Towards a global partnership model in interprofessional education for cross-sector problem-solving.

OBJECTIVES: A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. METHODS: This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students' data. RESULTS: We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest-posttest differences in students' readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students' social interaction anxiety after the IPE simulation. CONCLUSIONS: The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education.

Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation - a qualitative study.

BACKGROUND: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF. METHOD: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis. RESULTS: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. CONCLUSION: The findings revealed patients' knowledge gap in AF management which may be targeted using educational interventions to improve patients' understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

Applying motivational framework in medical education: a self-determination theory perspectives.

BACKGROUND: The application of self-determination theory in explaining student achievement has been well-established in various contexts. However, its application to medical education, particularly in interprofessional education (IPE) remains underexplored. Understanding how students' motivation plays a role in students' engagement and achievement is essential to optimize efforts to improve learning and instruction. OBJECTIVE: This two-stage study aims to contextualize the SDT framework to IPE through the adaptation of the Basic Psychological Need Satisfaction to IPE (Study 1) and to demonstrate how SDT can be applied in IPE by examining a model of SDT constructs (Study 2) in predicting outcomes (behavioral engagement, team effectiveness, collective dedication, goal achievement). DESIGN: In Study 1 (n=996), we adapted and validated BPNS-IPE using confirmatory factor analysis and multiple linear regression using data from 996 IPE students (Chinese Medicine, Medicine, Nursing, and Pharmacy). In Study 2 (n=271), we implemented an IPE program where we integrated SDT approaches and examined the relationship of SDT constructs with IPE outcomes using multiple linear regression. RESULTS: Our data supported the three-factor structure (autonomy, competence, and relatedness) of BPNS-IPE, meeting the required model fit. Autonomy predicted team effectiveness (F=51.290, p<.05, R2=.580); competence predicted behavioral engagement (F=55.181, p<.05, R2=.598); while relatedness predicted significantly four IPE outcomes: behavioral engagement (F=55.181, p<.01, R2=.598), team effectiveness (F=51.290, p<.01, R2=.580), collective dedication (F=49.858, p<.01, R2=.573), goal achievement (F=68.713, p<.01, R2=.649). CONCLUSIONS: The SDT motivational framework can be adapted and applied in the IPE context to understand and enhance student motivation in medical education. Potential studies with the use of the scale are provided to guide researchers.

Students' interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction.

BACKGROUND: Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE. METHOD: This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis. RESULTS: CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R2=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R2=.057) to IPE, suggesting between-network validity. CONCLUSIONS: Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students' data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students' social interactions in IPE.Key MessagesThe Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students' data in IPE in Hong Kong.Social interaction anxiety and social phobia negatively predicted students' behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline.Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

The pharmacogenetics of the response to warfarin in Chinese.

Warfarin is a commonly used oral anticoagulant with a narrow therapeutic range and large interindividual variability in daily dose. Compared with Caucasians, Chinese are known to require lower doses of warfarin. Differences between Caucasians and Chinese in the allelic frequencies of two genes, CYP2C9 and VKORC1, largely explain the difference in dose requirement. There are other genetic polymorphisms that may further explain the response to warfarin. The VKORC1 genotype is an important determinant of response to warfarin in Chinese, but some genetic variants found in other ethnic groups that have a large effect on warfarin response and dosing are not commonly found in Chinese. Therefore, it is important to recognize and beware of ethnic differences in the pharmacogenetics of the response to warfarin, especially in the design of algorithms to aid dosing in clinical practice.

Knowledge difference of sexually transmitted infections between Hong Kong undergraduates from local and international secondary schools: A cross-sectional study.

Background: Since the delivery of sex education is not standardized across local and international secondary schools in Hong Kong, this study aims to assess and compare the knowledge level of sexually transmitted infections (STIs) between university students who attended local and international secondary schools in Hong Kong. Methods: From January to March 2019, we conducted a cross-sectional survey among undergraduates at the University of Hong Kong. The primary outcome was STI knowledge as measured by a 29-item quiz. A higher quiz score meant a better STI knowledge level. Students' attitude toward sexual health and their sex education history was collected. Bivariate and multivariate analyses were conducted to evaluate the association factor with a better STI knowledge level. Results: Three hundred and ninety six students were included in the analysis. Three hundred thirty three (85.35%) students attended local secondary schools and 58 (14.65%) students attended international secondary schools in Hong Kong; 200 (50.51%) students were male and 196 (49.49%) students were female. Compared with students from local secondary school, those from international secondary schools had a significantly higher STI quiz score (18.19 vs. 15.4, p = 0.003). The results of multiple linear regression revealed that students in a higher year of study (ß = 1.07, p < 0.001), from medical faculties (ß = 6.96, p < 0.001), and from international secondary schools (ß = 2.27, p = 0.003) achieved a higher STI quiz score. Conclusion: University students who attended international secondary schools in Hong Kong possess a significantly higher knowledge level of STIs compared with those who attended local secondary schools. Nonetheless, the overall STI awareness among university students is inadequate. The inadequacy of STI awareness calls for the need to plan and implement satisfactory, comprehensive, and standardized sex education across the overall education system in Hong Kong.

