Factors associated with malnutrition among older people in Swedish short-term care: Poor oral health, dysphagia and mortality.

OBJECTIVES: To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short-term care. METHODS: This cross-sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short-term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF-II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors. RESULTS: Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well-nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40-17.68), poor oral health (OR: 5.73, 95% CI: 2.33-14.09) and female gender (OR: 2.2, 95% CI: 1.24-3.93) were independently associated with malnutrition. CONCLUSION: Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short-term care. These health risks should be given more attention in short-term care with early identification.

"From doing to knowing": medical students' experiences of working as Healthcare Assistants.

There is growing recognition that doctors need to deliver person-centered care. More evidence is needed on how to best equip students in an already busy curriculum. Providing medical students with the opportunity to work as Healthcare Assistants (HCAs) can help them develop the desired skills. This study examined medical students' experiences of working as HCAs and perceived impact on their future practice. Adopting an Interpretative Phenomenological Analysis approach, we analyzed narratives from two focus groups of 13 'Year 0' and 'Year 1' medical students, who had completed an HCA project. This project allowed participants to experience a new dimension of patient care whereby learning by "doing" evolved to a deeper level of "knowing" patients, the HCA role and the wider team. Four major themes were identified: seeing the doctor: gaining new perspectives; building confidence: learning from and about patients; understanding the overall patient experience: providing personal care; finding "the person behind the patient": exploring beyond the diagnosis. This study suggests that working as an HCA enables participants to develop sustainable skills that equip them for their future role as doctors able to deliver person-centered care as part of an interprofessional team. Recommendations for inclusion of this type of intervention into the medical curriculum are discussed.

Using interprofessional dementia learning opportunities to prepare the future healthcare workforce: findings from a pilot study.

Nearly 50 million people worldwide are living with dementia. Communication difficulties linked to this illness demand that all healthcare professionals are prepared to meet the needs of this group of service users. In response to this, the United Kingdom government is calling for professionals to acquire a basic (Tier 1) Dementia Awareness (DA) qualification. As healthcare students need to engage in interprofessional learning (IPL), this report describes the development, implementation and evaluation of an initiative to link the DA qualification to an existing IPL module delivered to first-year healthcare students (IPL1). A DA learning package was developed by a group of educators from a range of professions to ensure an interprofessional focus. It comprised of a set of practical exercises that students completed during and after IPL1. Sixty students evaluated the DA learning package by completing a post-intervention survey. 57 students rated it helpful or very helpful, in enhancing their knowledge of how to care for a person with dementia, while 3 students rated it as average. Two themes emerged from open-ended questions, which highlighted the importance of: i) learning to work together; and ii) blended learning. Students also suggested some changes for the full roll out, such as moving the Dementia Friends component into IPL1. This is an innovative approach that can be used to meet the challenges linked with the large-scale preparation of our future workforce and to ensure purposeful IPL.

University teachers' views of interprofessional learning and their role in achieving outcomes - a qualitative study.

Over the past decade, there has been a rapid increase in higher education institutions offering opportunities for interprofessional learning (IPL) to their students. The literature presents a number of factors that contribute to effective IPL, including having trained facilitators that help optimise the learning process. Many of these IPL facilitators are university teachers and the literature provides us with some insight into their views of IPL. However, little is known about university teachers' views about IPL and their role in supporting students in achieving outcomes linked to IPL during their own teaching; this paper explores these areas. University teachers, working with students in Norway and England who contribute to patients' care pathway were purposively invited to join focus groups. Data collected from the teachers' conversations during these focus groups were analysed to elicit the main themes. Findings show that university teachers have a wide range of views about IPL, its potential to enhance collaborative practice and care, and their role in helping students achieve outcomes linked to IPL. A key challenge appears to be whether IPL is "worth the struggle," which emphasises the need for strong leadership in order to align pedagogical approaches in education and practice that strive to achieve agreed outcomes.

Training students as interprofessional learning facilitators: An exploratory study highlighting the need to build confidence.

