The Use of Immersive Virtual Reality in Sensory Sessions on a Specialist Dementia Unit: Service Evaluation of Feasibility and Acceptability.

This service evaluation reviewed inclusion of Immersive Virtual Reality (iVR) relaxation activities as part of routine occupational therapy sensory sessions on a specialist dementia unit. Twenty-five sessions were completed over 13 wk with 14 participants. Nine participants chose to engage in multiple sessions. Feasibility was assessed through participant engagement and tolerability. Modal first session length was in the range 30 s to 2 min. This increased to over 2 min on second sessions. There was a lack of significant adverse effects measured by direct questioning, neuropsychiatric assessment before vs. after sessions and adverse incident reporting. Acceptability was assessed via structured review of user and staff feedback which noted positive experiences such as relaxation, openness to discussion, reminiscence, wider engagement and interest in future use. Further work is required to explore efficacy and use in other settings.

Violence and delusional jealousy in Parkinson's disease.

Psychosis in Parkinson's disease (PD) can have a hugely detrimental effect on patient outcomes and quality of life. It can be a feature of PD itself, or can be exacerbated by the very pharmacological agents that are prescribed to treat the motor symptoms of the disease. The treatment of psychosis in PD is often complex, with clinicians having to balance the debilitating physical symptoms of PD against the risk of exacerbating the psychosis. We describe the case of an octogenarian who presented with violence motivated by delusional jealousy in the context of PD, who was treated in a specialist psychiatric inpatient environment.

A comparison of medical and pharmacy student perspectives of a clinical interprofessional home-visit versus a virtual interprofessional workshop.

Background: No Place Like Home is a clinical interprofessional education (IPE) activity whereby pharmacy and medical students conduct home visits under the guidance and supervision of a clinical preceptor to homebound patients. Purpose: We examined pharmacy and medical student perceptions of mastery of interprofessional competencies during an in-person clinical home visit pre-COVID-19 pandemic versus a virtual IPE learning activity consisting of didactic and case discussions in response to the global COVID-19 pandemic. Methods: We administered the same modified Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, which uses a five-point Likert scale, to both the in-person and the virtual IPE students following their learning activity.   Results: We received a total of 459 completed survey responses with an overall response rate of 84%. For both groups of students, the in-person format was preferred, however, to our surprise, the results indicated that students in the virtual group reported greater perceived gain in interprofessional skills than students in the in-person group. In addition, pharmacy students perceived greater gain from the interprofessional activity and offered more thoughtful reflections about their experience. Conclusions: Even though both groups of students preferred the in-person visit, the IPE objectives were equally (for medical students) or better (for pharmacy students) absorbed in the virtual environment than the in-person clinical home visit.

In-person and online escape rooms for individual and team-based learning in health professions library instruction.

Background: A growing body of research demonstrates that adapting the popular entertainment activity "escape rooms" for educational purposes as an innovative teaching method can improve the learning experience. Escape rooms promote teamwork, encourage analytical thinking, and improve problem solving. Despite the increasing development and use of escape rooms in health sciences programs and academic libraries, there is little literature on the use of this method in health sciences libraries with health professions students. Case Presentation: Staff at a health sciences library collaborated with faculty to incorporate escape rooms into library instruction in a variety of settings (in-person, hybrid, online) and formats (team, individual) with health professions students from various disciplines (optometry, pharmacy, medicine). The escape rooms described in this paper offered unique experiences for students through active learning. Discussion: Important considerations when planning escape rooms for health sciences library instruction include deciding on team-based or individual design, calculating potential costs in time and money, deciding on an in-person, hybrid, or online format, and determining whether grades should be assigned. Escape rooms can be an effective strategy for library instruction in the health sciences, working in multiple formats to bring game-based learning to a variety of health professions students.

Knowledge and self-perception comparisons between students with and without prior technician experience in community pharmacy lab courses.

