Learning from interprofessional education: A cautionary tale.

BACKGROUND: Interprofessional education (IPE) is time consuming to develop and sustain and presents many logistical and practical challenges to curriculum developers. Drawing on findings from an evaluation study of an IPE pilot, this paper brings new insights into both positive implications and potentially negative consequences of delivering large scale IPE. OBJECTIVE: The aim of the study was to evaluate a large scale IPE pilot delivered to students in the first year of their training. DESIGN AND SETTING: The IPE pilot took place on campus and was focused on patient safety (human factors). PARTICIPANTS: The study involved 630 first year undergraduates across 10 programmes at a UK university. METHODS: A mixed methods evaluation was conducted comprising a paper-based survey circulated at the end of the taught session followed by uni-professional focus groups (n = 4). Questionnaire data was subject to descriptive statistical analysis and key themes were generated from the focus group data. RESULTS: Three overarching themes emerged from analysis of the qualitative data: Understanding differences in roles, Learning about stereotypes and Unintended perpetuation of stereotypes. CONCLUSIONS: IPE is an important part of the training of all health and social care professionals and the study revealed many benefits of this approach. However, we should be sensitive to the possibility of inadvertently perpetuating negative stereotypes as a consequence of IPE activities. Our work highlights the need for caution when considering the planning and executing IPE activities.

Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review.

BACKGROUND: Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death. Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians. AIMS: The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy. METHODS: Published, peer reviewed, English language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the mixed methods appraisal tool for all studies meeting the inclusion criteria. RESULTS: The findings of eight qualitative and seven quantitative studies, including patients who accepted or declined primary or secondary sudden cardiac death prevention devices, were clustered into two themes: knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature. CONCLUSION: The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.

Quality of life among adults following bariatric and body contouring surgery: a systematic review.

BACKGROUND: Weight loss following bariatric surgery is associated with significant improvements in obesity-related comorbidities, body satisfaction and psychosocial outcomes, at least in the short term. However, in the context of extreme weight loss, body image and appearance may worsen again because the "excess" or "loose" skin can lead to both functional and profound dissatisfaction with appearance. These concerns have led to an increasing uptake of post-bariatric surgery, "body-contouring" procedures but the implications for quality of life (QoL) have not been thoroughly considered. OBJECTIVE/PURPOSE: The objective was to identify the best available evidence regarding the QoL outcomes for adults following bariatric and body contouring surgery. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The review considered studies involving people aged 18 years and beyond who underwent bariatric surgery and body contouring surgery. TYPES OF INTERVENTIONS: The review considered studies that evaluated bariatric surgery as well as body contouring surgery. TYPES OF STUDIES: The review considered both experimental and epidemiological study designs. OUTCOMES: The primary outcomes were QoL as measured by validated tools at less than two years, two to five years and more than five years following body contouring surgery. The secondary outcomes were adverse events, unsatisfactory aesthetic appearance and weight gain. SEARCH STRATEGY: Six databases were searched, including Cochrane Central, MEDLINE, Embase, Web of Science, PsycINFO and CINAHL. Studies published from 1954 to 2014 were considered. Additional searches for unpublished studies were undertaken in BIOSIS citation index, Register of Current Controlled Trials and Global Health Observatory. METHODOLOGICAL QUALITY: The methodological quality of eligible studies was assessed independently by two reviewers using the Joanna Briggs Institute quality assessment tool. DATA EXTRACTION: Data extraction from the included studies was undertaken and summarized independently by two reviewers using the standardized Joanna Briggs Institute data extraction tool. DATA SYNTHESIS: Studies were too heterogeneous and could not be pooled in statistical meta-analysis. Therefore, the data results are presented as a narrative summary in relation to the outcomes of interest. RESULTS: Nine quantitative studies (four comparable cohort studies, including two group design and two four-group designs and five descriptive or case-series studies) were included in the review. The included studies reported significant clinical improvements in appearance, wellbeing and QoL. These included primary outcomes pointing to body image satisfaction, improved self-esteem and confidence, improved physical function/pain and improved social function. The secondary outcomes were related to adverse events in the early postoperative period and reported wound healing problems, including seromas, partial necrosis, dehiscence, hematoma and anemia because of blood loss. Also, some data sets shed light on appearance-related distress and body dysphoria post surgery associated with visible scars and contour deformities. CONCLUSION: Body contouring surgery has been shown to have positive benefits, especially in relation to improved wellbeing, function and QoL. However, adjustment to changing body image following body contouring is both challenging and empowering and seems to be a transitional process.

Comparison of male and female psychological outcomes related to implantable cardioverter defibrillators (COMFORTID).

BACKGROUND: While randomised, controlled trials have established the efficacy of the implantable cardioverter defibrillator (ICD) for primary and secondary prevention of life threatening arrhythmias, psychosocial responses remain complex and poorly understood, especially across Europe. There appears to be a greater need to understand differences in the experience of men and women. AIM: The aim of this prospective study was to explore differences in psychosocial adjustment over a 12 month period following ICD implantation. METHODS: Fourteen female and thirty three male device recipients completed a series of questionnaires over a 12 month period. Instruments included a generic and an ICD specific Quality of Life (QOL) measure and the state-trait anxiety inventory. RESULTS: Women reported higher levels of anxiety than men at discharge but over time demonstrated a significant improvement such that at 4, 8 and 12 months men were more anxious. Women reported significantly poorer emotional wellbeing at discharge, however by 12 months this was significantly improved with no difference in the perceptions held by men and women. Women consistently across the 12 months worried more than men about the impact of the device on appearance. CONCLUSION: This study confirmed that most individuals adjust positively to the ICD during the first 12 months. Some gender differences in adjustment were evident. Further studies across Europe are warranted to establish gender specific interventions to support men and women as they adapt to life with ICD implants.