ADHD Drug Prescribing Trend Is Increasing Among Children and Adolescents in Hong Kong.

OBJECTIVE: To investigate the prevalence of ADHD medication prescribing of school-aged children in Hong Kong (HK) from 2001 to 2013 and to compare with other countries. METHOD: Using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System, we investigated the epidemiology and prevalence of ADHD medication prescribing. RESULTS: The prevalence of children on ADHD medication increased 14 times throughout the study period-0.072% in 2001 (95% confidence interval [CI] = [0.068%, 0.077%]) to 1.027% (95% CI = [1.008%, 1.047%]) in 2013. Prevalence in females increased at a faster rate than in males. The prescribing trend in kindergarten children (3- to 5-year-old) was relatively steady from 2001 to 2008-0.025% (95% CI = [0.019%, 0.033%]) in 2001-until a marked increase from 2009 to 2013-0.121% (95% CI = [0.105%, 0.139%]) in 2013. CONCLUSION: The prevalence of ADHD medication prescribing in Hong Kong is increasing but remains lower than most Western countries. However, the prevalence of ADHD medication prescribing for kindergarten children should be monitored to ensure appropriate use.

The effectiveness of a 'Do Not Use' list and perceptions of healthcare professionals on error-prone abbreviations.

BACKGROUND: The use of error-prone abbreviations has led to medication errors. Many safety organisations have introduced 'Do Not Use' lists (lists of error-prone abbreviations that should be avoided by prescribers), but the effectiveness of these lists have not been studied. OBJECTIVE: We assessed the effectiveness of the 'Do Not Use' list introduced to the study hospital, and sought the attitudes of healthcare professionals on other potentially dangerous abbreviations (not included in the 'Do Not Use' list) used in prescriptions. SETTING: The study was conducted in a university affiliated tertiary hospital in Hong Kong. METHODS: An uncontrolled observational study was conducted. In-patient prescriptions were reviewed to assess the use of error-prone abbreviations included in the 'Do Not Use' list before, after its introduction, and following the first reinforcement. An on-line survey was also conducted among prescribers, pharmacists and nurses. MAIN OUTCOME MEASURE: Rate of using error-prone abbreviations and other unapproved abbreviations among reviewed prescriptions. RESULTS: 3,238 prescriptions (23,398 drug items) were reviewed. The use of abbreviations in the 'Do Not Use' list decreased from 7.8 to 3.3 % after its introduction (P < 0.001) and to 1.3 % after the first reinforcement (P < 0.001). However, unapproved abbreviations were used to denote prescribing instructions in 19.2 % of the drugs prescribed. 49 different types of unapproved abbreviations were used for drug names. CONCLUSIONS: A 'Do Not Use' list is effective in reducing error-prone abbreviations. Reinforcements of the 'Do Not Use' list further improves prescriber adherence. However, many other unapproved abbreviations (not included in current 'Do Not Use' lists) are used when prescribing. Periodic reminders on error-prone abbreviations and education of prescribers on associated risks may help to reduce the use of error-prone abbreviations in hospitals.

Pharmacogenetics of allopurinol--making an old drug safer.

Allopurinol is a drug that has been used for decades to lower serum urate levels in patients with gout or chronic renal failure and in cancer patients undergoing chemotherapy at risk of tumor lysis syndrome. Patients may develop cutaneous hypersensitivity reactions, ranging from mild rashes to potentially fatal severe cutaneous adverse reactions (SCARs) namely drug hypersensitivity syndrome, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Recent studies have demonstrated the association between human leukocyte antigen (HLA) B*58:01 allele and allopurinol-induced SCARs, which might explain ethnic differences in their incidences. Genotyping is now required before starting abacavir and carbamazepine so as to identify individuals susceptible to SJS. However, no genetic screening is advocated before commencement of allopurinol. The lack of availability of a rapid and inexpensive screening test for the HLA-B*58:01 allele is one of the obstacles to such screening. Development of a test that is quick, accurate, and cost-effective is warranted.

The use of STOPP/START criteria as a screening tool for assessing the appropriateness of medications in the elderly population.

Although numerous initiatives and interventions have been developed to promote medication safety, medication incidents still remain an important cause of hospitalization. To avoid this, it is important for physicians to prescribe safely. To date, the Beers criteria have been the most widely used explicit criteria for assessing the appropriateness of medications in the elderly, but they do have limitations. The more recent STOPP/START criteria were developed in the hope of addressing the deficiencies observed in the Beers criteria. This article gives an overview of STOPP/START criteria and its applications, and reviews the studies that assessed medication appropriateness using STOPP/START and/or the Beers criteria.