INTRODUCTION: It is unknown if students with previous pharmacy technician experience benefit from a community pharmacy dispensing lab. Anecdotally, students with previous technician experience often do not feel a substantial benefit from the course. The purpose of this project was to evaluate pharmacy practice knowledge and perceptions of those with and without prior technician experience in a community lab course. METHODS: Doctor of pharmacy students enrolled in the lab course were included in the study. All students were administered a pre- and post-course self-perceptions survey and knowledge assessment (20 scenario-based multiple-choice questions). The knowledge assessment evaluated understanding of community pharmacy law, workflow, inventory, insurance, and prescription verification. Survey variables analyzed included length of experience, confidence, and course expectations. Results were analyzed using student's t-tests. RESULTS: A total of 216 students completed the pre- and post-assessments and were included for analysis. Students with previous technician experience scored statistically significantly higher on the knowledge assessment than students without experience (pre: 57% vs. 33%, post: 67% vs. 53%, respectively). Students without prior technician experience had many statistically significant increases in perceptions of knowledge and confidence, while those with prior technician experience had few. CONCLUSIONS: There is a baseline knowledge gap between students with technician experience and those without in a community pharmacy simulation lab. Results of this study have identified specific gaps which may be useful for course structure and design. This data supports investigation into 'testing out' or providing separate tracks in a community lab for experienced and non-experienced students.

No place like home redesign: home-based clinical care as an interprofessional training model for medical and pharmacy students.

Proper program assessment is necessary to ensure the delivered curriculum aligns with the intended curriculum. No Place Like Home (NPLH) is an interprofessional experience in which a healthcare team provides clinical services to patients in a home environment. Following review of program evaluation data, we determined the original design of NPLH was not meeting the intended objectives, and NPLH was redesigned in January 2018. Changes include lengthening the experience, decreasing the team size, improving assessment tools and additional training for the preceptors. The revised curriculum includes a care team with a preceptor, a medical, and a pharmacy student who visit four to six patients on an assigned day. From May 1, 2018 to April 30, 2019, there were 320 students who participated in NPLH. The preceptor assessments of students across the five objectives had mean scores of 3.4-3.7 on a 4 point scale indicating that on average preceptors placed students between Demonstrates Competence and Demonstrates Excellence for all objectives. When students were asked to compare their ability to collaborate interprofessionally after NPLH to the time before, 79% stated Somewhat Better Now or Much Better Now. It is not sufficient to create interprofessional learning activities and assume learning objectives are being met. Ongoing performance assessment and curricular evaluation are essential to ensure such goals are achieved. When intended objectives are not being met, it is possible to make deliberate and purposeful changes to redirect interprofessional learning experiences while maintaining the integrity, novelty and uniqueness of the experience.

Using a Resuscitation-Based Simulation Activity to Create an Interprofessional Education Activity for Medical, Nursing, and Pharmacy Students.

Introduction: To achieve high-quality, patient-centered care, teaching programs across health professions must prepare their learners to work in effective teams. We created a simulation activity to formatively assess interprofessional objectives in graduating medical, nursing, and pharmacy students. This simulation also gave learners an opportunity to practice clinical airway resuscitation skills. Methods: The simulation featured a decompensating adult asthmatic with a chief complaint of shortness of breath and a final diagnosis of severe asthma exacerbation and respiratory failure. Students completed a prebrief to formulate a plan and then interacted with a mannequin. Faculty led a debriefing and completed assessments of the team's performance. The students completed a questionnaire assessing their own and the team's performance. Results: Four sessions were held over a 2-year period. A total of 91 graduating students participated in the activity: 33 from Baylor College of Medicine, 26 from University of Houston College of Pharmacy, and 28 from Texas Woman's University Nelda C. Stark College of Nursing. Postsession questionnaire data demonstrated very good overall team performance and good individual performance. Student comments demonstrated an understanding of the importance of teamwork and thoughtful reflection on their own areas for improvement. All students rated the activity as valuable and effective. Multirater assessments of the students found that most met three of the four objectives. Discussion: This activity allows for real-time formative assessment with a focus on roles, communication, and managing difficult situations. The debriefing demonstrates the students' understanding of interprofessional goals in providing effective patient-centered care.

The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK.

BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide. METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). RESULTS: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. CONCLUSIONS: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

Efficacy of a dementia intensive support (DIS) service at preventing admissions to medical and psychiatric wards: qualitative and quantitative evaluation.

AIMS AND METHOD: To establish whether a dementia intensive support (DIS) service that is part of a crisis resolution and home treatment team for older people is preventing admissions to acute hospital and psychiatric wards. The number of referrals in 2017 to the DIS service was established and those admitted to hospital ascertained. Senior doctors examined 30 sets of notes in detail and reached a conclusion on whether DIS had contributed to admission prevention. This information was then re-examined in two meetings with at least eight senior psychiatrists present. A consensus opinion was then reached as to whether DIS had contributed to admission prevention in each case. RESULTS: Over 12 months, 30/171 patients (18%) referred were admitted to hospital. For the subset of 30 referrals examined in detail, DIS contributed to admission avoidance in 21 cases (70%). CLINICAL IMPLICATIONS: Our evaluation demonstrates that the DIS service is an effective way of preventing admission.