Interprofessional learning (IPL) aims to equip students for future interprofessional and collaborative practice. Involving students as IPL facilitators is becoming increasingly commonplace as an attempt to catalyse the necessary transformation of our workforce needed to deliver truly integrated and person-centred care. Evidence in the literature highlights the key role of trained facilitators in reaching successful IPL outcomes. Some guidelines are available as to how we train staff facilitators, but little evidence is available that describes how to appropriately prepare student IPL facilitators. The aim of this exploratory study was to investigate whether student IPL facilitators felt that they were sufficiently prepared for their role. Data in the form of open-ended text-based responses from student facilitators (n = 9) were collated after an intervention where student facilitators had been given the role of supporting IPL. Data were analysed using principles of thematic analysis. Three main themes emerged: i) building confidence; ii) purpose of IPL; iii) learning moments. Student IPL facilitators who took part in this study felt that they were adequately prepared for their role. Findings show that preparing students for IPL facilitation has similar, yet unique, components compared to the training staff. In particular, this study highlighted a need for student facilitators to receive further preparation to help build their confidence. Involving students as IPL facilitators has great potential in staff and students joining forces to equip students for future interprofessional and collaborative practice that can deliver high-quality care.

Mentoring medical students as a means to increase healthcare assistant status: A qualitative study.

AIM: To offer a practical way in which the status of healthcare assistants (HCAs) can be increased by drawing on their experience, knowledge and skillset, whilst mentoring medical students during an HCA project. DESIGN: Qualitative, reflexive thematic analysis. METHODS: One-to-one semi-structured interviews were conducted between April and June 2019, with 13 participants. Participants included five healthcare assistants; three practice development nurses, two of whom were former HCAs; one registered general nurse and four clinical educators. RESULTS: Two themes were identified: HCAs as silent, invisible caregivers (theme 1) and the formation of an HCA identity through mentoring (theme 2). HCAs are often silent performers of complex patient care with limited opportunity to engage in the interprofessional team dialogue. Social perceptions of HCAs describe them as a marginalised, poorly understood, 'unqualified' group with 'lowly status'. Mentoring medical students allows HCAs to draw on their experience, knowledge and skillset by actively contributing to the learning and development of future doctors. CONCLUSION: The mentoring of medical students gave HCAs an active voice within the interprofessional team, instilling their confidence and self-worth. Mentoring allowed HCAs to move from a homogenous, group-based social identity to a role-based one that enabled HCAs to reveal the true extent of their work whilst negotiating their place and identity within the interprofessional team. IMPACT: Leaders in healthcare will see that a re-evaluation of HCAs as performers of basic, hands-on patient care is needed to breakdown ingrained beliefs, eliminating a 'us and them' mentality. Involving HCAs in the mentoring of medical students will impact on the personal development of both HCAs and medical students in the cultivation of a future, person-centred, inclusive and collaborative workforce. REPORTING METHOD: COREQ guidelines to enhance methodological rigour were strictly adhered to. PATIENT AND PUBLIC INVOLVEMENT: There is no patient or public involvement.

Caring for attitudes as a means of caring for patients--improving medical, pharmacy and nursing students' attitudes to each other's professions by engaging them in interprofessional learning.

INTRODUCTION: Negative attitudes between pharmacists, doctors and nurses can impact adversely on patients' medicines management. A seven-week interprofessional learning (IPL) intervention was delivered to foster positive attitudes. METHODS: First-year pharmacy, nursing and medical students' attitudes were assessed using the Attitudes to Health Professionals Questionnaire before and after IPL intervention. RESULTS: Students viewed pharmacists, doctors and nurses as more 'caring' after IPL. Nurses were viewed as most 'caring'. Nursing and pharmacy students perceived doctors as least 'caring' before and after IPL whereas medical students viewed pharmacists as least 'caring'. Students perceived their own profession as more 'caring' than others did. The three-way analysis of variance showed a significant difference between student groups (p<0.0001), professions (p<0.0001) and before-and-after IPL (p<0.005). CONCLUSION: Findings suggest that students' attitudes are more positive after they have worked together during seven weeks of IPL. Each student group view their own profession more positively than others. Views become more aligned after this IPL intervention. Time may be an important factor in allowing for attitudes to change. IPL can help foster positive attitudes between doctors, pharmacists and nurses, which may facilitate effective collaboration and thus enhance patients' medicines management.

