Experiential learning in an undergraduate BPHARM programme: impact of an intervention on academic achievement

The extended role of today’s pharmacist with the emphasis on patient-focused care has highlighted the need for increased exposure of undergraduate pharmacy students to experiential learning in patient-centred environments, and additional skills development in therapeutics, problem solving and clinical decision making. At the Nelson Mandela Metropolitan University (NMMU), final year pharmacy students complete a university-coordinated, hospital-based, structured experiential learning programme (ELP) for the exit-level module, Pharmacology4. However, the students consistently experience difficulties in the application of pharmacological knowledge during the transition from lecture-based learning to the patient-focused clinical setting. The student population at the NMMU is diverse, with varied cultural, ethnic, language and secondary level education backgrounds, as well as different learning preferences and approaches. The extent to which these factors affect academic achievement in the experiential learning environment is unknown. Central research question The central research question for this study was therefore, “What would be the effect of an intervention aimed at supporting undergraduate pharmacy students during clinical placements, on academic achievement in, and student attitudes towards, experiential learning programmes (ELP)?” In order to explore the research question, several factors which may influence academic achievement in ELPs were investigated, namely: academic achievement (pre-university, in the BPharm programme and, in pharmacology); the admission route into the BPharm programme and the subsequent rate of academic progression; English reading comprehension ability; learning styles; problem solving ability; the extent to which students are prepared for application of knowledge in the ELP, in terms of assessment methods used prior to the final year and previous pharmacy work-based experience. In addition, the students’ lived experience of the ELP was explored, and the need for, and nature of, an intervention was determined. The research was based in a pragmatic paradigm, using an advanced mixed methods approach. An intervention-based, two-phase, quasi-experimental design was employed with an initial exploratory Preliminary Phase (in 2013) preceding the larger experimental framework (Phases One and Two, in 2014 and 2015 respectively). The research design was primarily quantitative, with pre- and post- testing conducted before and after the ELP. The ELP was completed by the comparator cohort in Phase One and the experimental cohort in Phase Two. Supplementary qualitative data was collected before, during and after the ELP. The intervention, in the form of supplementary academic support sessions, was developed from the qualitative data using an iterative approach, and implemented during the ELP in Phase Two. Attitudes and expectations of the students towards the hospital-based ELP were generally positive and realistic. Areas of concern included the difficulties experienced in the application and integration of pharmacological knowledge, both in the clinical setting and the clinical case study-based assessments; students feeling overwhelmed, inadequate and inferior in the clinical environment, compounded by an absence of clinical pharmacists as role models; and feeling unprepared for patient-focused care. The qualitative data strongly supported the need for supplementary academic support sessions. The intervention was developed and implemented in Phase Two, using patient case-based, active learning strategies. The majority of students (91.0%; n = 104) reported improved case analysis skills. A statistically significant (p = .030, Cohen’s d = 0.34) improvement was noted in the summative Pharmacology4 assessment marks obtained by the experimental cohort post-intervention, although of small practical significance. Predictors of academic achievement in the ELP were found to be language, specifically English reading comprehension skills, academic achievement in the BPharm programme and pharmacology, the university admission score, the rate of academic progression, and problem solving ability. Previous pharmacy-based work experience and assessment questions requiring application of knowledge were also found to influence achievement in the ELP. The need for an intervention in the form of supplementary academic support sessions was confirmed. The intervention was subsequently developed and successfully implemented, with student-reported self-perceived improvements in patient case analysis skills. These positive findings were supported by quantitative data which showed a statistically significant improvement in academic achievement in the ELP. Several predictors of academic achievement in the ELP were identified, and invaluable insight was gained into the nature of the difficulties experienced by pharmacy students in the transition from lecture-based learning to experiential learning in patient-focused environments

Fashioning contemporary art: a new interdisciplinary aesthetics in art-design collaborations

A surge in creative collaboration between fine artists and fashion designers might be troubling the art world, but these mergers have prompted little debate within academic research in the visual arts. Various artists now work directly with fashion designers, and though often derided by the art press, the growth of inter-disciplinary collaboration reflects a shift in how art is perceived, especially in relation to popular culture. This discussion considers historical moments when fashion and art found common cause, but we view the distinctive qualities of recent collaborative ventures as an entrenchment of postmodernist aesthetics in both realms. Since the mid-twentieth century, art-fashion interplays have disorganised disciplinary boundaries, but they also illustrate the unsettling effects of neoliberalism on cultural production. By exploring the fashioning of contemporary art through the work of various artists and designers, including Matthew Barney, Vanessa Beecroft and Yayoi Kusama, we ask whether shared concerns in art and design around power, spectacle and the somatic might signal the emergence of a new interdisciplinary aesthetics

Do age, period or cohort effects explain circulatory disease mortality trends, Scotland 1974-2015?

