive Function-Preschool Version": Correction.

Reports an error in "Factor structure and utility of the Behavior Rating Inventory of Executive Function-Preschool Version" by Jamie A. Spiegel, Christopher J. Lonigan and Beth M. Phillips (Psychological Assessment, 2017[Feb], Vol 29[2], 172-185). In the original article, paraphrased references to the BRIEF-P test items originally provided in Table 2 have been removed by request of the copyright holder due to discrepancies between the APA guidelines and the copyright holder's internal policies. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2016-22451-001). Executive function (EF) is a domain general cognitive construct associated with a number of important developmental outcomes. The Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) is intended to assess 5 distinct components of EF in preschool age children. In this study, a series of factor analyses was conducted with teacher-reported EF of 2,367 preschool students to assess the structure of the BRIEF-P, and the predictive relations between the resulting factors and children's academic abilities and behavioral self-regulation were assessed to test the construct and convergent validity of the BRIEF-P scores. Results yielded mixed findings concerning the structure of the BRIEF-P and validity of its resultant scores. Results of the factor analyses indicated that the items of the BRIEF-P did not map onto factors in the way that would be expected based on its item-to-subscale mapping. The best solutions were a 4-factor and a bifactor model. The 4-factor solution revealed substantial correlations between factors, and although the bifactor solution identified a General Self-Regulation factor that explained variance in responses across items, this general factor did not account for all of the overlap among specific factors. Analyses of the relations for the factors from the correlated-factors and the bifactor models indicated that the majority of the factors had limited convergent validity with academic ability or with a measure of behavior self-regulation. Overall, these findings call into question the validity of aspects of BRIEF-P. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving stigma and psychosocial outcomes among post-abortion Kenyan women attending private clinics: A randomized controlled trial of a person-centered mobile phone-based intervention.

OBJECTIVES: The objective of this study was to evaluate a person-centered abortion care mobile-based intervention on perceived social stigma, social support, mental health and post-abortion care experiences among Kenyan women who received abortion services at private clinics. METHODS: This randomized controlled study enrolled women who obtained an abortion from private clinics in Nairobi county, Kenya and randomized them into one of three study arms: 1) standard of care (follow-up by service provider call center); 2) post-abortion phone follow-up by a peer counselor (a woman who has had an abortion herself and is trained in person-centered abortion care); or 3) post-abortion phone follow-up by a nurse (a nurse who is trained in person-centered abortion care). All participants were followed-up at two- and four-weeks post-abortion to evaluate intervention effects on mental health, social support, and abortion-related stigma scores. A Kruskal-Wallis one-way ANOVA test was used to assess the effect of each intervention compared to the control group. In total, 371 women participated at baseline and were each randomized to the study arms. RESULTS: Using Kruskal-Wallis tests, the nurse arm improved mental health scores from baseline to week two; however this was only marginally significant (p = 0.059). The nurse arm also lowered stigma scores from baseline to week four, and this was marginally significant (p = 0.099). No other differences were found between the study arms. This person-centered mobile phone-based intervention may improve mental health and decrease perceived stigma among Kenyan women who received abortion services in private clinics. CONCLUSIONS: Nurses trained in person-centered abortion care, in particular, may improve women's experiences post-abortion and potentially reduce feelings of shame and stigma and improve mental health in this context.

The impact of synchronous hybrid instruction on students' engagement in a pharmacotherapy course.

Background: Synchronous hybrid instruction offers flexible learning opportunities by allowing a portion of students to attend class sessions on campus while simultaneously allowing the remaining students to attend remotely. Although such flexibility may offer a number of advantages for pharmacy students, one area of concern is whether online participation options within synchronous hybrid courses can promote similar levels of engagement as courses that are designed entirely for face-to-face (FTF) participation. Objectives: The objective of this study was to evaluate the impact of synchronous hybrid instruction on pharmacy students' engagement in a pharmacotherapy course. An evaluation was completed to determine if students were more likely to actively engage in class when they were participating remotely via teleconferencing technology or when FTF. Additionally, students' perspectives were evaluated to determine their views of the benefits and challenges of the hybrid model for engagement in learning. Methods: The course utilizes team-based learning to apply critical thinking skills and develop a comprehensive care plan. A mixed methods approach was used to examine students' engagement in the hybrid learning environment by quantitatively analyzing students' responses to likert-scale survey items and qualitatively analyzing their responses to open-ended survey questions. Results: Students reported they were more likely to actively listen (p=0.004), avoid distractions (p=0.008), and react emotionally to a topic or instruction (p=0.045) when FTF. There were no significant differences found in student reported note taking, asking questions, responding to questions, or engaging in group work between the two modes of participation. Content analysis identified other benefits that supported student engagement, including perceived flexibility and enhanced ability to interact during class via the teleconferencing technology. For some students, challenges that negatively impacted engagement included difficulties with internet connectivity and a sense of dislocation or isolation in the course. Conclusion: This study demonstrated that when participating in a synchronous hybrid course, students participating remotely were less likely (compared to in-person attendance) to pay close attention and react emotionally, but were just as likely to take notes and communicate with teachers and groups. Key benefits of the hybrid approach were increased flexibility and the usefulness of online communication tools, while key challenges focused on technical and psychological isolation from others. The principles of flexible learning environments and self-regulated learning provide opportunities for pharmacy educators who are interested in improving hybrid instruction in the future.

A Scoping Review Evaluating the Effect of SGLT-2 Inhibitors on Insulin Dose Requirements in Insulin-Dependent Patients With Type 2 Diabetes.

OBJECTIVE: Assess evidence describing the effect of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on total daily insulin (TDI) requirements in insulin-dependent patients with type 2 diabetes. DATA SOURCES: A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) guidelines. The search was conducted in PubMed; citation mapping was completed in Web of Science. Filters for human studies, English language, and a publication date, from January 1, 2005 to April 12, 2021, were applied. STUDY SELECTION AND DATA EXTRACTION: Studies assessing insulin dose requirements with concurrent use of an SGLT2 inhibitor for patients with type 2 diabetes were included. DATA SYNTHESIS: Sixteen studies were included and demonstrated that addition of an SGLT2 inhibitor typically reduced TDI requirements. Insulin reductions were often statistically significant, occurring in studies evaluating (1) within subjects who received SGLT2 inhibitors, and (2) between subjects receiving SGLT2 inhibitors versus placebo. Compared with placebo, insulin dose reduction ranged from -0.72 to -19.2 units. However, studies were relatively small, not designed to assess TDI change, and some utilized fixed dose insulin protocols or empiric insulin dose reductions. CONCLUSIONS: Lowering insulin requirements may have benefits, such as decreased hypoglycemia risk, insulin resistance, and cost. Addition of an SGLT2 inhibitor may modestly reduce TDI requirements for patients with type 2 diabetes. Evidence indicating SGLT2 inhibitor use reduces TDI may lead to additional implementation in practice and inform future research. Further research is needed to clarify insulin type (i.e., basal or prandial) and degree of TDI reduction expected with addition of an SGLT2 inhibitor.

Does preschool children's self-regulation moderate the impacts of instructional activities? Evidence from a randomized intervention study.

There is strong evidence linking children's self-regulation with their academic and behavioral outcomes. These relations have led to the development of interventions aimed at improving academic outcomes by promoting self-regulation, based in part on the idea that self-regulation promotes the development of academic skills. Although a considerable number of studies have examined the degree to which interventions designed to improve aspects of self-regulation have a positive impact on academic outcomes, only a few studies have examined the degree to which children's self-regulation moderates the effects of academic interventions. The goal of this study was to examine whether self-regulation, indexed by a direct assessment of executive function and teacher-rated attention, moderated the uptake of early literacy interventions for 184 children (average age = 58 months, SD = 3.38; 66% Black/African American, 28% White; 59% male) at risk for reading difficulties who participated in a randomized controlled trial examining the efficacy of Tier 2 interventions in preschool. Multilevel models were used to examine the degree to which children's self-regulation moderated the impacts of the interventions. The results of this study provided little evidence that self-regulation moderated the impacts of the interventions and call into question the likelihood of a causal relation between self-regulation and academic achievement.

Evaluation of GLP-1 Receptor Agonists in Combination With Multiple Daily Insulin Injections for Type 2 Diabetes.

OBJECTIVE: To assess the available literature evaluating the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with multiple daily insulin injections (MDII). DATA SOURCES: A literature search of MEDLINE and Embase was performed (2004 to May 2020) using the following search terms: glucagon-like 1 receptor agonist, liraglutide, albiglutide, dulaglutide, exenatide, semaglutide, diabetes mellitus, and prandial insulin or bolus insulin. Additional references were obtained from cross-referencing the bibliographies of selected articles. STUDY SELECTION AND DATA EXTRACTION: All information obtained from the searches were reviewed. All relevant trials are included in this review. DATA SYNTHESIS: Eight studies met criteria for inclusion. The addition of a GLP-1 RA to multiple daily insulin injections was associated with a reduction in A1c in 7 out of 8 studies, and weight loss in 5 studies. In studies that allowed insulin adjustment after the addition of GLP-1 RA, the average total daily insulin dose was reduced in 3 studies. When evaluated, hypoglycemia frequency or other adverse events were not increased when GLP-1 RAs were added to MDII. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Guidelines do not offer recommendations regarding the use of GLP-1 RAs in combination with MDII regimens. This review evaluates current studies demonstrating efficacy and safety considerations of this combination. CONCLUSIONS: While some studies did demonstrate an improvement in A1c and reduction in insulin doses without increased hypoglycemia, larger randomized controlled trials are needed to adequately assess the benefit and safety of GLP-1 RAs in combination with MDII.

National Study of Nursing Faculty and Administrators' Perceptions of Professional Identity in Nursing.

