Inter Professional Education: An evaluation of a joint learning experience for podiatry and pharmacy students

Working with and understanding the roles of other healthcare professionals will impact on the quality of care of the patient. Interprofessional learning forms part of the Standards for the Initial Education and Training of Pharmacists2 . The Healthcare Professionals Council have also identified that allied health professionals will work as part of a team whose collective focus is the health and well-being of people and understanding this collaboration is essential. At the University of Huddersfield second year pharmacy students attend a clinic run by podiatry students, under the supervision of podiatrists. Following excellent student feedback it was decided to expand this collaboration and produce a 2 hour workshop. Tutors from both disciplines met to design and develop case scenarios based on patients with high risk medical conditions that would impact on the work of both professions. Aim: To expose pharmacy and podiatry students to inter professional learning at an early stage in their careers. Thus developing their knowledge, skills and attitudes to enhance patient centred care

Essays in Social Economics

This dissertation consists of three essays using economic methods to understand social policy issues. The first chapter uses a regression discontinuity framework to understand how teen birth rates respond to the first college opening in a county. The predicted effect of a college opening on teen births is ambiguous. Teen births could fall if college and motherhood are substitutes, but they could rise if a local college allows teen mothers to attend college or if teen mothers are not on the margin for attending college. Using data on teen births and college openings from 1969-1988, I find that teen births do not fall and may increase following a college opening. The effect is strongest among older teens, lending support to the notion that a local college allows more women to simultaneously become a mother and go to college. The second chapter examines why whites tend not to support welfare programs to the extent that blacks do. I recruited a racially and economically diverse set of subjects in Chicago Heights, IL and Boston and collected an original dataset combining survey questions and preferences for redistribution plans with economic consequences. Black subjects were not systematically more risk or inequity averse than white subjects and were only less confident when the task was a trivia quiz.Economic

An exploration of the use of devices for the prevention of heel pressure ulcers in secondary care: A realist evaluation

Background The heel is a particularly high-risk and problematic area for pressure ulcers (PU) to develop. The effectiveness of devices and the factors that lead to their use for the prevention of heel PUs is poorly understood. Aims 1. To assess the effectiveness of devices used for the prevention of heel PUs. 2. Explore what factors influence the implementation, and how heel-specific devices are used (or not used) in secondary care. Methods To address aim 1: Systematic review of the evidence of effectiveness for devices in the prevention of heel PU. Aim 2: Realist evaluation, including Phase 1 - theory elicitation through stakeholder interviews with Tissue Viability Nurse Specialists (TVNS) from across the UK and Phase 2 - testing theories using ethnography in three orthopaedic wards in the North of England. Results Systematic review: identified 29 trials with fifteen comparisons and eight meta-analyses conducted. Offloading devices were found to be effective in the prevention of ≥Category 1 and ≥Category 2 heel PUs when compared to standard care, but this is based on low to moderate quality evidence and intervention compliance was found to be an issue. Realist evaluation Phase 1: Interviews with eight TVNS elicited thirteen candidate theories into three program theories, regarding the proactive and reactive use of offloading devices, along with patient factors that influenced their use. Phase 2: Ethnography found that heel-specific devices are used in practice. Leadership, protocols, identification of high-risk patient groups, and access to devices influenced staff knowledge but did not necessarily increase device use. Conclusion Exploring the perceptions and realities of how offloading and heel-specific devices are used in practice can not only influence their use, but also inform how future device trials are designed and conducted to improve protocol compliance and reduce withdrawals and attritions

Patient and public involvement in the development of clinical practice guidelines: a scoping review

OBJECTIVES: Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four questions: (1) who are the patients and publics involved in developing the CPG?; (2) from where and how are the patients and publics recruited?; (3) at what stage in the CPG development process are the patients and publics involved? and (4) how do the patients and publics contribute their views? We also extracted data on the use of PPI reporting checklists by the included studies. DESIGN: We used the methodology developed by Arksey and O’Malley and refined by the Joanna Briggs Institute. We searched PubMed, Embase, CINAHL and PsycINFO, websites of national guideline bodies from the UK, Canada, Australia and the USA, and conducted a forward citation search. No language, date or participant demographics restrictions were applied. Data were synthesised narratively. RESULTS: We included 47 studies addressing 1 or more of the 4 questions. All included studies reported who the patient and publics involved (PPI members) were, and several studies reported PPI members from different groups. Patients were reported in 43/47 studies, advocates were reported in 22/47 studies, patients and advocates reported in 17/47 studies, and general public reported in 2/47 studies. Thirty-four studies reported from where the patients and publics were recruited, with patient groups being the most common (20/34). Stage of involvement was reported by 42/47 studies, most commonly at question identification (26/42) and draft review (18/42) stages. Forty-two studies reported how the patients contributed, most commonly via group meetings (18/42) or individual interviews. Ten studies cited or used a reporting checklist to report findings. CONCLUSIONS: Our scoping review has revealed knowledge gaps to inform future research in several ways: replication, terminology and inclusion. First, no standard approach to PPI in CPG development could be inferred from the research. Second, inconsistent terminology to describe patients and publics reduces clarity around which patients and publics have been involved in developing CPGs. Finally, the under-representation of research describing PPI in the development of screening, as opposed to treatment, CPGs warrants further attention