Patient care, integration and collaboration of physician associates in multiprofessional teams: A mixed methods study.

AIMS: The aim of the study was to explore the physician associate role in patient care, integration and collaboration with team members, within the hospital setting. DESIGN: Convergent mixed methods case study design. METHODS: Questionnaires with some open-ended questions and semi-structured interviews were analysed with descriptive statistics and thematic analysis. RESULTS: Participants included 12 physician associates, 31 health professionals and 14 patients/relatives. Physician associates provide effective, safe and, importantly, continuity of care and patients received patient-centred care. Integration into teams was variable, and there was a lack of knowledge about the physician associate role amongst staff and patients. Views towards physician associates were mostly positive, but support for physician associates differed across the three hospitals. CONCLUSION: This study further consolidates the role of physician associates to multiprofessional teams and patient care and emphasises the importance of providing support to individuals and teams when integrating new professions. Interprofessional learning throughout healthcare careers can develop interprofessional working within multiprofessional teams. IMPACT: Leaders in healthcare will see that clarity about the role of physician associates must be given to staff members and patients. Employers and team members will see the need to properly integrate new professions and team members within the workplace and to enhance professional identities. The research will also impact on educational establishments to provide more interprofessional training. PATIENT AND PUBLIC INVOLVEMENT: There is no patient and public involvement.

Reflections and unprompted observations by healthcare students of an interprofessional shadowing visit.

This paper reports work from a Centre for Interprofessional Practice in a higher education institution in the UK that offers four levels of interprofessional learning (IPL) to all healthcare students. The second level (IPL2) integrates professional practice into the learning process, requiring students to shadow a qualified healthcare professional (from a different profession) for half a day. Students complete a reflective statement upon their learning experience on their return. A study was undertaken to analyse students' reflective statements in depth to see their observations and reflections on the shadowing visit. Using frame analysis, 160 reflective statements were analyzed, identifying common words and phrases used by students, which were then grouped together under six themes. Three of these related directly to the assignment: communication styles and techniques; communication between healthcare professionals and comparison of students' own and other healthcare professionals' roles. Three themes emerged from student's own interpretation of observations and reflections made during the shadowing of a different professional: attitudes toward other professions; power structures between professionals and patients and between professionals and impact of communication on patient care. Interprofessional shadowing gives students an opportunity to observe communication between healthcare professionals and patients and to reflect on broader issues surrounding collaborative working.

Cognitive profile in young adults born preterm at very low birthweight.

AIM: the aim of this study was to assess cognitive function at the age of 19 years in individuals of very low birthweight (VLBW; ≤ 1500g) and in term-born comparison individuals. METHOD: in this hospital-based follow-up study, 55 VLBW participants (30 males, 25 females; mean birthweight 1217g, SD 233g; mean gestational age 29.1wks, SD 2.5wks) and 81 comparison individuals (42 males, 39 females; mean birthweight 3707g, SD 433g; mean gestational age 39.7wks, SD 1.2wks) were examined with a standardized IQ test (Wechsler Adult Intelligence Scale III) to assess general cognitive ability. RESULTS: over half (53%) of the VLBW participants achieved a low IQ score (defined as >1SD below the mean in the comparison group; odds ratio 6.4 vs comparison individuals; 95% confidence interval 2.8-14.4; p<0.001). None of the VLBW group, compared with 22% of the comparison individuals, achieved a high IQ score (>1SD above the comparison mean). VLBW participants scored lower than comparison individuals on full, verbal, and performance IQ, as well as on all four indices (p ≤0.001). The subtest profile indicated problems on all subtests, but especially on those related to arithmetic and visual-perceptual tasks. INTERPRETATIONS: few studies have undertaken a comprehensive assessment of general cognitive outcome (IQ) among young adults of VLBW. Our results indicate that VLBW seems to have a global and lasting impact on cognitive ability. Full-scale IQ assessment may reveal important learning problems in young adults of VLBW, and should be performed to inform appropriate assistance to enhance academic achievement and the chances of permanent employment as adults.

