Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers.

BACKGROUND: Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. OBJECTIVE: To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. METHODS: The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). RESULTS: The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. CONCLUSIONS: The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.

An online intervention to improve oncology health professional self-efficacy in communicating with carers: Hybrid effectiveness-implementation evaluation of the eTRIO program.

OBJECTIVES: Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed. METHODS: This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed. RESULTS: Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful. CONCLUSIONS AND PRACTICE IMPLICATIONS: eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout.

This is why we are staying: Job satisfaction among Physiotherapists in the Kimberley region of Western Australia.

INTRODUCTION: The Kimberley region of Western Australia (WA) is classified by the Modified Monash Model as MM6 & 7 ('Remote/Very Remote'). Many physiotherapists in the Kimberley are considered 'rural generalists' and require a diverse set of clinical and non-clinical skills to work successfully within this setting. OBJECTIVE: To understand physiotherapists' perspectives regarding job satisfaction within the Kimberley region a 'rural and remote' areas of Australia. DESIGN: An exploratory case study approach examined physiotherapists' job satisfaction in the Kimberley. Each participant completed a demographic survey and a one-on-one face-to-face interview lasting for approximately 60 minutes. Transcriptions were analysed and presented thematically. Eleven physiotherapists (nine women, two men, median age = 32 [27-60] years) participated in the study. Participants' median time working in the Kimberley was 2 (1-15) years; eight participants completed a rural placement, and eight participants had a rural background. FINDINGS AND DISCUSSION: Two overarching themes relating to job satisfaction emerged: 'personal factors' and 'workplace factors'. Furthermore, several sub-themes illustrated high levels of job satisfaction. Positive sub-themes relating to personal factors included 'belonging to the community and a rural lifestyle'. 'Diversity in caseloads' and 'workplace culture' were examples of positive workplace sub-themes. Subthemes that challenged the participants personally were 'family arrangements' including schooling, 'spousal employment and family separation' and the 'transiency and social issues' within these remote communities. Workplace challenges comprised of 'barriers to providing best practice' and the 'workforce and clinical experience' found within the Kimberley physiotherapy community and the wider health care workforce. The primary challenge of job satisfaction that encompassed both personal and workplace factors was 'accommodation', with 'cost', 'lack of availability', and 'perceived unsafe location' challenging physiotherapists' decisions to remain in the Kimberley. CONCLUSION: This study describes the many factors impacting job satisfaction among physiotherapists in a rural and remote location in WA Australia. These factors warrant consideration by organisations interested in improving recruitment and retention in this context. Improving recruitment and retention in physiotherapists in rural and remote Australia has the potential to positively influence health service provision, and therefore improve health outcomes for those living in rural and remote communities.

The Hamas massacre of Oct 7, 2023, and its aftermath, medical crimes, and the Lancet commission report on medicine, Nazism, and the Holocaust.

BACKGROUND: The report of the Lancet Commission on medicine, Nazism, and the Holocaust, released in November 2023, calls for this history to be required for all health professions education, to foster morally courageous health professionals who speak up when necessary. MAIN BODY: The report was released a month after Hamas' October 7 invasion of Israel, with the accompanying massacre of over 1200 people, taking of civilian hostages, and gender-based violence. These acts constitute crimes against humanity including genocide. Post-October 7, war in Gaza resulted, with a legitimate objective of Israel defending itself within international law. The authors discuss an accompanying Statement to the report condemning Hamas crimes and denouncing the perpetrators' use of their own civilians as human shields, including in healthcare facilities, and with the Hamas attack unleashing immense and ongoing suffering in Israel and beyond. With some exceptions, the medical literature shows a marked absence of condemnation of Hamas atrocities and includes unsubstantiated criticisms of Israel's military. A significant surge in global antisemitism including on university campuses since October 7, 2023, has occurred; and health professionals, according to the Commission, have a special responsibility to fight antisemitism and discrimination of all kinds. In this context, the authors discuss the controversy and criticism regarding diversity, equity, and inclusion education programs ("DEI") including such programs failing to protect Jews on campuses, especially as the U.S. President Biden's "The U.S. National Strategy to Counter Antisemitism," released in May 2023, calls for the inclusion of issues of antisemitism and religious discrimination within all DEI education programs. The authors support an evidence-based approach to the Hamas massacre, its aftermath and its relevance to health professionals both within medicine and their global citizenship, including refuting the international community accusations and anti-Israel libel. CONCLUSIONS: The report of the Lancet Commission on medicine, Nazism, and the Holocaust has striking relevance to the Hamas massacre of October 7, 2023 and its aftermath. This is further conveyed in an accompanying Statement, that describes the report's implications for contemporary medicine, including: 1) provision of skills required to detect and prevent crimes against humanity and genocide; (2) care for victims of atrocities; (3) upholding the healing ethos central to the practice of medicine; and (4) fostering history-informed morally courageous health professionals who speak up when necessary.

