The applicability of interprofessional education for collaborative people-centered practice and care to health plans and workforce issues: A thematic global case review.

Background: This article focuses on a growing, global recognition of the importance of the field of interprofessional education for person-centered collaborative practice (IPECP) expressed through high-level policy and accreditation decisions/actions taking place in 5 countries. Policy decisions are used to motivate strategies related to IPECP that align with national health plans, and workforce issues. Methods: Using a collective of representative stories from around the globe, a grouping of case studies were developed to illustrate different approaches and challenges to IPECP implementation. Results: Institutions from countries of various income levels face many similar challenges in the execution, delivery, and sustainability of IPECP. All programs face issues of financing, of preparing faculty, of developing and organizing curricula, and of bridging between campus and community. Discussion: Policies are being developed that promote a global approach to the inclusion of IPECP in the accreditation and regulation of postsecondary institutions and health service organizations, in keeping with WHO National Health Workforce Accounts. Policies developed promote and demonstrate the benefits of IPECP through remote emergency learning methods. The policies also build national systems for IPECP as an integral part of continuing professional development and lifelong learning. The organization of interprofessional research programs and the increasing publication of their results of such programs will lead to a clearer understanding of the efficacy of the field of IPECP. To ensure sustainability, stakeholders and policymakers should continue to foster policies that facilitate IPECP.

Results and lessons learned from a virtual multi-institutional problem-based interprofessional learning approach: The VIPE program.

The importance of interprofessional collaborative practice has come into focus over the past decade as coordination and delivery of health care becomes increasingly complex. The need for students to acquire collaboration-building skills to prepare them to work effectively within diverse healthcare teams to improve patient outcomes is a goal of interprofessional education (IPE). Accrediting bodies across healthcare professions require IPE as part of a robust curriculum to build collaborative skill sets and create a practice ready workforce. To respond to this need, an online healthcare program developed an innovative model for student collaboration across professions and institutions through a virtual interprofessional education (VIPE) program. The VIPE model aims to simulate clinical practice via an asynchronous and synchronous pedagogical approach that combines PBL/CBL with psychological safety. VIPE demonstrated statistically significant gains in knowledge and positive attitudes toward interprofessional collaborative practice as a result of participation in the VIPE program. During COVID-19, the demand for high quality IPE for health professions' students in virtual settings has grown, VIPE has the potential to be a solution for this. VIPE requires a dedicated committee and technical lead. Further research could involve longitudinal studies and nonaggregate models.

Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in Children-A Retrospective Quality Improvement Report.

Background: Many children attend Emergency Departments (ED) and Out of Hours (OoH) frequently for acute asthma. Follow up care is often suboptimal leaving these children at risk of a future attacks. We report on the development, implementation and evaluation of a safe asthma discharge care pathway (SADCP). Methods: This is a retrospective report on the development, implementation and evaluation of outcomes of a SADCP. The pathway was based on the Teach-to-goal educational methodology that supported the mastery correct inhaler technique and ability to action the personalized asthma action plan (PAAP). Children with frequent asthma attacks were entered as they were discharged from the Emergency Department or ward. The first training session occurred within 1-3 weeks of the index asthma attack with 2 further sessions in the following 8 weeks. Children exiting the pathway were discharged either back to primary care or to a hospital clinic. Results: 81 children entered the pathway (median age 5 years) with 72 discharged from the ED and 9 from the medical wards of the Royal Belfast Hospital for Sick Children. At pathway entry 13% had correct inhaler technique, 10% had a Personalized Asthma Action Plan (PAAP), and 5% had >80% (45% >50%) repeat refill evidence of adherence to inhaled corticosteroid over the previous 12 months. On pathway exit all children demonstrated correct inhaler technique and were able to action their PAAP. One year later 51% and 95% had refill evidence of >80% and >50% adherence. Comparisons of the 12 months before and 12 months after exit from the pathway the median number of emergency ED or OoH asthma attendances and courses of oral corticosteroids reduced to zero with >75% having no attacks requiring this level of attention. Similar findings resulted when the SADCP was implemented in a district general hospital pediatric unit. Conclusion: Implementing an asthma care pathway, using Teach-to-Goal skill training methods and frequent early reviews after an index asthma attack can reduce the future risk of asthma attacks in the next 6 to 12 months.

