Unpacking the perceptions and experiences of student facilitators in interprofessional education: a qualitative study.

Enhancing health professional students' effective learning and collaborative practice requires a deep understanding of strategies for facilitating interprofessional learning. While faculty members and clinical preceptors are recognized as facilitators in interprofessional education (IPE), there is limited knowledge about the impact of student facilitators' engagement in IPE. Accordingly, this study aims to explore the perceptions and experiences of student facilitators in IPE. Thirteen student facilitators were recruited to lead an interprofessional learning program, and they were subsequently invited to participate in one-on-one interviews. An interview guide was developed to explore their motivations, expectations, engagement, effectiveness, and achievements in IPE facilitation. Thematic analysis was conducted using MAXQDA software to analyze the student facilitators' experiences and perceptions. Eight interviewees from various disciplines, including Medicine, Nursing, Pharmacy, Speech and Hearing Sciences, and Social Work, took part in the study. The findings revealed that student facilitators highly valued their IPE facilitation experience, which aligned with their expectations and led to the creation of social networks, increased confidence, improved understanding of other professions, and the development of lifelong skills. Furthermore, the student facilitators demonstrated cognitive and social congruence by establishing a relaxed learning environment, displaying empathetic and supportive behaviors, and using inclusive language to engage IPE learners in group discussions. This study provides a comprehensive understanding of the role of student facilitators in IPE, contributing to the evolving literature on IPE. A conceptual framework was developed to explore the entire facilitation experience, encompassing the motivations and expectations of student facilitators, their engagement and effectiveness, and the observed achievements. These findings can inform the development of peer teaching training in IPE and stimulate further research in identifying relevant facilitator competencies for optimal delivery of IPE.

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.

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.

Health Orientation as a Psychographic Framework for Understanding Physical Exercise Behavior.

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general.

Autonomous motivation predicts students' engagement and disaffection in interprofessional education: Scale adaptation and application.

OBJECTIVES: Despite the popularity of interprofessional education, the empirical and theoretical development of its scholarship and science is just emerging. This may be caused in part by the non-availability of measures that can be used by researchers in this field. This study aimed to contribute to the psychological theorizing of interprofessional education by uncovering the psychometric properties of Perceived Locus of Causality adapted to Interprofessional Education (PLOC-IPE) in healthcare education and provide a comprehensive guide on how this can be used to advance the IPE research agenda. METHODS: Confirmatory factor analysis (quantitative design) was used to examine the acceptability of psychometric properties of PLOC-IPE. Data were collected through questionnaires administered at two different time points. The participants consisted of 345 students from Chinese Medicine, Clinical Psychology, Medicine, Nursing, Pharmacy, and Social Work from a university in Hong Kong. RESULTS: Based on confirmatory factor analysis, results of within-network construct validity showed good psychometric properties of PLOC-IPE while between-network validity indicated that the scale can predict IPE-related outcomes. Students' intrinsic motivation in IPE positively predicted emotional engagement and negatively predicted emotional disaffection, demonstrating the applicability of the newly validated PLOC-IPE. Amotivation was a negative predictor of emotional engagement and a positive predictor of emotional disaffection. CONCLUSIONS: Findings support the acceptability of PLOC when adapted to IPE. PLOC-IPE obtained acceptable psychometric properties as a measure of students' academic motivation in IPE. It is an adapted scale that can be used to understand self-determined motivation in the context of IPE in health and social care education. A guide on how PLOC-IPE can be a means by which researchers can contribute to the advancement of scholarship of IPE was provided.

What factors facilitate interprofessional collaboration outcomes in interprofessional education? A multi-level perspective.