Cobertura de vacunación contra COVID-19 e influenza en personal de salud y administrativo en Paraguay

Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India.

BACKGROUND: The proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers (primary care physicians (PCPs)), especially in LMICs, are often not equipped to handle survivorship care. This study aimed to assess knowledge, and attitude among trainee healthcare providers concerning major issues of paediatric survivorship care. METHODS: A multi-centre, cross-sectional, questionnaire-based study was conducted among nursing and medical undergraduate students, and postgraduate medical residents across three tertiary-care teaching hospitals in India-All India Institute of Medical Sciences, New Delhi; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry; and Maulana Azad Medical College, New Delhi. A questionnaire with total of 24 questions (14 knowledge-based and 10 attitude-based) was finalised after validation by expert review and piloting. The major domains covered in the questionnaire included knowledge and attitude regarding long-term adverse effects and psychosocial, employment-related issues faced by the survivors. It was administered to the study participants electronically. The knowledge-based questions had true/false responses (scored as 0 or 1 if incorrect or correct, respectively). Attitude-based questions were scored as 5-point Likert scale. RESULTS: Total 898 responses were collected (median age: 21 years, 64% (576/898) female). Among the respondents, 44% were undergraduate medical students, 42% were nursing students and 14% were postgraduate medical residents. The mean (SD) of knowledge score was 8.72 (2.04) (out of 14). On multivariable analysis, only discipline of training predicted knowledge scores regarding survivorship care. Postgraduate medical residents (9.08) as well as undergraduate medical students (8.85), had significantly higher mean knowledge scores than nursing students (8.47) (p=0.004).Two questions were answered incorrectly by the majority; children and siblings of CCS need additional genetic screening (79% incorrectly answered true), and CCS face intimacy issues in relation to normal sexual functioning (59% incorrectly answered false).Nearly half (48%) of respondents believed that their knowledge of cancer survivorship issues was inadequate. Majority of respondents (84%) suggested that oncologists should handle long-term survivorship care rather than PCPs. CONCLUSION: Trainee healthcare providers in India reported inadequate knowledge regarding survivorship care. Improving awareness by incorporating survivorship in teaching curriculum is imperative to equip future PCPs to provide survivorship care across the country.

Assessing the equivalency of face-to-face and online simulated patient interviews in an educational intervention.

BACKGROUND: In adapting to COVID-19, many health professional training programs moved abruptly from in-person to online simulated patient interviews for teaching and evaluation without the benefit of evidence regarding the efficacy of this mode of delivery. This paper reports on a multi-methods research project comparing in-person and online simulated patient interviews conducted by allied health professionals as part of an educational intervention offered at a large university teaching hospital. METHODS: Twenty-three participants conducted two 15-min interviews with simulated patients using previously validated scenarios of patients presenting with suicide risk. In order to assess the equivalency of the two modalities, physiological and psychological stress were measured using heart rate variability parameters and the State-Trait Anxiety Inventory respectively, and then were compared across cohorts using t-tests. Reflective interviews elicited qualitative impressions of the simulations that were subject to thematic qualitative analysis. RESULTS: There were no statistical differences in measures of psychological stress or physiological arousal of participant health care professionals who engaged with in-person versus online simulated interviews, suggesting they were equally effective in eliciting reactions commonly found in challenging clinical situations. In reflective interviews, participants commented on the realism of both modalities of simulated patient encounters and that simulated interviews provoked emotional and physiological responses consistent with actual patient encounters. CONCLUSIONS: These findings provide developing evidence that carefully designed online clinical simulations can be a useful tool for the education and assessment of healthcare professionals.

The impact of using an authentic patient video on health professional students' attitudes toward interprofessional and person-centered care.

Authentic patient activities in an interprofessional education (IPE) setting can develop collaborative, practice ready health professionals who have the skills to work within and across teams with patients at the center of their care. In this qualitative study, the student experience of a novel interprofessional case study activity, with lived experience content delivered via an authentic patient video was explored. Transcripts were analyzed using reflexive thematic analysis and identified three major themes: (a) from disease-centered to person-centered care, (b) reflecting on roles in interprofessional collaborative practice, and (c) teamwork and lived experience facilitates learning. When considered within the Interprofessional Education Collaborative (IPEC) framework, the student experience suggested positive change in all four core competencies: interprofessional communication, values and ethics, roles and responsibilities and teamwork. In addition, students highly valued the interprofessional learning experience, and the patient video created a more realistic case study by reducing clinical assumptions. In conclusion, a short, single exposure to a written case followed by an authentic patient video in an IPE setting had an immediate positive impact on entry-level student health professionals. This simple methodology is a viable way of bringing the authentic patient voice into the classroom with additional benefit from the interprofessional format.

