Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues

Background: In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed. Approach: Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students’ self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education. Outcomes:To understand student’s learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set – largely unspecific – goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process. Reflection: The contrast between students’ aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.</p

(Vi)-rushed Into Online Group Schema Therapy Based Day-Treatment for Older Adults by the COVID-19 Outbreak in the Netherlands

BACKGROUND: Societal measures in context of the COVID-19 outbreak forced us to transform our schema therapy based day-treatment for older adults with chronic affective disorders and personality problems into an online program. The objective of this paper is to present first impressions of this transformation. METHODS: Using over-the-phone instructions initially, all patients were able to participate with the online therapy program. To reduce screen-time for patients, the nonverbal therapies were shortened. Four patients, aged 64-70 years, started our online program. RESULTS: Therapists were positive about the online capabilities and resilience of patients to adapt to the new situation. Prejudices on limited effectiveness of online psychotherapy were counteracted. Sending homework by email and mail seems to facilitate therapy adherence. Nonverbal therapy could be important to stimulate the online group process. CONCLUSION: We were positively surprised by the online capabilities of our geriatric mental healthcare patients and encourage further formal effectiveness studies

Impact of personality functioning and pathological traits on mental wellbeing of older patients with personality disorders

BACKGROUND: Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults. METHODS: Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses. RESULTS: The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions – and in particular Identity integration (large effect size with partial eta-squared = 0.36) – were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24). CONCLUSIONS: Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-022-03857-8

Additional file 1: of Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study

Questionnaire of Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: The Bhaktapur Retina Study. Title of data – Questionnaire of “Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: The Bhaktapur Retina Study”. Description of data- structured questionnaire. (DOC 38 kb

Determinants of agreement between proposed therapeutic windows of platelet function tests in vulnerable patients

Aims Therapeutic windows for residual platelet reactivity in patients with coronary artery disease on P2Y12 inhibitors were proposed in a consensus document. We aimed to explore the level of agreement between windows for different platelet function tests (PFTs) used to classify patients in low, optimal, and high on-treatment platelet reactivity categories, and to identify variables contributing to the level of agreement.Methods and results In this explorative clinical study, the VerifyNow P2Y12, Multiplate adenosine diphosphate (ADP), and light transmission aggregometry (LTA) 20 mu mol/L ADP were performed simultaneously in 145 consecutive vulnerable patients. Measurements were performed within 6 months of percutaneous intervention. Patients were considered vulnerable if they had &gt;= 2 risk factors for bleeding or ischaemic events. Window-agreement between PFT pairs was slight to moderate. Multiplate-VerifyNow agreed in 72 patients (50%), kappa = 0.41; VerifyNow-LTA agreed in 76 patients (52%), kappa = 0.36; and LTA-Multiplate agreed in 64 patients (44%), kappa = 0.20. Several variables including the type of P2Y12 inhibitor, aspirin, haemoglobin level, platelet count, age, and previous stroke significantly influenced agreement between PFTs.Conclusions Our results suggest that the PFTs, with accompanying therapeutic windows, are not interchangeable when determining the response to antiplatelet therapy in vulnerable coronary artery disease patients on P2Y12 inhibitors. Hence, the type of PFT can directly affect the treatment strategy, which may be especially relevant for patients with multiple factors influencing individual PFTs and thereby test agreement.</p