Becoming an anti-racist interprofessional healthcare organization: Our journey.

The COVID-19 pandemic amplified the egregious disproportionate burden of disease based on race, ethnicity, and failure of organizations to address structural racism. This paper describes a journey by members of the National Academies of Practice (NAP) who came together to address diversity, equity, and inclusion (DEI). Through collaborative efforts, a virtual, interactive workshop was designed and delivered at NAP's 2021 Virtual Forum to facilitate discussions about DEI priorities across professions and to initiate a sustainable action plan toward achieving inclusive excellence. Resulting discoveries and reflections led us to the essential question: can we truly become an anti-racist interprofessional healthcare organization?

Audiology, an Important Contributor to Interprofessional Holistic Care: An Interprofessional Collaborative Case Example.

PURPOSE: Interprofessional collaboration improves health outcomes, enhances health care satisfaction, and facilitates more effective use of resources. Interprofessional collaborators increasingly understand and value other professions. A.T. Still University provides students from multiple programs with opportunities to develop interprofessional collaboration skills. This research note presents details of one such interprofessional education (IPE) opportunity, a collaborative case. Audiology was part of this case in two ways: Audiologic details of the simulated patient were provided to all students, and audiology students participated in the experience. The results of this involvement are reported. This research note is primarily descriptive in nature; however, the question of whether students viewed their interprofessional competencies as improving following the IPE experience was explored using a validated self-report tool, the Interprofessional Collaborative Competency Attainment Survey (ICCAS). METHOD: A total of 23 students completed the ICCAS. Additionally, student case presentations were reviewed and audiology-based recommendations were tallied. RESULTS: Highly significant differences (p ≤ .01) for all 20 items on the ICCAS were observed for differences in self-assessed interprofessional skills knowledge. All but one of the 12 teams made specific recommendations regarding the communication needs of the patient. CONCLUSIONS: Students viewed their own competencies related to interprofessional collaboration as improved following the collaborative case experience. Overall, the collaborative case experience was effective in providing students with the opportunity to develop a breadth of skills needed for interprofessional collaboration. Providing audiologic information in the case history prompted all but one team to consider patient communication needs.

Interagency Collaboration for Pediatric Autism Spectrum Disorder: Perspectives of Community-Based Providers.

BACKGROUND: Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD). PURPOSE: We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD. METHOD: Medical and behavioral/mental health professionals practicing in community settings were recruited. Participants (N = 116) completed an online survey about their interagency collaboration experiences with schools. RESULTS: The majority of the sample reported engaging in interagency collaboration with school-based providers; however, the frequency was limited and was associated with the number of years working in the field. Community-based providers wanted more didactic and hands-on experiences in collaboration. Barriers and facilitators were related to schools' administration, school personnels' training in ASD, information exchange, and delineating between identification systems. DISCUSSION AND CONCLUSION: Our findings highlight the importance of leadership support and the need for innovative training experiences to support school-community interagency collaboration.

Use of oximetry to screen for paediatric obstructive sleep apnoea: is one night enough and is 6 hours too much?