Concerns Regarding the Glorification of Mental Illness on Social Media.

In today's world, it is becoming increasingly important to address not only the need for awareness of mental illnesses but also the undue glorification of the same by certain segments of society. Social media has been a major influence on Generation Z in terms of self-diagnosing mental illnesses and romanticizing them. More and more individuals have started recognizing online trends of self-diagnosis of mental illness, and it is increasingly plausible in the process of normalizing the conversation around mental health through memes, TikTok videos, and viral tweets; this has had the paradoxical effect of romanticization of mental illness in certain segments of society.  Through this editorial, we would like to highlight this important issue and urge the mental health community to be cognizant of this phenomenon, lest it curtail society's recent advancements in mental health destigmatisation.

Development of a University-Government Partnership for Public Health Response and Workforce Development in the State of Oregon.

The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.

A systematic review of online team based learning approaches in health professional education.

AIMS AND OBJECTIVES: The purpose of this study was to systematically review studies related to the use of online Team Based Learning (TBL) platforms with a focus on health professional education. The objectives were to identify best practices, highlight what technological platforms are effective for TBL processes and evaluate educational outcomes in terms of student experience, learning and preference. DESIGN: A systematic review of published TBL research was undertaken between August and October 2021 and supplemented in September 2022. DATA SOURCES: ERIC, PsycINFO, Scopus, Embase, Medline, and Cinahl databases were used. The keywords were identified from researchers' knowledge and PICO/PICo framework. REVIEW METHODS: Titles and abstracts were screened individually by two reviewers for eligibility. Data extraction was undertaken by two researchers independently and checked for consistency by discussion between the two. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Out of 656 articles 14 were involved in the final review. All others were rejected due to duplication, ineligibility, or poor quality. The studies were from a range of countries and focussed on a range of health professionals including nursing. Inconsistencies in approaches for TBL, platforms used and mixed results in terms of outcomes were noted. There was no real consensus other than that TBL was equally as effective if carried out online or face-to-face, with no clear differences to outcomes related to satisfaction in online or traditional TBL approaches. CONCLUSIONS: It is recommended that further research is carried out into the outcomes of TBL on learning and experiences of students in health professional courses. The development and appraisal of integrated TBL platforms should be invested in and infrastructure and resources are put in place to support this.

Implementing routine paediatric height/length and weight screening and weight management advice by clinicians: an evaluation.

OBJECTIVE: To determine the views of health care professionals (HCPs) in South Western Sydney Local Health District (SWSLHD) about the effectiveness of implementation strategies used to increase routine height/length and weight screening, advice, and referral for children and adolescents. A secondary aim was to explore the prevalence of weight bias among HCPs. METHODS: A questionnaire was sent to all HCPs who had undertaken online or face-to-face training between December 2018 and June 2020 in SWSLHD (n=840). The questionnaire collected data on their experience of routine height and weight screening and the effectiveness of strategies used in the implementation. It also included a weight bias assessment. Data were provided by the New South Wales (NSW) Ministry of Health on the performance of routine height/length and weight measures entered into the electronic medical records (eMR) in SWSLHD. RESULTS: Of the 840 questionnaires sent, 87 were undeliverable; of the remaining 753, 285 were returned (38% response rate). More than half (53%, 151/285) of the participants were nurses. Most HCPs agreed that there was a need for routine screening and reported that education, training, and access to resources were the most helpful implementation strategies. Most HCPs were confident in performing routine screening but were less confident in raising the issue of weight with children and their families. Barriers to implementation were lack of time, equipment, appropriate clinical setting, and HCPs' perceptions and beliefs about obesity. CONCLUSION: Routine screening is the first step in identifying children and adolescents at risk of overweight and obesity, but many HCP found it challenging to incorporate into daily practice. Multifaceted strategies are effective in increasing routine screening across diverse healthcare settings so that children and adolescents receive timely and appropriate intervention.

Dialogued into being: Constructing knowledge about hand osteoarthritis from a polyphony of voices in healthcare encounters.