An Interprofessional Standardized Patient Case for Improving Collaboration, Shared Accountability, and Respect in Team-Based Family Discussions.

Introduction: The science of patient safety demonstrates that good communication is essential for effective interprofessional collaboration. Methods: We created a low-stakes, formative assessment with which medical students, pharmacy students, and nursing students could practice several of the Interprofessional Education Collaborative competencies. We aimed to enable students to practice collaborative care, respect for other disciplines, and shared accountability. Senior students from medicine, nursing, and pharmacy worked in teams to disclose a medical error to a standardized patient. The activity began with an icebreaker exercise wherein students learned about each other. Next, each team planned a strategy for error disclosure and collaboratively disclosed the error. Standardized patients evaluated the team's performance. Subsequently, students regrouped for a debriefing. The participating institutions administered a survey to their students. Results: In total, 1,151 students participated: 464 fourth-year students from the University of Houston College of Pharmacy, 450 third- and fourth-year students from Baylor College of Medicine, and 237 fourth-year students from Texas Woman's University Nelda C. Stark College of Nursing, all in Houston, Texas. Postsession survey data showed that students thought they achieved the relevant competencies. Students' understanding of the perspectives of the other two disciplines improved. Students found the simulation encounter and debriefing effective in helping them consider the contributions of other disciplines to patient care. Discussion: This interprofessional standardized patient activity enabled collaborative problem solving. The debriefing discussion broadened students' understanding of the expertise of the other disciplines and promoted shared accountability. Students found this activity engaging and effective.

Patient Safety Interprofessional Training for Medical, Nursing, and Pharmacy Students.

INTRODUCTION: Patient safety education is required in medical, nursing, and pharmacy training, and interprofessional education offers an ideal format for teaching the core concepts of patient safety. This training activity was developed to fulfill interprofessional education core competencies for communication and teamwork and was nested within a required patient safety course taught at a medical school. However, the activity can easily be adapted as a stand-alone offering that can be included in a preclinical doctoring course, offered as an elective, or hosted at a college of nursing or pharmacy. Our goal was to prepare learners for the clinical environment by providing a context for patient safety, communication, and teamwork. METHODS: Students participate in a 1.5-hour large-group activity that explores a case from the perspectives of each discipline. Faculty from all three disciplines sequentially present and debrief the case using focused questions to guide students' reflections and interactions between team members. RESULTS: We have presented this activity for 4 consecutive years. Students complete a questionnaire with retrospective pre-post ratings of their perspectives on the activity and its impact on their awareness of disciplinary roles and responsibilities, communication errors, and strategies for addressing interdisciplinary conflicts. Results show statistically significant increases in the items of interest. DISCUSSION: This interprofessional education offering is effective in terms of increasing awareness and knowledge among members of three health care disciplines, improving awareness of potential kinds of communication errors, and helping students consider the role of interdisciplinary interactions.

Factors that influence student completion of course and faculty evaluations.

OBJECTIVE: To determine if there is a relationship between students' grades, gender, age, or ethnicity and their completion of course and/or faculty evaluations. METHODS: Data were collected and analyzed for relationships among students' gender, age, ethnicity, and course grade on their completion rates of course and faculty evaluations. RESULTS: The grade a student received in a course was not related to completion rates for course or faculty evaluations. Students born in 1987 or earlier were significantly more likely to complete course or faculty evaluations. Significant differences in completion rates were also found based on the course taken and the gender and ethnicity of the students. CONCLUSIONS: Several demographic characteristics were identified that correlated with the completion of course and/or faculty evaluations. However, no correlation was found with the grade a student receives in a course and completion of either course or faculty evaluations. In order to improve course and faculty evaluation rates, further analysis of the influence of demographics on completion rates is warranted.

Diagnostic tools for dementia.

As population ageing means that dementia is becoming more prevalent, it is increasingly important that clinicians from all types of practice are familiar with assessing patients who have possible cognitive impairment. The diagnosis of the syndrome of dementia remains a clinical process, supplemented by relevant investigations including cognitive testing. This paper reviews some of the more commonly used tools for assessing cognition, behaviour and overall functioning in patients with possible or established dementia. Several categories of instruments are considered, including brief screening tests, neuropsychological test batteries, scales for behavioural and psychiatric symptoms, and functional and global assessments. It is recommended that clinicians familiarize themselves with a small number of scales that can be readily employed in everyday practice.