Facilitator training for educators involved in interprofessional learning.

The provision of interprofessional education (IPE) within undergraduate healthcare programmes is now widespread, and a selection of approaches can be found in the literature. Although no optimal method of delivering IPE has been identified, some key elements, such as effective facilitation, are acknowledged to be a crucial part of successful IPE. However, to date, limited guidance is available on how to prepare facilitators involved in interprofessional learning (IPL). This paper aims to contribute towards bridging this gap by describing a facilitator training programme (FTP) for IPL facilitators in a Higher Education setting. The FTP comprises eight components relating to: objectives, context, role and skills, small group work, group dynamics, resources, support and evaluation. These components are designed to accommodate trainees with different learning styles (activists, pragmatists, theorists and reflectors) using training methods underpinned by adult learning theory and contact hypothesis. A description of the facilitator training is provided within this paper to illustrate how these eight components can be utilised by educators, to apply to their own IPE intervention and customising training to suit their own specific need.

Medical students working as health care assistants: an evaluation.

BACKGROUND: The General Medical Council requires that medical students are taught human values and how to work effectively with colleagues. Health care assistants (HCAs) provide fundamental patient care as part of the wider health care team. Reports suggest that medical students gain valuable insights when working as HCAs. METHODS: In 2015, a pilot was developed for medical students to work as and with HCAs. The experience involved 3 days training in preparation for three supervised shifts. The pilot was expanded to involve more students and clinical partners. RESULTS: A total of 131 students completed the HCA project between 2015 and 2018. Students were asked to complete a questionnaire where they scored a set of statements using a 5-point Likert scale, and gave open comments that were analysed thematically. A total of 119 students completed the questionnaire, of which 91% of students rated the experience as good or excellent and 98% of students agreed or completely agreed that they had met the learning outcomes. Themes centred around: feeling empathy; building confidence; appreciating the HCA team role; and how this experience may influence their future practice as doctors. A total of 87% of students said the experience should be mandatory. CONCLUSIONS: Students find the opportunity to work as HCAs meaningful and enjoyable. This brief initiative may help students develop a number of skills and attributes that assist in shaping future doctors. Further to helping medical students understand what values-based practice actually means and why it matters to patients, it also clarifies HCAs' and other professionals' contribution to the wider health care team. A research study is underway to evidence its impact.

A two-week stay in an Interprofessional Training Unit changes students' attitudes to health professionals.

Attitudes amongst health professionals can impact on the effectiveness of teamworking and patient care. Interprofessional education (IPE) is thought to contribute to the development of positive attitudes. An Interprofessional Training Unit (ITU) was set up to create an optimal learning environment for healthcare students. Students' attitudes were assessed, using a version of the Attitudes to Health Professionals Questionnaire (AHPQ) that had been translated into the students' native language. This paper describes the process undertaken to obtain a trustworthy translation. One hundred and sixty two students from occupational therapy, physiotherapy, medicine and nursing completed the questionnaire before and after their stay at the ITU. Their responses were analysed in relation to the constructs "caring" and "subservient" from the validated English version of AHPQ. Echoing earlier studies elsewhere, at the beginning students viewed doctors as being the least "caring" and the least "subservient" professional group. Nurses were seen by the students as being the most "caring" and the most "subservient" profession. After the ITU experience students viewed most professions as more "caring" and less "subservient", apart from doctors, who were seen as being more subservient after the ITU experience. This study indicates that an IPE initiative such as the ITU can impact positively on students' attitudes and that the translated AHPQ can be used to monitor this attitudinal change.