PURPOSE: Multiple knowledge sources inform healthcare. In healthcare encounters, patients and health professionals' ideas intersect to understand illness and disease. Exploring what is thought of as legitimate knowledge, and where those reflections come from is central to the process of improving and developing healthcare. Within this context, we aim to explore how knowledge about hand osteoarthritis (OA) is constructed and negotiated in clinical consultations. METHODOLOGY: The article is based on interviews with 21 patients and 14 health professionals in combination with observation in 16 clinical consultations. Reflexive thematic analysis was used to interpret the data. RESULTS: We generated four themes from codes to tell an interpretive story about how hand OA meaning-making is "talked into being" in patient-provider encounters: from the dominant voice of health professionals, from patients as knowers in the chronic healthcare dialogue, from health professionals and patients constructing knowledge together and from the construction of knowledge in hybrid positions when patients are health professionals and health professionals have hand OA. CONCLUSION: New knowledge about hand OA is co-constructed in the situated context of the clinical encounter through a polyphony of voices-some of which are dominant, while others occupy the periphery-within and between the interactants in dialgue.

A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals.

INTRODUCTION: Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management. OBJECTIVE: This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting. DESIGN: Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis. FINDINGS: Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1-Patient, carer and family's understanding about medication management is improved, 4.2-Patient, carer and family travel is decreased, 4.3-Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1-Enhanced communication between the patient and health care team, 5.2-Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1-Understanding about medications and their management is improved, 7.2-Workload is reduced, 7.3-Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1-A need for greater pharmacist capacity to meet demand, 10.2-A need for increased and sustained funding for the pharmacist role, 10.3-Large amount of travel to get to patients. CONCLUSION: Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.

Health professional competency building for the Baby-Friendly Hospital Initiative in Malawi.

Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby-Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low-income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in-service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in-service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI- and breastfeeding-specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students.

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Self-monitoring blood pressure in Pregnancy: Evaluation of health professional experiences of the BUMP trials.

BACKGROUND: The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether they improved detection or control of hypertension for women at risk of hypertension or with hypertension during pregnancy. This process evaluation aimed to understand healthcare professionals' perspectives and experiences of the BUMP trials of self-monitoring of blood pressure during pregnancy. METHODS: Twenty-two in-depth qualitative interviews and an online survey with 328 healthcare professionals providing care for pregnant people in the BUMP trials were carried out across five maternity units in England. RESULTS: Analysis used Normalisation Process Theory to identify factors required for successful implementation and integration into routine practice. Healthcare professionals felt self-monitoring of blood pressure did not over-medicalise pregnancy for women with, or at risk of, hypertension. Most said self-monitored readings positively affected their clinical encounters and professional roles, provided additive information on which to base decisions and enriched their relationships with pregnant people. Self-monitoring of blood pressure shifts responsibilities. Some healthcare professionals felt women having responsibility to decide on timing of monitoring and whether to act on self-monitored readings was unduly burdensome, and resulted in healthcare professionals taking additional responsibility for supporting them. CONCLUSIONS: Despite healthcare professionals' early concerns that self-monitoring of blood pressure might over-medicalise pregnancy, our analysis shows the opposite was the case when used in the care of pregnant people with, or at higher risk of, hypertension. While professionals retained ultimate clinical responsibility, they viewed self-monitoring of blood pressure as a means of sharing responsibility and empowering women to understand their bodies, to make judgements and decisions, and to contribute to their care.

Introducing www.epidemic-em.org: A Collection of Online Resources and Training Materials for Strengthening use of Emergency Operations Centers for Epidemic Response.

OBJECTIVE: This work aimed to demonstrate that a website, www.epidemic-em.org, encompassing "static" resources, and videos, as well as other tools, can be used to strengthen public health emergency management capacity during epidemic response. METHODS: Existing resources were updated and developed for self-directed Emergency Operations Centers' capacity strengthening, in order to encompass current best practices, and to emphasize how public health emergency management concepts can support epidemic response activities. These materials formed the core of the website, launched in June 2020, to which country case studies were added. In 2021, a pilot virtual training program was designed using recorded video lectures and interviews with global experts in addition to the website material, which was delivered to South African responders. RESULTS: The website has been accessed in more than 135 countries, demonstrating widespread reach and interest in online and freely accessible materials to support public health emergency operations. Over 30 people participated in the pilot virtual training, and the evaluation showed improvement in knowledge, confidence in using emergency management concepts for epidemic response, and positive feedback on the virtual modality. CONCLUSIONS: Online tools can expand access to materials and resources for public health emergency management capacity strengthening. Virtual modalities can further serve as a powerful complement, and perhaps replacement, for traditional in-person technical assistance, despite some limitations.

How can countries respond to the health and care workforce crisis? Insights from international evidence.

Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.