BACKGROUND: Establishing a professional identity in nursing is integral to professional development, yet this area of inquiry remains understudied. PURPOSE: This segment of a multiphased national study measured nursing faculty's perceived level of importance regarding key components of professional identity in nursing using the newly developed Professional Identity in Nursing Survey (PINS). METHODS: Fifty subject matter experts from nursing education, practice, and regulation utilized the DeVellis scale development process to develop the PINS over the course of 2 years. Nearly 1200 nurse educators evaluated the importance of a 34-item scale relating to professional identity in nursing. RESULTS: At endorsement of 95% or greater, 28 items were found to be important components of nursing identity. Effective communication, integrity, and being trustworthy and respectful were reported as most important to nursing identity. CONCLUSIONS: Nurse educators identified the important items to assess professional identity in nursing. Item refinement and psychometric evaluation of the survey are the next phase of the multiphased study.

Team feedback: A missing piece of the interprofessional education puzzle.

INTRODUCTION: The ambulatory care practice model has long embraced interprofessional collaboration, well before it was formalized by the Interprofessional Education Collaborative. Establishing a mechanism to gather insight from other members of the interprofessional team may facilitate further development of interprofessional education (IPE). COMMENTARY: There is limited evidence investigating non-pharmacy trainees and medical provider perceptions of advanced pharmacy practice experience (APPE) student involvement in IPE. Most available evidence evaluates the satisfaction of non-pharmacy trainees and other health care professionals with APPE student recommendations. IMPLICATIONS: Emphasis on IPE, such as formalizing feedback from other health care professionals during experiential rotations, may assist preceptors in adapting interactions, strengthening interprofessional collaborations, and ensuring that students are valued team members who contribute to providing quality patient care.

Influences of the Home Language and Literacy Environment on Spanish and English Vocabulary Growth among Dual Language Learners.

Little is known regarding the extent to which aspects of the home language and literacy environment (HLE) promote growth in language skills among dual language learners (DLLs). Therefore, the purpose of this study was to evaluate which aspects of the HLE significantly predict growth in English and Spanish vocabulary among Spanish-speaking DLLs. 944 Spanish-speaking DLLs (51.6% female; mean age = 53.77 months) completed assessments of English and Spanish vocabulary at four time points across two academic years. Parents completed a survey of the HLE that included information on language exposure, reading exposure, and family reading habits. Results indicated that specific literacy-related practices, including availability of books in the home, language read to the child, and parental reading skills were significant predictors of growth in children's Spanish and English vocabulary knowledge, even after controlling children's initial level of language skills and family socioeconomic status.

Differential Patterns of Growth in Reading and Math Skills during Elementary School.

This study investigated developmental trajectories of reading and math using latent-growth-curve analyses across multiple academic skills, measures, and multiple time periods within a single sample. Reading-related growth was marked by significant individual differences during the early elementary-school period and non-significant individual differences during the late elementary-school period. For math-related skills, non-significant individual differences were present for early math growth and significant individual differences were present in late elementary-school. No clear pattern of cumulative, compensatory, or stable development emerged for either reading-related or math skills. These differing growth patterns highlight developmental complexities and suggest domain-specific differences in achievement growth that are potentially associated with contextual factors.

Assessing the impact of group antenatal care on gestational length in Rwanda: A cluster-randomized trial.

BACKGROUND: Research on group antenatal care in low- and middle-income contexts suggests high acceptability and preliminary implementation success. METHODS: We studied the effect of group antenatal care on gestational age at birth among women in Rwanda, hypothesizing that participation would increase mean gestational length. For this unblinded cluster randomized trial, 36 health centers were pair-matched and randomized; half continued individual antenatal care (control), half implemented group antenatal care (intervention). Women who initiated antenatal care between May 2017 and December 2018 were invited to participate, and included in analyses if they presented before 24 weeks gestation, attended at least two visits, and their birth outcome was obtained. We used a generalized estimating equations model for analysis. FINDINGS: In total, 4091 women in 18 control clusters and 4752 women in 18 intervention clusters were included in the analysis. On average, women attended three total antenatal care visits. Gestational length was equivalent in the intervention and control groups (39.3 weeks (SD 1.6) and 39.3 weeks (SD 1.5)). There were no significant differences between groups in secondary outcomes except that more women in control sites attended postnatal care visits (40.1% versus 29.7%, p = 0.003) and more women in intervention sites attended at least three total antenatal care visits (80.7% versus 71.7%, p = 0.003). No harms were observed. INTERPRETATION: Group antenatal care did not result in a difference in gestational length between groups. This may be due to the low intervention dose. We suggest studies of both the effectiveness and costs of higher doses of group antenatal care among women at higher risk of preterm birth. We observed threats to group care due to facility staff shortages; we recommend studies in which antenatal care providers are exclusively allocated to group antenatal care during visits. TRIAL REGISTRATION: ClinicalTrials.gov NCT03154177.