Purposeful involvement of experts by experience.

BACKGROUND: There is a growing requirement from professional bodies in the UK that health and social care education must include the voice of experts by experience (EbE). Active steps have been taken at the international level in order to truly embed their involvement. In parallel with this development, there is compounding evidence collated globally that links interprofessional education (IPE) to improved health outcomes. As the involvement of EbE plays a central role in IPE there is an increased expectation for teachers to be able to successfully involve EbE in IPE and other health education. ISSUE: Although there is some guidance available to teachers on how to involve EbE in pre-registration health and social care education, less guidance is available on how to involve EbE in complex educational interventions, such as IPE. Hence the need for faculty member development. APPROACH: The Centre for Interprofessional Practice (CIPP) has involved nearly 350 EbE in a variety of IPE since 2005. This review draws on insights from the CIPP to identify a number of practice points for teachers who wish to involve EbE in IPE, or as part of education for their specific profession. The practice points are endorsed by EbE and discussed in light of initiatives and evidence reported by others in the literature. To help contextualise and make use of these practice points they were grouped according to the presage-process-product (3P) model. This article can inform faculty member development aimed at new or senior educators, and our insights are equally applicable to both uni- and interprofessional contexts.

The development, outline and evaluation of the second level of an interprofessional learning programme ­ listening to the students.

The delivery and content of interprofessional education (IPE) varies greatly. Currently there is little evidence to suggest the most effective approach. This paper describes an interprofessional learning programme offered to second year healthcare students (IPL2), which was developed together with the students. At the outset of developing IPL2, an interprofessional student planning group (supported by a facilitator) was formed. The student planning group (SPG) reported back their ideas to an IPL steering group. Student feedback forms from 2005­2006 were used for the review and further development of IPL2. Analysis of student feedback was completed using median (for the quantitative elements of the form) and content analysis (for the qualitative elements). Post-programme student feedback included suggestions such as improvements to the case scenario, issues such as the logistical problems associated with students being on placement and how to overcome this by expanding the use of a virtual learning environment. Student views have informed both the original and ongoing development of IPL2 and ensure that the IPL programme remains relevant to the students. This model of involving students in the development of IPL has proven effective and can be applied to other settings.

Promoting collaboration in emergency medicine.

BACKGROUND: Collaborative practice between paramedics and medical staff is essential for ensuring the safe handover of patients. Handover of care is a critical time in the patient journey, when effective communication and collaborative practice are central to promoting patient safety and to avoiding medical error. To encourage effective collaboration between paramedic and medical students, an innovative, practice-based simulation exercise, known as interprofessional clinical skills (ICS) was developed at the University of East Anglia, UK. Emphasising patient safety, effective handover of care and teamwork, within the context of emergency medicine, the ICS promotes collaborative practice amongst health care students through the use of high- and low-fidelity simulation, human factors and values-based practice. METHODS: A total of 123 undergraduate students from paramedic (60) and medical backgrounds (63) took part in the ICS. Evaluation data were collected from all students through the completion of an internal feedback/satisfaction questionnaire with 13 statements and one open-ended comment box. RESULTS: The response rate for the questionnaire was 100%. Of the 123 students from paramedic and medical disciplines, 99% agreed or strongly agreed with the statement 'I enjoyed this session'. Students also felt that the ICS helped them to build mutual respect (98%), enhance understanding of roles (94%) and develop as collaborative practitioners (92%). Collaborative practice between paramedics and medical staff is essential CONCLUSION: The ICS is an innovative, enjoyable and meaningful intervention for promoting interprofessional collaborative practice between paramedic and medical students in a simulated practice setting. It encourages students to gain core training in clinical skills and patient safety, within a safe, supervised environment.

Facilitators' perceptions of delivering interprofessional education: a qualitative study.