Objective: We aimed to explore whether age, period or cohort effects explain the trends and inequalities in ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in Scotland. Methods: We analysed IHD and CeVD deaths for 1974–2015 by sex, age and area deprivation, visually explored the data using heatmaps and dotplots and built regression models. Results: CeVD mortality improved steadily over time while IHD mortality improved more rapidly from the late 1980s. Age effects were evident; both outcomes showed an exponential relationship with age for all except males for IHD in the 1980s and 1990s. The mortality profiles by age became older, although improvement was slower for those aged <50 years for IHD, especially for males, and faster for CeVD in females aged <65 years. Rates were higher, and inequalities greater, among males, especially for IHD. For IHD, increased risk for males over females reduced with age (incidence rate ratio for 41–50 year old males=4.28 (95% CI 4.12 to 4.44) and 1.17 (95% CI 1.16 to 1.18) for 71–80 year olds). Inequalities in IHD mortality by area deprivation persisted over time, increasing from around 10% to around 25% higher risk in the most deprived areas between 1974 and 1986 before declining in absolute terms from around 2000. Inequalities for CeVD increased after the late 1980s. Conclusions: IHD and CeVD mortality in Scotland exhibit age but not recent distinct period or cohort effects. The improvements in mortality rates have been more sustained for CeVD and inequalities greater for IHD

Documentation of antipsychotic-related adverse drug reactions: An educational intervention

Antipsychotic agents are associated with harmful adverse reactions which impact negatively on patient adherence and clinical management. Accurate and complete documentation of signs and symptoms in the clinical notes is an important means of communication between healthcare providers, and an essential component in the management of antipsychotic-induced adverse drug reactions. To determine the impact of an educational intervention on the incidence and extent of antipsychotic-induced adverse drug reaction documentation in patient medical records

Deaths from ‘diseases of despair’ in Britain: comparing suicide, alcohol-related and drug-related mortality for birth cohorts in Scotland, England and Wales, and selected cities

Background: The contribution of increasing numbers of deaths from suicide, alcohol-related and drug-related causes to changes in overall mortality rates has been highlighted in various countries. In Scotland, particular vulnerable cohorts have been shown to be most at risk; however, it is unclear to what extent this applies elsewhere in Britain. The aim here was to compare mortality rates for different birth cohorts between Scotland and England and Wales (E&W), including key cities. Methods: Mortality and population data (1981–2017) for Scotland, E&W and 10 cities were obtained from national statistical agencies. Ten-year birth cohorts and cohort-specific mortality rates (by age of death, sex, cause) were derived and compared between countries and cities. Results: Similarities were observed between countries and cities in terms of peak ages of death, and the cohorts with the highest death rates. However, cohort-specific rates were notably higher in Scotland, particularly for alcohol-related and drug-related deaths. Across countries and cities, those born in 1965–1974 and 1975–1984 had the highest drug-related mortality rates (peak age at death: 30–34 years); the 1965–1974 birth cohort also had the highest male suicide rate (peak age: 40–44 years). For alcohol-related causes, the highest rates were among earlier cohorts (1935–1944, 1945–1954, 1955–1964)—peak age 60–64 years. Conclusions: The overall similarities suggest common underlying influences across Britain; however, their effects have been greatest in Scotland, confirming greater vulnerability among that population. In addressing the socioeconomic drivers of deaths from these causes, the cohorts identified here as being at greatest risk require particular attention

Changing mortality trends in countries and cities of the United Kingdom (UK): a population-based trend analysis

Objectives: Previously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail. Design: Population-based trend analysis. Participants/setting: Whole populations of countries and selected cities of the UK. Primary and secondary outcome measures European age-standardised mortality rates (calculated by cause of death, country, city, year (1981–2017), age group, sex and—for all countries and Scottish cities—deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities. Results: Changes in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%–6% during the 1980s and 1990s, approximately 7%–9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%–7%, 8%–12% and 1%–3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow). Conclusions: The study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government ‘austerity’ measures which have disproportionately affected the poorest

Recent cohort effects in suicide in Scotland:A legacy of the 1980s?

Background: Mortality rates are higher in Scotland relative to England and Wales, even after accounting for deprivation. This ‘excess’ mortality is partly due to higher mortality from alcohol-related and drug-related deaths, violence and suicide (particularly in young adults). This study investigated whether cohort effects from exposure to neoliberal politics from the 1980s might explain the recent trends in suicide in Scotland. Methods: We analysed suicide deaths data from 1974 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects. Results: Suicide was most common in young adults (aged around 25–40 years) living in deprived areas, with a younger peak in men. The peak age for suicide fell around 1990, especially for men for whom it dropped quickly from around 50 to 30 years. There was evidence of an increased risk of suicide for the cohort born between 1960 and 1980, especially among men living in the most deprived areas (of around 30%). The cohort at highest risk occurred earlier in the most deprived areas, 1965–1969 compared with 1970–1974. Conclusions: The risk of suicide increased in Scotland for those born between 1960 and 1980, especially for men living in the most deprived areas, which resulted in a rise in age-standardised rates for suicide among young adults during the 1990s. This is consistent with the hypothesis that exposure to neoliberal politics created a delayed negative health impact

What is the potential for plural ownership to support a more inclusive economy? A systematic review protocol

Abstract: Background: The world is facing an unprecedented systemic shock to population health, the economy and society due to the devastating impact of the COVID-19 pandemic. As with most economic shocks, this is expected to disproportionately impact vulnerable groups in society such as those in poverty and those in precarious employment as well as marginalised groups such as women, the elderly, Black, Asian and Minority Ethnic (BAME) groups and those with health conditions. The current literature is rich in normative recommendations on plural ownership as a key building block of an inclusive economy rooted in communities and their needs. There is, however, a need for a rigorous synthesis of the available evidence on what impact (if any) plural ownership may potentially have on the inclusivity of the economy. This review seeks to synthesise and compare the available evidence across the three economic sectors (private, public and third). Methods: We will search eight bibliographic databases (Sociological abstracts, EBSCO Econlit, OVID Embase, OVID Medline, Applied Social Sciences Index and Abstracts (ASSIA), ProQuest Public Health, Web of Science, Research Papers in Economics (Repec) – EconPapers) from the earliest data available in each database until January 2021. Grey literature will be identified from Google (advanced), Google Scholar and 37 organisational websites identified as relevant to the research question. We will include comparative studies of plural ownership from high-income countries that report outcomes on access to opportunities, distribution of benefits, poverty, and discrimination. A bespoke search strategy will be used for each website to account for the heterogeneity in content and search capabilities and will be fully documented. A standardised data extraction template based on the Population-Intervention-Context-Outcome (PICO) template will be developed. We will assess the strength of evidence for different forms of economic ownership identified in relation to the impact of each on the four economic outcomes of interest, paying particular attention to the role of wider contextual factors as they emerge through the evidence. Discussion: The findings of this review are intended to inform policymaking at local, national and international level that prioritises and supports the development of different economic and business models. Systematic review registration: Open Science Framework registration DOI: https://doi.org/10.17605/OSF.IO/BYH5

Corporate sponsorship of physical activity promotion programmes: part of the solution or part of the problem?

Background Parklives is a programme intended to raise levels of physical activity across the UK, funded by Coca-Cola GB and delivered in association with Local Authorities and other organizations. Such public-private partnerships have been advocated by many however critics suggest that the conflict between stakeholder motives is too great. Methods This study conducted a content analysis of twitter content related to the ParkLives physical activity programme. Images and text were analysed from two separate weeks, one from the school vacation period and one during school term time. Results Three hundred and eighteen tweets were analysed. Content analysis revealed 79% of images contained children and 45% of these images contained prominent Coca-Cola branding, a level of exposure that suggests ParkLives simultaneously provides opportunities for children's physical activity and for targeted marketing. Content analysis also demonstrated that the programme allowed increased access to policy-makers. Conclusions The sponsorship of a physical activity promotion campaign can allow a corporation to target its marketing at children and gain access to health-related policy development networks. This study reinforces the need for independent evaluation of all potential impacts of such a partnership and calls on those responsible for community health to fully consider the ethical implications of such relationships

Multifactorial falls prevention programme compared with usual care in UK care homes for older people: Multicentre cluster randomised controlled trial with economic evaluation

Objectives: To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. Design: Multicentre, parallel, cluster randomised controlled trial. Setting: Long term care homes in the UK, registered to care for older people or those with dementia. Participants: 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. Interventions: Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. Main outcome measures: Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. Results: Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval −£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (−0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. Conclusions: The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. Trial registration: ISRCTN34353836