OBJECTIVES: Interprofessional education (IPE) harnesses the power of teams to facilitate collaborative learning across disciplines. However, prior research has not paid sufficient attention to the role of team-level factors on IPE outcomes, posing a major theoretical and methodological limitation. In response to this, using social interdependence theory (SIT), this study aimed to delineate the independent contributions of both team-level and student-level interprofessional attitudes (teamwork, roles, and responsibilities; patient-centeredness; and community-centeredness) in predicting IPE collaboration outcomes (goal achievement, team effectiveness, and team performance) employing multi-level analysis. METHODS: To test whether interprofessional attitudes at the team and student levels predict IPE collaboration outcomes, conducted multilevel modeling. We used the pretest and posttest data from 323 healthcare students in Hong Kong from Chinese medicine, medicine, nursing, pharmacy, and social work programmes enrolled in the IPE Cancer module. RESULTS: Among the interprofessional attitudes, "teamwork, roles, and responsibilities" was found to be the best predictor of IPE outcomes, both at the student and team levels. Students who recognized the benefits of shared learning had better goal achievement and team effectiveness. Furthermore, teams that emphasized shared learning also had better overall team performance. CONCLUSIONS: Students' attitudes towards teamwork, roles, and responsibilities in interprofessional collaborative practice, both at the student and team levels, are important to attaining positive student- and team-level outcomes. The study contributes to the expansion of existing knowledge in medical education, theoretically, by adopting SIT as a lens through which collaborative learning in healthcare teams can be understood, and methodologically, by applying multi-level approaches and delineating important student- and team-level predictors of IPE outcomes.

Trust Ecologies and Channel Complementarity for Information Seeking in Cancer Prevention.

Our paper extends channel complementarity theory, which has focused on evidence of complementarity and patterns of channel use, by elucidating the notion of trust complementarity. We examined trust, an information-carrier characteristic and a core construct in health-focused decision-making to understand cancer information seeking, based on data from two nationally representative surveys in Singapore. Trust is found to be differential, relational, and ecological, with implications for individuals' access to and reliance on doctors, family/friends, newspapers/magazines, radio, TV, and the Internet for cancer prevention information. In an ideal trust complementarity environment, an individual should be able to traverse a range of communication channels seamlessly. Our findings however suggest that although individuals trust different channels complementarily, their trust patterns are limited and fettered. We identified two types of trust ecologies shaped by dual-channel and polymorphic complementarity patterns that suggest that health information seekers are trapped within specific trust ecologies that prevent them from navigating a broader range of communication channels for cancer prevention.

Health Information Seeking Among Singaporeans: Roles and Collective Contexts.

This article seeks to contribute to the literature on health information seeking (HIS) by culturally locating the search for health information within the local contexts of everyday life in Singapore, and within the meaning-making processes that individuals participate in. Based on in-depth interviews with 100 participants selected through stratified sampling, it asks: How do Singaporeans make sense of HIS in the realm of their everyday lived experiences? The study contributes to the literature on the roles familial ties play in information gathering and sharing in a collective context. More importantly, these familial ties provide perspective on the ways in which culture spatio-temporally constitutes HIS. HIS is informed by familial role expectations in a collectivist context where filial piety and "respect for the elderly" are guiding anchors for behavior. Moreover, harmony and community well-being define societal roles and responsibilities of caregiving, directed broadly at communal care. These collective-oriented contexts therefore inform HIS.

Health Meanings among Foreign Domestic Workers in Singapore: A Culture-Centered Approach.

Economic migration is integral to processes of globalization, with large numbers of the global poor moving across borders in search of employment in the face of structural adjustment programs and large-scale displacement of the poor from traditional forms of livelihood. One such group are foreign domestic workers (FDWs). In this culture-centered study, we listen to the voices of FDWs in Singapore to understand the key meanings of health held by this group of migrant workers as they negotiate living and working in Singapore. Through the representation of FDW voices at sites where they have previously been excluded, we hope to co-create participatory spaces in national discourse so that policies and interventions can be developed to address the health needs of FDWs. The results represented in this essay are part of a larger project engaging the CCA to foster communicative platforms for structural transformation.

Development of a discriminating in vitro dissolution method for a poorly soluble NO-donating selective cyclooxygenase-2 inhibitor.

