What Do We Know About Uncertainty, and Teaching Around Uncertainty, in Health Professions Education? A Scoping Review

Introduction Managing uncertainty is central to practice in the health professions and the ability to cope with uncertainty is considered a day one competency for veterinary surgeons. Although there is a growing literature in this area, there has been a lack of clarity in how uncertainty is conceptualised, and approached in undergraduate education 1. The aim of this scoping review is to answer the ‘broader questions’ 2 concerning what is known about the concept of uncertainty in the health professions and the nature of the evidence for educational interventions in this area. Methods We used an approach based on Joanna Briggs institute guidelines 3. The presentation will describe the initial stages of the review process, specifically: • The research team • Scoping review protocol, including the search strategy • Pre-test exercise to evaluate reviewer agreement • First round of screening (title and abstract) • Second round of screening (full text review) Results 4681 records were identified through database searching and an additional 34 records identified through other sources. After duplicates were removed, a total of 3336 records were screened (title and abstract), of which 667 were eligible for inclusion in the second round (full text review). Discussion Preliminary results suggest that uncertainty is an area of discussion for most health professions, yet there is no clear educational approach to address the topic. We outline teaching and learning strategies as well as recognising uncertainty ‘bedfellows’ such as ethics, clinical reasoning, communication, professionalism, evidence based medicine and end-of-life topics. References 1. Luther VP, Crandall SJ. Commentary: ambiguity and uncertainty: neglected elements of medical education curricula? Acad Med J Assoc Am Med Coll. 2011;86(7):799-800. http://www.ncbi.nlm.nih.gov/pubmed/21715991. 2. Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16(1):15. doi:10.1186/s12874-016-0116-4. 3. Peters MDJ, Godfrey CM, McInerney P, Baldini Soares C, Khalil H, Parker D. The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI Scoping Reviews.; 2015. www.joannabriggs.org. Accessed March 15, 2019

What Do We Know About Uncertainty, and Teaching Around Uncertainty, in Health Professions Education? A Scoping Review

Introduction Managing uncertainty is central to practice in the health professions and the ability to cope with uncertainty is considered a day one competency for veterinary surgeons. Although there is a growing literature in this area, there has been a lack of clarity in how uncertainty is conceptualised, and approached in undergraduate education 1. The aim of this scoping review is to answer the ‘broader questions’ 2 concerning what is known about the concept of uncertainty in the health professions and the nature of the evidence for educational interventions in this area. Methods We used an approach based on Joanna Briggs institute guidelines 3. The presentation will describe the initial stages of the review process, specifically: • The research team • Scoping review protocol, including the search strategy • Pre-test exercise to evaluate reviewer agreement • First round of screening (title and abstract) • Second round of screening (full text review) Results 4681 records were identified through database searching and an additional 34 records identified through other sources. After duplicates were removed, a total of 3336 records were screened (title and abstract), of which 667 were eligible for inclusion in the second round (full text review). Discussion Preliminary results suggest that uncertainty is an area of discussion for most health professions, yet there is no clear educational approach to address the topic. We outline teaching and learning strategies as well as recognising uncertainty ‘bedfellows’ such as ethics, clinical reasoning, communication, professionalism, evidence based medicine and end-of-life topics. References 1. Luther VP, Crandall SJ. Commentary: ambiguity and uncertainty: neglected elements of medical education curricula? Acad Med J Assoc Am Med Coll. 2011;86(7):799-800. http://www.ncbi.nlm.nih.gov/pubmed/21715991. 2. Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16(1):15. doi:10.1186/s12874-016-0116-4. 3. Peters MDJ, Godfrey CM, McInerney P, Baldini Soares C, Khalil H, Parker D. The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI Scoping Reviews.; 2015. www.joannabriggs.org. Accessed March 15, 2019

“This is me, this is what I am, I am a man”: The masculinities of men who pay for sex with women.

This paper draws on theories of masculinity to explore men’s motivations for beginning and continuing to pay for sex with women. Based on in-depth interviews with thirty-five male clients of female sex workers in the UK during 2007/2008, our findings suggest that a desire to pay for sex is often entrenched in notions of hegemonic masculinity (Connell, 2000) such as sex as a drive, or need for a variety of experiences and partners and is rationalised as an economic exchange. Yet, the men interviewed also expressed a need for intimacy, female friendship and conversation in a controlled environment, which challenged dominant masculine ideals. For participants there was often an overlap between various motivational factors, and accounts are complicated by the anxieties and disappointments the men express about their non-commercial relationships and the intimacy and emotion frequently attached to encounters with sex workers. The pathologization of men who engage with paid sexual services fails to account for participants’ complex, diverse motivations, which should be understood in the context of other relationships and gender relations rather than as a distinct type of interaction. We find that the theory of hegemonic masculinity provides a useful but partial account of the range of behaviours and characteristics expressed in paid-for sex, which participants use to negotiate the expectations, ambivalences and disappointments of everyday life and relationships

The ubiquity of uncertainty: a scoping review on how undergraduate health professions' students engage with uncertainty.

Although the evidence base around uncertainty and education has expanded in recent years, a lack of clarity around conceptual terms and a heterogeneity of study designs means that this landscape remains indistinct. This scoping review explores how undergraduate health professions' students learn to engage with uncertainty related to their academic practice. To our knowledge, this is the first scoping review which examines teaching and learning related to uncertainty across multiple health professions. The scoping review is underpinned by the five-stage framework of (Arksey and O'Malley in Scoping studies: Towards a methodological framework International Journal of Social Research Methodology 8(1) 19-32, 2005). We searched MEDLINE, Embase, PsychINFO, ISI Web of Science, and CINAHL and hand-searched selected health professions’ education journals. The search strategy yielded a total of 5,017 articles, of which 97 were included in the final review. Four major themes were identified: “Learners’ interactions with uncertainty”; “Factors that influence learner experiences”; “Educational outcomes”; and, “Teaching and learning approaches”. Our findings highlight that uncertainty is a ubiquitous concern in health professions’ education, with students experiencing different forms of uncertainty at many stages of their training. These experiences are influenced by both individual and system-related factors. Formal teaching strategies that directly support learning around uncertainty were infrequent, and included arts-based teaching, and clinical case presentations. Students also met with uncertainty indirectly through problem-based learning, clinical teaching, humanities teaching, simulation, team-based learning, small group learning, tactical games, online discussion of anatomy topics, and virtual patients. Reflection and reflective practice are also mentioned as strategies within the literature

A Convergent Synthetic Platform for Single-Nanoparticle Combination Cancer Therapy: Ratiometric Loading and Controlled Release of Cisplatin, Doxorubicin, and Camptothecin

The synthesis of polymer therapeutics capable of controlled loading and synchronized release of multiple therapeutic agents remains a formidable challenge in drug delivery and synthetic polymer chemistry. Herein, we report the synthesis of polymer nanoparticles (NPs) that carry precise molar ratios of doxorubicin, camptothecin, and cisplatin. To our knowledge, this work provides the first example of orthogonally triggered release of three drugs from single NPs. The highly convergent synthetic approach opens the door to new NP-based combination therapies for cancer.MIT Research Support CommitteeLincoln Laboratory. Advanced Concepts CommitteeUnited States. Dept. of Defense (Ovarian Cancer Research Program Teal Innovator Award)National Institutes of Health (U.S.) (Ruth L. Kirschstein National Research Service Award 1F32EB017614-01)Natural Sciences and Engineering Research Council of Canada (Postdoctoral Fellowship)Natural Sciences and Engineering Research Council of Canada (Graduate Fellowship)National Cancer Institute (U.S.) (Koch Institute Support (Core) Grant P30-CA14051

Retrospective evaluation of thoracic computed tomography findings in dogs naturally infected by Angiostrongylus vasorum

Angiostrongylus vasorum (A. vasorum) is an important emerging disease of canidae. Cardiorespiratory signs are common in affected dogs, therefore thoracic imaging is critical for diagnosing andmonitoring disease. Descriptions of thoracic computed tomography (CT) findings in dogs naturallyinfected with A. vasorum are currently lacking. Aims of this multicenter, retrospective study were to describe thoracic CT findings in a group of dogs with confirmed disease, determine whether any changes were consistent among dogs, and propose standardized terms for describing thoracic CT findings. Nine UK-based referral centers’ clinical and imaging databases were searched for dogs that had a confirmed diagnosis of A. vasorum, and had undergone thoracic CT examination. Eighteen dogs, from seven of the centers, fulfilled the inclusion criteria. The lung lobes were divided into the following three zones and the CT changes described in each: pleural (zone 1), subpleural (zone 2), and peribronchovascular (zone 3). The predominent abnormality was increased lung attenuation due to poorly defined ground-glass opacity or consolidation. There were regions of mosaic attenuation due to peripheral bronchiectasis. Nine/18 (50%) dogs showed hyperattenuating nodules of varying sizes with ill-defined margins. The distribution always affected zones 1and 2 with varied involvement of zone 3; this resulted in clear delineation between zones 2 and 3.Tracheobronchial lymphadenomegaly was frequently noted. Findings were nonspecific and there was considerable overlap with other pulmonary conditions. However, authors recommend that A. vasorum be considered a likely differential diagnosis for dogs with a predominantly peripheral distribution of lung changes

“Success” in policy piloting: Process, programs, and politics

From Wiley via Jisc Publications RouterHistory: received 2021-03-28, rev-recd 2021-09-28, accepted 2021-10-07, pub-electronic 2021-10-25Article version: VoRPublication status: PublishedFunder: NIHR Policy Research Programme; Grant(s): PR‐R16‐0516‐22001Abstract: Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer‐term effects can all be judged in both program and political terms. We test this new framework in a pilot program in the English National Health Service, the Vanguard program, showing how consideration of these different aspects of success sheds light on the program and its aftermath. We consider the implications of the framework for the comprehensive and multifaceted evaluation of policy pilots

‘Success’ in policy piloting: process, programmes and politics

Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgement against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing programme success from process and political success. We adapt Boven's modification of this framework and apply it to policy pilots, arguing that pilot process, outcomes and longer term effects can all be judged in both programme and political terms. We test this new framework in a pilot programme in the English National Health Service, the Vanguard programme, showing how consideration of these different aspects of success sheds light on the programme and its aftermath. We consider the implications of the framework for the comprehensive and multi-faceted evaluation of policy pilots

The Impact of Occupational Therapy on the Self‐Management of Rheumatoid Arthritis: A Mixed Methods Systematic Review

Objective: To determine the impact of occupational therapy (OT) on the self‐management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). Methods: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE‐ Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. Results: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long‐term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self‐management for fatigue. Conclusion: Although patient education is promising for self‐managing RA, no strong evidence was found to support OT programs for self‐managing fatigue or patient experience and long‐term effectiveness. More research is required on lived experience, and the long‐term efficacy of self‐management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date