INTRODUCTION: Nocturnal pulse oximetry can be used to screen for obstructive sleep apnoea (OSA) using the McGill Oximetry Score (MOS). The MOS has a time threshold for a technically adequate study of 6 hours. It has been suggested that one night of oximetry is sufficient to screen for OSA using the MOS. AIMS: (1) To evaluate night-to-night variation of the MOS. (2) To determine the impact of recording three nights of oximetry on the screening yield for OSA. (3) To explore whether useful MOS data are discarded when a threshold of 6 hours of oximetry recording is used. METHODS: A retrospective study of nocturnal pulse oximetry done at home over three consecutive nights in paediatric patients with suspected OSA. Studies were scored (MOS) using thresholds of ≥6 and ≥4 hours of recording. RESULTS: A total of 329 patients were studied. MOS scores over three nights showed only fair to moderate agreement. On the first night 126 patients (38%) screened positive for OSA. When three nights of oximetry were done 195 patients (59%) screened positive on at least one of the nights. There were 48 patients with studies of between 4 and 6 hours duration on one or more nights. If these studies are scored 20 patients (42%) would screen positive for OSA on at least one night based on scoring these studies alone. CONCLUSION: One night of oximetry screening may not be sufficient to screen for OSA. Lowering the time threshold to ≥4 hours may increase the screening capability of nocturnal oximetry.

Night-to-night variation of pulse oximetry in children with sleep-disordered breathing.

BACKGROUND: Sleep-disordered breathing is a common and serious feature of many paediatric conditions and is particularly a problem in children with Down syndrome. Overnight pulse oximetry is recommended as an initial screening test, but it is unclear how overnight oximetry results should be interpreted and how many nights should be recorded. METHODS: This retrospective observational study evaluated night-to-night variation using statistical measures of repeatability for 214 children referred to a paediatric respiratory clinic, who required overnight oximetry measurements. This included 30 children with Down syndrome. We measured length of adequate trace, basal SpO2, number of desaturations (>4% SpO2 drop for >10 s) per hour ('adjusted index') and time with SpO2<90%. We classified oximetry traces into normal or abnormal based on physiology. RESULTS: 132 out of 214 (62%) children had three technically adequate nights' oximetry, including 13 out of 30 (43%) children with Down syndrome. Intraclass correlation coefficient for adjusted index was 0.54 (95% CI 0.20 to 0.81) among children with Down syndrome and 0.88 (95% CI 0.84 to 0.91) for children with other diagnoses. Negative predictor value of a negative first night predicting two subsequent negative nights was 0.2 in children with Down syndrome and 0.55 in children with other diagnoses. CONCLUSIONS: There is substantial night-to-night variation in overnight oximetry readings among children in all clinical groups undergoing overnight oximetry. This is a more pronounced problem in children with Down syndrome. Increasing the number of attempted nights' recording from one to three provides useful additional clinical information.

Closeout of the HALT-PKD trials.

BACKGROUND: The HALT Polycystic Kidney Disease Trials Network consisted of two randomized, double blind, placebo-controlled trials among patients with autosomal dominant polycystic kidney disease. The trials involved 5-8years of participant follow-up with interventions in blood pressure and antihypertensive therapy. We provide a framework for designing and implementing closeout near the end of a trial while ensuring patient safety and maintaining scientific rigor and study morale. METHODS: We discuss issues and resolutions for determining the last visit, tapering medications, and unblinding of participants to study allocation and results. We also discuss closure of clinical sites and Data Coordinating Center responsibilities to ensure timely release of study results and meeting the requirements of regulatory and funding authorities. RESULTS: Just over 90% of full participants had a 6-month study visit prior to their last visit preparing them for trial closeout. Nearly all patients wanted notification of study results (99%) and treatment allocation (99%). All participants were safely tapered off study and open label blood pressure medications. Within 6months, the trials were closed, primary papers published, and 805 letters distributed to participants with results and allocation. DCC obligations for data repository and clinicaltrials.gov reporting were completed within 12months of the last study visit. CONCLUSIONS: Closeout of our trials involved years of planning and significant human and financial resources. We provide questions for investigators to consider when planning closeout of their trials with focus on (1) patient safety, (2) dissemination of study results and (3) compliance with regulatory and funding responsibilities.

The relationship of pre-operative health status to sustained outcome in gastric bypass surgery.

The task of sustaining initial weight loss after gastric bypass surgery has been identified as the area of greatest concern in this intervention. The present study investigated the role of good vs. poor pre-operative health as a moderator variable in identifying useful pre-operative predictors of continued weight loss. Follow-up data at a mean of 12.8 months and again at 3.2 years post-operatively were available for 79 patients on 227 interview variables and four psychological assessment instruments. These measures were studied for their success in predicting continued weight loss over the 1­3-year period separately for patients who were in good and in poor general pre-operative health. Previous findings showed that the overall mean simple weight loss to 12.8 months was 45.61 kg, but additional weight loss to 3.2 years was only 0.28 kg. The good and poor pre-operative health groups differed little on these figures. However, the significant predictors of continued weight loss for good-health patients (high anxiety and distress, low self-esteem, poor eating habits, strong expectations of life improvement, and good achievement and coping skills) were quite different from those for poor-health patients (good psychological health and happiness, strong personal support and life satisfaction, good eating habits, and little knowledge about their health). Thus, pre-operative health status served as a powerful moderator in predicting continued weight loss from pre-operative characteristics. These findings offer a means of making more accurate predictions as to which patients are the best candidates for surgery, and also suggest that different psychological and other interventions should be selected according to pre-operative health status.

Prediction of long-term outcome after gastric bypass surgery.

BACKGROUND: To investigate the predictability and sustainability of weight loss in gastric bypass (GBP) surgery after the first year, we conducted a 3-year follow-up of patients who had already been comprehensively studied preoperatively and after 1 year. METHODS: Preoperative data had been obtained for 131 morbidly obese patients on a 273-item interview and five psychological assessment instruments, and some of these data had been obtained again after a mean of 12.8 months. For this study, weight data were obtained on 79 patients at a mean of 3.2 years postoperatively. RESULTS: Over the 1-3 year interval, mean simple weight loss and simple BMI decrease were essentially zero, compared with 45.61 kg and 16.52 respectively over the 0-1 year interval. Further, the 0-1 year and 1-3 year losses were uncorrelated. Optimal predictor variables for 1-3 year loss included three preoperative measures (expectation of increased self-confidence, amount of informational support, and total coping skills) plus functional eating behaviors after 1 year. Together they showed a multiple correlation of .55 with weight loss and .55 with BMI change. These predictors differed from the predictors of change over 0-1 year, and they continued to be significant after controlling for several preoperative characteristics. CONCLUSIONS: The factors influencing long-term continuing weight loss after GBP are different from those influencing initial loss, and involve positive characteristics such as skills, information, and expectations. The results suggest the importance of actively teaching such skills during the first postoperative year.

Predictors of outcome after gastric bypass surgery.

BACKGROUND: Weight loss outcome predictions after gastric bypass (GBP) surgery based on individual findings have shown relatively little consistency. The present study took a more comprehensive approach, utilizing extensive pre-surgery interview and psychological test data both individually and in composite predictors. METHODS: Pre-surgery data were obtained for 131 morbidly obese patients on a 273-item interview and 5 psychological assessment instruments, and weight loss measures (simple weight change and BMI change) were obtained at a mean of 12.8 months following surgery. RESULTS: Individual predictor variables based on existing research findings showed expected but mostly nonsignificant correlations with weight loss. Optimal composite predictor variables were constructed for 4 general areas of pre-surgery assessment as represented in the literature: physica/medical health, psychological health, interpersonal support, and eating disorder. Each composite variable significantly predicted weight loss, and together they showed multiple correlations of .50 with simple weight change and .54 with simple BMI change. CONCLUSIONS: Sustained weight loss after GBP was related to a rather wide range of pre-surgery variables, each of which made a small contribution, but composite variables grounded in the general literature provided more effective prediction. It is cautioned that continued success after > or =2 years could be dependent on yet other variables, with a possible contribution from some post-surgery factors.