'Rules of engagement': Does competition drive engagement in faculty development.

INTRODUCTION: Faculty development (FD) is integral to the implementation of educational programmes. However, attracting new faculty is challenging. Competition is a motivator for learning at an undergraduate level; however, incorporating competition to engage faculty in continued FD has not been explored. In the context of a new strategy to embed in situ simulation in postgraduate education across our healthcare group, and drawing on motivational theory, we asked 'does competition drive engagement in new FD initiatives?' METHODS: We conducted semi-structured interviews with nine healthcare professionals (HCPs) who had participated in an in situ simulation 'SimStars' competition. Guided by thematic analysis and borrowing from constructivist grounded theory, we explored participants' motivations for entering a competition, their experiences of competition throughout their education and how this process impacted on their engagement in FD. RESULTS: Three overarching concepts arose and challenged our understanding of the role of competition as a motivator: (1) 'Competition is a necessary evil'; (2) 'It really is the taking part that counts'; and (3) 'Teamwork makes the dream work'. In contrast to previously published work, our results suggest participants view competition negatively and as a means to career progression. However, the opportunity to work as part of an (interprofessional) team towards a goal, and to develop a new skill (i.e. the process), was more motivating for participants than 'winning' a competition. CONCLUSION: Competition may not provide a motivation for HCPs to engage in FD and may be a barrier. Providing collaboration opportunities, faculty coaching and the chance to develop new skills could enhance engagement.

Potentially inappropriate medication use and mortality in patients with cognitive impairment.

PURPOSE: Potentially inappropriate medications (PIMs) are associated with falls, hospitalization, and cognitive decline. Few studies have investigated the association between PIMs related to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI). METHODS: This was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013 to 2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥ 5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: Four hundred eighteen patients were included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range [IQR] 74-82) and median follow-up was 809 days (IQR 552-1571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson's Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease (HR 1.96, 95% CI 1.24-3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51-7.11) but not with non-vascular death (HR 1.40 95% CI 0.78-2.52). CONCLUSION: PIMCog use in patients with cognitive impairment is high. It is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in this patient cohort. Further research is required to independently validate this finding.

Younger British men's understandings of prostate cancer: A qualitative study.

The purpose of this study was to explore young British men's understandings of prostate health and cancer of the prostate. A total of 16 White-British men between 31-50 years of age took part in interviews face-to-face or through computer-mediated communication. Thematic analysis broadly informed by grounded theory identified two key themes; 'limited knowledge about the prostate' and 'early detection & unpleasant procedures'. Accounts are discussed with reference to implications for improving men's understandings of prostate cancer, and likelihood of self-referral for prostate screening where necessary.

Proximal interphalangeal joint dislocations and treatment: an evolutionary process.

BACKGROUND: Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. METHODS: We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. RESULTS: There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. CONCLUSIONS: The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

A meta-analysis evaluating the effectiveness of two different upper limb hemiparesis interventions on improving health-related quality of life following stroke.

PURPOSE: The aim of this article is to quantitatively assess the efficacy of different upper limb interventions on health-related quality of life (QOL) in stroke patients. METHOD: Two botulinum type A injection (BTX-A) studies and 4 constraint-induced movement therapy (CIMT) studies were separately combined in a meta-analysis using a fixed effects model. QOL mean scores were extracted and transformed into weighted mean differences. RESULTS: Combined, the BTX-A studies showed no significant improvements in overall health-related QOL. Similarly, a meta-analysis of 4 CIMT studies revealed nonsignificant findings for the domains of activities of daily living, communication, and hand function. A separate meta-analysis of 3 CIMT studies showed a significant increase in strength scores (P = .007); however, sensitivity analysis for this domain due to significant heterogeneity led to a newP value of .078, showing a nonsignificant increase in strength. Further results for memory, mobility, mood, participation, and overall recovery were all nonsignificant. CONCLUSION: This report did not show these types of upper limb interventions to be effective in improving health-related QOL in the poststroke population.

Assessing the efficacy of different upper limb hemiparesis interventions on improving health-related quality of life in stroke patients: a systematic review.

BACKGROUND: This review aims to assess the efficacy of upper limb interventions on stroke survivors' health-related quality of life (QOL). METHOD: Published studies were identified following a systematic search of the literature from 10 electronic databases, 3 subject-relevant journals, a Web search via a popular search engine, and reference lists of the included articles. In total, 22 articles met the inclusion criteria and were subjected to data extraction to establish the effectiveness of the intervention on QOL scores. Interventions varied according to their content, including acupuncture treatment, botulinum toxin type A (BTX-A) injections, constraint-induced movement therapy (CIMT), task training, and therapeutic exercise. Studies were required to have at least 1 quantitative outcome QOL measure. RESULTS: Of the 22 studies, 12 reported significant findings within groups and between control groups. Interventions including BTX-A injections, CIMT, exercise programs, baclofen pump, robotic-assisted therapy, electrical stimulation, and acupuncture were reported to significantly improve either overall health-related QOL or certain individual QOL domains, such as strength, hand function, memory, mood, activities of daily living, mobility, social participation, communication, energy, pain, and sleep. CONCLUSION: The review demonstrates the need for upper limb intervention studies to focus on QOL as a primary outcome measure in addition to the functional outcomes currently used.