A discriminating dissolution method using a USP apparatus 2 dissolution tester was developed for a nitric oxide donating selective COX-2 inhibitor to support phase I and II formulation development, clinical supplies release and stability testing of an immediate release oral tablet. The BCS class II compound showed very low aqueous solubility and required the use of surfactant-containing (sodium lauryl sulfate (SLS)) dissolution medium in order to achieve an appropriate release profile. The dissolution method utilized 900 mL of 2% SLS (w/v). Samples were withdrawn at five specified time-points over 60 min, at a paddle speed of 75 rpm. Analysis of samples was performed using a validated HPLC method. Despite the use of high levels of SLS, the ability to discriminate variations in physical properties such as drug particle size, granule particle size and tablet compression force was demonstrated. In order to confirm the relationship between these physical parameters and the tablet in vivo release profile, oral dosing of the formulations in fasted beagle dogs was performed to determine if the changes observed in the dissolution profiles were biorelevant. The results of the dissolution and corresponding in vivo experiments helped identify the critical processing parameters likely to influence product bioavailability.

A rapid and sensitive method for the quantitation of montelukast in sheep plasma using liquid chromatography/tandem mass spectrometry.

A rapid LC-MS/MS method was developed and partially validated for the quantitation of montelukast in spiked sheep plasma. A total run time of 1.5 min was achieved using a short monolithic column and employing a rapid gradient. Sample preparation involved protein precipitation with twofold acetonitrile by volume during which a deuterated internal standard (montelukast D-6) was incorporated. The MRM transitions for montelukast and the deuterated internal standard were 586/422 and 592/427, respectively. A linear dynamic range of 0.25-500 ng/mL with a correlation coefficient of 0.9999 was achieved. Precision was below 5% at all levels except at the LOQ (0.36 ng/mL) which demonstrated an overall of R.S.D. of 8%. Post-column infusion experiments were performed with precipitated plasma matrix and showed minimal interference with the peaks of interest.

MF tricyclic and sulindac retard tumor formation in an animal model.

New selective cyclooxygenase-2 inhibitors offer the benefit of cancer protection with less gastrointestinal toxicity associated with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). We hypothesize that MF tricyclic and sulindac can retard all stages of tumor formation in nude mice. In a blinded placebo controlled study, 3 types of experiments were performed: 1) 2.5 x 10(6) cells were injected into 2 flanks of nude mice subcutaneously, as a model for in situ cancer (n = 192); 2) 1 x 10(6) cells were injected into the cecum of mice as a model for in situ colorectal cancer (n = 78) and 3) 0.5 x 10(6) cells were implanted into the splenic subcapsule to establish a colorectal cancer liver metastasis model (n = 78). The animals were fed with standard chow containing either placebo, MF tricyclic (67 mg/kg of chow) or sulindac (150 mg/kg of chow). Mice that were given MF tricyclic or sulindac, at clinical anti-inflammatory plasma concentrations, were significantly more tumor free and had significantly smaller primary tumors and fewer metastases, as compared to mice that consumed placebo. The mortality and the latency period were significantly better in the treatment groups. These findings suggest that selective COX-2 inhibitors may serve as an adjunct to standard therapy in colorectal cancer.

Cerebrospinal fluid and plasma pharmacokinetics of the cyclooxygenase 2 inhibitor rofecoxib in humans: single and multiple oral drug administration.

Cerebrospinal fluid (CSF) pharmacokinetics of orally administered cyclooxygenase 2 inhibitors, with single or multiple dosing, is of clinical relevance because it may relate to the analgesic efficacy of these drugs. We enrolled 9 subjects with implanted intrathecal catheters in the study. After 50-mg oral rofecoxib administration, the CSF drug concentration lagged slightly behind the plasma drug concentration. The ratio of the 24-h area under the drug-concentration curve (AUC) in CSF to plasma was 0.142. After daily dosing of rofecoxib 50 mg/d for 9 days, rofecoxib concentrations in plasma and CSF were larger on Day 9 than on Day 1, with the 24-h AUC on Day 9 more than twice the Day 1 AUC for both plasma and CSF. After nine consecutive daily doses of rofecoxib, the AUC(CSF)/AUC(plasma) ratio was 0.159. The important findings of this study are that CSF rofecoxib levels are approximately 15% of plasma levels and that repeated daily dosing more than doubles the AUC in CSF.

