UK guideline for the use of HIV post-exposure prophylaxis 2021.

We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

What students and new graduates perceive supports them to think, feel and act as a health professional in a rural setting.

OBJECTIVE: Clinical placements in rural locations are perceived by students to provide positive learning experiences to support their transition to practice. This study explores how clinical placements in a rural health setting might influence students and new graduates to think, feel and act as a health professional. DESIGN: A qualitative study comprising focus group discussions was conducted. SETTING: The study was conducted in a rural health service in Queensland, Australia. PARTICIPANTS: Allied health students (n = 12) on placement and new graduates (n = 11) working in a regional health service. MAIN OUTCOME MEASURES: This study identified allied health student and new graduate perspectives on clinical placement factors which support them to think, feel and act as a health professional. RESULTS: Thematic analysis was used to understand student and new graduate perceptions of how rural placements support thinking, feeling and acting as a health professional. Suggestions for supporting learning included the following: Development of learning partnerships between students and clinical educators with inbuilt expectations and opportunities for reflection and supervision. Creating a culture where students are welcomed, valued and encouraged to take meal breaks with the team supported connectedness. The importance of balancing student autonomy with educating and grading support to increase independence. CONCLUSIONS: Findings show clinical placement experiences identified by allied health students and new graduates which support them to begin to think, feel and act as a health professional. Suggestions provided by students and new graduates can be used to inform implementation of clinical placement experiences.

What supports allied health students to think, feel and act as a health professional in a rural setting? Perceptions of allied health staff.

OBJECTIVE: Clinical placements in rural locations provide student health professionals with diverse learning opportunities. Engaging in clinical work and learning from role models and peers in the workplace are primary ways students develop professional skills, behaviour and identities as a health professional. The purpose of this study was to examine the influences supporting allied health students undertaking clinical placements in a rural health service to think, feel and act as a health professional from the perspective of allied health staff. DESIGN: A qualitative study comprising focus group discussions was conducted. SETTING: The study was conducted in a rural health service in Queensland, Australia. PARTICIPANTS: Seventeen allied health staff whose roles support clinical placement education in the health service MAIN OUTCOME MEASURES: This study identified clinical placement factors which can support allied health students thinking, feeling and acting as a health professional. RESULTS: Thematic analysis was used to understand staff perceptions of how rural placements support students to think, feel and act as a health professional. Key placement actions included taking advantage of the diverse learning experiences in a rural area, facilitating student connectedness in the workplace and grading learning to support independence and autonomy for practice. CONCLUSIONS: Findings from this study show that the diverse work environment and experiences in a rural setting provide unique opportunities for students to begin to think, feel, and act as a health professional. Strategies identified might be applied in other similar contexts.

Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service.

INTRODUCTION: Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service. METHODS: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed. RESULTS: Twenty-four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty-eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change. CONCLUSION: Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings.

Implementation of a new model of clinical education for regional occupational therapy student clinical placements.

Expansion of occupational therapy education programs has resulted in increased student numbers and demand on clinicians to host clinical placements while also maintaining the delivery of high-quality, safe clinical services to patients. Much of the research about innovative placement models, including student contributions to service delivery, has been conducted in metropolitan areas. Therefore, there is a need to develop models that are suited to regional settings that face diversity of caseload, more generalised occupational therapy roles and variations in patient flow. The aim of the present study was to describe the initial application of the Calderdale Framework in student education in a regional context and look at lessons learnt. The Calderdale Framework provided a structured, clinically governed process whereby occupational therapists were able to determine which tasks could be allocated to students and provided a framework to support student training and competency development. The Calderdale Framework has been used successfully to implement allied health models involving professional skill sharing and delegation of tasks to allied health assistants, but it has not been used in clinical education. Pilot implementation of the Calderdale Framework showed that the model supports quality and safety of student-provided occupational therapy services and that the teaching method provides a platform for student skill development. These results warrant further investigation and are potentially transferrable to student education in other health professions.

Acute and conditioned hyperalgesic responses to illness.

It has been argued that pain functions to facilitate recovery from injury and/or illness by stimulating recuperative behaviors. If this is the case, then hyperalgesia might be expected to be part of the constellation of adaptations that occur during sickness. The present series of studies tested two agents that induce illness (lithium chloride and bacterial cell-wall endotoxin (lipopolysaccharide)) to determine their acute effects on pain responsivity in rats. Both agents produced hyperalgesia as measured by the tail-flick and formalin tests. This enhanced responsivity appears to be specific to pain since (a) no enhanced response was observed to a non-painful stimulus (6 g von Frey hairs), and (b) the effect could not be accounted for by changes in tail skin temperature. In addition, a conditioned taste aversion paradigm was used to examine the possibility that illness-induced hyperalgesia could be conditioned to a novel taste (saccharine). This procedure was successful in producing a conditioned hyperalgesia which was comparable in magnitude and duration to acute illness induced pain facilitation. Taken together, this series of studies suggests that such pain facilitation might have adaptive functions similar to those ascribed to other illness-induced behaviors.