BACKGROUND: The literature on facilitation of interprofessional learning (IPL) tends to discuss its importance rather than providing empirical accounts focused on understanding its nature and the factors that might make it effective. AIM: This study aims to provide an initial insight into facilitators' experiences of facilitation, and begin to identify some of the key elements that contribute to successful facilitation of IPL. METHODS: 2 focus group interviews were held with facilitators of IPL (n = 5; n = 8) within a higher education setting. Follow-up telephone interviews were undertaken with 6 facilitators. Thematic analysis was undertaken on the data. All facilitators were invited to a presentation of findings in order to help validate the authors' interpretation of the data. RESULTS: Results indicated that facilitators valued both their induction and their weekly debriefing meetings in preparing and developing them for their role. To be effective, facilitators felt they needed to display a range of attributes including enthusiasm, humour and empathy. Despite enjoying their work, facilitators reported that their role in IPL was challenging, more so than problem based learning (PBL) with uni-professional groups. CONCLUSIONS: The study indicated that the facilitation of IPL is a complex and demanding activity. It also indicated that the use of a facilitator induction and regular de-briefing sessions were key to supporting the facilitators work and fostering interprofessional collegiality.

The colon-selective spasmolytic otilonium bromide inhibits muscarinic M(3) receptor-coupled calcium signals in isolated human colonic crypts.

1. Otilonium bromide (OB) is a smooth muscle relaxant used in the treatment of irritable bowel syndrome. Otilonium bromide has been shown to interfere with the mobilization of calcium in intestinal smooth muscle, but the effects on other intestinal tissues have not been investigated. We identified the muscarinic receptor subtype coupled to calcium signals in colonic crypt derived from the human colonic epithelium and evaluated the inhibitory effects of OB. 2. Calcium signals were monitored by fluorescence imaging of isolated human colonic crypts and Chinese hamster ovary cells stably expressing the cloned human muscarinic M(3) receptor subtype (CHO-M(3)). Colonic crypt receptor expression was investigated by pharmacological and immunohistochemical techniques. 3. The secretagogue acetylcholine (ACh) stimulated calcium mobilization from intracellular calcium stores at the base of human colonic crypts with an EC(50) of 14 micro M. The muscarinic receptor antagonists 4-DAMP, AF-DX 384, pirenzepine and methroctamine inhibited the ACh-induced calcium signal with the following respective IC(50) (pK(b)) values: 0.78 nM (9.1), 69 nM (7.2), 128 nM (7.1), and 2510 nM (5.8). 4. Immunohistochemical analyses of muscarinic receptor expression demonstrated the presence of M(3) receptor subtype expression at the crypt-base. 5. Otilonium bromide inhibited the generation of ACh-induced calcium signals in a dose dependent manner (IC(50)=880 nM). 6. In CHO-M(3) cells, OB inhibited calcium signals induced by ACh, but not ATP. In addition, OB did not inhibit histamine-induced colonic crypt calcium signals. 7. The present studies have demonstrated that OB inhibited M(3) receptor-coupled calcium signals in human colonic crypts and CHO-M(3) cells, but not those induced by stimulation of other endogenous receptor types. We propose that the M(3) receptor-coupled calcium signalling pathway is directly targeted by OB at the level of the colonic epithelium, suggestive of an anti-secretory action in IBS patients suffering with diarrhoea.

Visual function and white matter microstructure in very-low-birth-weight (VLBW) adolescents--a DTI study.

Premature birth is associated with visual impairments, due to both cerebral and ocular pathology. This study examined the relationship between cerebral white matter microstructure, evaluated by diffusion tensor imaging (DTI), and visual function, in 30 preterm born adolescents with very low birth weight (VLBW=birth weight⩽1500g) and an age-matched group of 45 term born controls. Visual acuity correlated positively with fractional anisotropy (FA) in corpus callosum and in frontal white matter areas in the VLBW participants, but not in the control participants. Callosal visual connections may play a more important role in the development of good visual acuity than previously acknowledged in preterm born children.