Impact of a facial-ageing intervention versus a health literature intervention on women's sun protection attitudes and behavioural intentions.

This study was designed to investigate the impact of a facial-ageing intervention on women's sun protection attitudes and behavioural intentions, compared to a health literature intervention where participants viewed literature on the effect of ultraviolet (UV) exposure on health. Seventy women (35 in each condition) completed questionnaires at baseline and immediately post-intervention. The average age of the participants was 23.70 (SD = 5.03) years. Participants in the facial-ageing intervention condition scored significantly higher on intentions, negative attitudes and perceived sun damage susceptibility after taking part in the intervention, compared to those in the health literature intervention condition. The results are discussed in relation to suggestions for sun protection interventions aimed at women aged from 18 to 34. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regard to UV exposure and sun protection intentions.

Men's experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study.

The study investigated men's experiences of taking part in an age-appearance-focussed intervention which involved seeing how their faces would age with and without UV exposure. Thirty-five men gave accounts of their experiences whilst taking part in the intervention, and eight men discussed their experiences retrospectively in focus groups. Transcripts were analysed using inductive thematic analysis. Men were shocked about the impact of ageing on their faces, and particularly the added impact of UV exposure, with a subgroup of men expressing lack of concern. The findings are discussed in relation to gender roles and appearance concerns in men, and comparisons are made between the thematic model produced and that produced in a similar study focussing on women's experiences of the same intervention. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regards to UV exposure and sun protection intentions in men.

Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: a systematic review and meta-analyses.

OBJECTIVES: A systematic review and meta-analyses were conducted to identify and review research examining the impact of appearance-based interventions on sun protection intentions and/or ultraviolet (UV) exposure behaviour. METHODS: A search of 16 databases including PsycARTICLES, Cochrane Library and Web of Knowledge was conducted to identify studies examining the impact of appearance-based interventions on reducing UV exposure and/or increasing sun protection intentions and behaviours. A total of 21 articles met the inclusion criteria, and these studies were subjected to a systematic review and meta-analyses to determine the effectiveness of the interventions. RESULTS: Interventions used a variety of techniques including UV technology and photoaging information. Study design and outcome measures varied. The research indicated that appearance-based interventions have a positive effect on UV exposure and sun protection intentions and behaviour. CONCLUSIONS: Findings suggest that interventions based on the appearance-damaging effects of UV exposure, and the positive effects of sun protection, may have a role in health promotion. It is concluded that there is a need for further research incorporating a wider range of participants, and using qualitative and mixed methods designs. STATEMENT OF CONTRIBUTION: What is already known on the subject? Recreational exposure to ultraviolet (UV) radiation, are the primary causes of all melanomas, leading to skin cancer. A previous systematic review (Dodd & Forshaw, ) looking at the efficacy of appearance-focussed interventions in skin cancer prevention, suggested that there were significant effects for UV protection behaviour after such interventions. What does this study add? An up-to-date systematic review of studies that has carried out appearance-based interventions to reduce UV exposure and/or increase sun protection intentions and behaviours. A meta-analysis of data providing statistical evidence indicating that appearance-based interventions have a positive effect on UV exposure and sun protection intentions and behaviour.

A qualitative study examining women's experiences of an appearance-focussed facial-ageing sun protection intervention.

The study was designed to investigate women's experiences of an appearance-focussed, facial-ageing, morphing intervention to show the effect of UV exposure on their skin. Forty-seven women aged 18-34 took part in the intervention: 35 women in individual sessions, and 12 in four focus groups. Transcripts were analysed using inductive thematic analysis. Women were shocked about the likely effect of UV exposure on their skin. All of the women stated that they were going to make changes to their UV exposure and sun protection behaviours after viewing the images of themselves which were morphed to show the effects of UV exposure. The results are discussed in relation to suggestions for interventions aimed at women aged 18-34. It is concluded that appearance-based interventions do have a role to play in healthcare and educational settings with regards to UV exposure and sun protection intentions.

Ten years of lesbian health survey research in the UK West Midlands.

BACKGROUND: Very little is known about the physical health needs of lesbian and bisexual women in the UK; most research has looked at mental or sexual health only. This article reports the results of four surveys carried out in the West Midlands between 1995 and 2005. METHODS: The first two surveys were conducted in 1995-6 by a volunteer group, with participants from a lesbian health conference (n = 69) and in a convenience sample from a wide range of relevant groups and venues (n = 354). The second two surveys were commissioned by the West Midlands South Strategic Health Authority in partnership with the Gay Men's Health Network and were conducted in 2002 (n = 449) and 2005 (n = 166) and again used convenience sampling methods including the internet. RESULTS: The mean age of respondents varied between 29-33 years and 5-7% were from a non-white ethnic background. The smoking rates varied from 42% o 55%, being twice the West Midlands regional average of 21% for women aged 16 or more. Similarly, problems with alcohol were reported in 25-37% of respondents, higher than the West Midlands regional average of 7% for women aged 16+. The prevalence of any mental health problem varied between 31-35% and any suicide attempt between 20-31%. Only 29-45% had revealed their sexual orientation to their GP and of these, approximately 50% had experienced a positive reaction. CONCLUSION: The results suggest health needs that current UK health services may not be meeting. There is a need to identify and target specific health measures for lesbians and bisexual women in order to ensure improved physical and mental health in the longer term.