Chemoprevention of mammary carcinogenesis in female rats by rofecoxib.

Epidemiological and experimental studies indicate that non-steroidal anti-inflammatory drugs play role in the prevention of human neoplasia including mammary gland cancer. In this study, tumour suppressive effects of a selective inhibitor of cyclooxygenase-2 (COX-2) rofecoxib in the prevention of N-methyl-N-nitrosourea (NMU)-induced mammary carcinogenesis in female Sprague-Dawley rats were evaluated. Rofecoxib was dietary administered in two concentrations-0.01 mg/1 g (ROFE 0.001%), or 0.05 mg/1 g (ROFE 0.005%). Rofecoxib decreased the incidence by 40% (ROFE 0.001%) and by 42.5% (ROFE 0.005%) (P=0.043) when compared to the control group. Similarly, tumour frequency and tumour volume decreased depending on an increasing rofecoxib dose by 18.5 or 40% (tumour frequency) and by 35 or 43% (tumour volume). Rofecoxib shifted the rate of fibroadenomas from 15% (control group) to 32% (ROFE 0.001%), or 38% (ROFE 0.005%), respectively. The present study points to pronounced dose-dependent tumour suppressive effects of rofecoxib in mammary carcinogenesis.

Inhibition of cyclooxygenase-2 by rofecoxib attenuates the growth and metastatic potential of colorectal carcinoma in mice.

A large number of epidemiological studies have shown that regular use of aspirinor other nonsteroidal anti-inflammatory drugs (NSAIDs) results in a 40-50% reduced risk of colorectal cancer (CRC). Furthermore, NSAIDs cause the regression of preexisting adenomas in patients with familial adenomatous polyposis and significantly inhibit tumor growth in animal models of CRC. To establish a CRC liver metastasis model, we implanted mouse colon tumor MC-26 cells into the splenic subcapsule of BALB/c mice, after which mice were given either standard chow or chow containing the cyclooxygenase (COX)-2-specific inhibitor rofecoxib, alone or in combination with the standard antineoplastic agents, 5-fluoruracil or irinotecan. After 14 days, mice that were given rofecoxib or irinotecan, but not 5-fluoruracil, had significantly smaller primary tumors and fewer metastases. Rofecoxib, at clinical anti-inflammatory plasma concentrations, enhanced the effects of both antineoplastic agents when used in combination. Biochemical analyses of the primary splenic tumor in rofecoxib-treated mice showed no alteration in COX-1 expression, but significant decreases in the expression of the tumor-promoting proteins COX-2, cyclin D1, cytosolic beta-catenin, matrix metalloproteinases-2 and -9, and vascular endothelial cell- derived growth factor. Rofecoxib also decreased growth-enhancing prostaglandin E(2) and tumor-suppressive interleukin-10, whereas antineoplastic interleukin-12 was increased. Two separate survival studies were performed. When mice were fed chow containing 0.01% rofecoxib beginning on day 0 after tumor cell implantation, which achieved clinical anti-inflammatory plasma concentrations, survival time was significantly longer compared with mice given control chow. After 30 days, mortality in the control group was 90%, whereas only one mouse (5%) treated with rofecoxib had died after 30 days. In the second survival study, all of the mice were initially fed with regular chow after tumor cell implantation. On day 7, mice were randomly divided into three dietary groups: control chow, low-dose (0.01%) rofecoxib chow, and high-dose (0.025%) rofecoxib chow. After 28 days, mortality was 100%, 20%, and 10% in control, low-, and high-dose rofecoxib fed groups, respectively. These studies demonstrate that rofecoxib decreases the growth and metastatic potential of CRC in mice through multiple mechanisms. These studies in mice also provide important information that supports the benefit of COX-2 inhibition, not only in the prevention of CRC, but also potentially in the treatment of this common malignancy. Clinical trials will be necessary to assess the utility of COX-2 inhibitors as adjuvant therapy for early-stage disease and as potential agents, either alone or in combination, with more established drugs, for the treatment of refractory CRC.