Rates and predictors of disengagement and strength of engagement for people with a first episode of psychosis using early intervention services: a systematic review of predictors and meta-analysis of disengagement rates

Disengagement is a problem in early intervention for psychosis services; identifying predictors is important to maximise mental-health care. Aim To establish the average disengagement rate, time to disengage, and predictors of disengagement or strength of engagement. Methods Papers were identified from 5 databases and citation searches; chosen if they reported dis/engagement in early intervention services, discarded if they didn't give a clear definition of disengagement. The studies were rated for quality and a systematic review identified predictors of engagement; meta-analysis established the average disengagement rate. Meta-regression evaluated associations between disengagement and year of study or length of follow up. Results 26 papers were reviewed comprising over 6800 participants, meta-analysis of 15 eligible cohorts found that the average disengagement rate was 15.60% (95% confidence intervals 11.76%–20.45%), heterogeneity was considerable, important to note when reporting as a global average. Higher disengagement rates were associated with earlier studies and length of follow up; causal factors are unclear due to the lack of data and complex interaction between clinical and methodological issues. Robust predictors of disengagement were substance use, contact with the criminal justice system, medication non-adherence, and lower symptom severity. Conclusions Disengagement rates have declined although the cause is not clear partly due to methodological variation, we suggest a guide for defining disengagement. Underpinning reasons for disengagement could include people who struggle to engage (substance users), don’t want to engage (medication non-adherence) or feel they don’t need to engage (lower symptomology). Future research should focus on minority status, education/employment during treatment, and digital technologies

Offloading devices for the prevention of heel pressure ulcers: a realist evaluation

Background Heel pressure ulcers can cause pain, reduce mobility, lead to longer hospital stays and in severe cases can lead to sepsis, amputation, and death. Offloading boots are marketed as heel pressure ulcer prevention devices, working by removing pressure to the heel, yet there is little good quality evidence about their clinical effectiveness. Given that evidence is not guiding use of these devices, this study aims to explore, how, when, and why these devices are used in hospital settings. Objective To explore how offloading devices are used to prevent heel pressure ulcers, for whom and in what circumstances. Methods A realist evaluation was undertaken to explore the contexts, mechanisms, and outcomes that might influence how offloading devices are implemented and used in clinical practice for the prevention of heel pressure ulcers in hospitals. Eight Tissue Viability Nurse Specialists from across the UK (England, Wales, and Northern Ireland) were interviewed. Questions sought to elicit whether, and in what ways, initial theories about the use of heel pressure ulcers fitted with interviewee's experiences. Results Thirteen initial theories were refined into three programme theories about how offloading devices are used by nurses ‘proactively’ to prevent heel pressure ulcers, ‘reactively’ to treat and minimise deterioration of early-stage pressure ulcers, and patient factors that influence how these devices are used. Conclusions Offloading devices were used in clinical practice by all the interviewees. It was viewed that they were not suitable to be used by every patient, at every point in their inpatient journey, nor was it financially viable. However, the interviewees thought that identifying suitable ‘at risk’ patient groups that can maintain use of the devices could lead to proactive and cost-effective use of the devices. This understanding of the contexts and mechanisms that influence the effective use of offloading devices has implications for clinical practice and design of clinical trials of offloading devices. Tweetable abstract How, for whom, and in what circumstances do offloading devices work to prevent heel pressure ulcers? Tissue viability nurses' perspectives

Oxytocin Receptor Binding Sites in the Periphery of the Neonatal Prairie Vole

The oxytocin receptor (OXTR) has been observed in the periphery of neonatal C57BL/6J mice (Mus musculus), including facial regions and the anogenital area. In those studies, ligand specificity was confirmed with a congenital OXTR knockout mouse as well as competitive binding techniques. The aim of this study was to determine if OXTR is present in the same peripheral sites in the neonatal prairie vole (Microtus ochrogaster) for cross-species comparisons. Receptor autoradiography was performed on 20 μm sagittal sections of whole postnatal day 0 (P0) male and female prairie voles using the 125iodinated-ornithine vasotocin ([125I]-OVTA) radioligand. A competition binding assay was used to assess the selectivity of [125I]-OVTA for peripheral OXTR. Radioactive ligand (0.05 nM [125I]-OVTA) was competed against concentrations of 0 and 1000 nM excess unlabeled oxytocin (OXT). Previously identified regions of significant OXTR ligand binding in the mouse were analyzed for comparison: rostral and lateral periodontium, olfactory epithelium, ciliary bodies of the eye, whisker pads, adrenal gland, and anogenital area. We also evaluated the liver and scapular brown adipose tissue, which displayed strong but non-specific signal on film in mice. While there were some areas that showed conserved OXTR ligand binding in the prairie vole (e.g., ciliary body of the eye and the anogenital area), areas showing OXTR ligand binding in the neonatal prairie vole were not identical to OXTR ligand binding in the periphery of the C57BL/6J neonatal mouse. Further, some of the regions measured in the prairie vole suggest sex differences in OXTR ligand binding. Collectively, as is well-established in the central nervous system, these data indicate that patterns of OXTR ligand binding in the infant periphery are species-specific

Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: a systematic review

Background Pressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown. Methods Systematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate. Results Fifteen RCTs (4724 participants) were identified. Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01). Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67). Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence. In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively). Conclusions Off-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence