Workplace-based learning for undergraduate and pre-registration healthcare professionals: A systematic map of the UK research literature 2003-2013

What do we want to know? What is the nature of the research on workplace-based learning for undergraduate and pre-registration healthcare professionals in the UK? How many studies are there and what do they focus on? Who wants to know? The map was funded by the Higher Education Academy, UCL Institute of Education, University College London, and the Association for the Study of Medical Education. Workplace based learning is a key component of healthcare professionals education and training and is therefore a key concern of educators, professional bodies, professional regulators, the NHS and Health Education England. What did we find? We identified 117 UK studies about workplace-based learning for undergraduate/pre-registration healthcare students published between 2003 and 2013. The majority of studies (n = 111) focused on students views or experiences of workplace-based learning. Very few studies (n= 6) investigated the impacts of workplace-based learning (using quantitative measurements of change in student attitudes, knowledge or skill). There were no studies that measured impacts on organisational practice or patient/client outcomes. The highest number of studies focused on nursing students in workplace- based learning (n = 52) and there were relatively fewer studies examining students in medicine (n = 13), dentistry (n = 11) and midwifery (n = 10). Studies of workplace-based learning for students of the allied health professions were also limited in number (e.g. four physiotherapy studies). Eighteen studies focused on workplace-based learning in an inter-professional context. The majority of studies used qualitative data collected using questionnaires and interviews. What are the conclusions? This is the first report, to our knowledge, that systematically identifies and characterises empirical research literature from the UK on workplace-based learning for undergraduate and pre-registration students across multiple healthcare professions and settings. Based on the findings above, strategies for future research should include: Further research in the field of workplace-based learning for undergraduate and pre-registration healthcare professionals; More research that can measure the impact of workplace-based learning (using quantitative, independent outcome measures); In-depth systematic reviews of student or educator views of workplace-based learning in the healthcare professions; More research on workplace-based learning for healthcare professions other than nursing. How did we get these results? This project undertook a rapid systematic map. This approach employs systematic and transparent methods to describe the research field. The map included two main stages: A focused search and screening process to identify relevant literature. Two electronic databases and a selection of websites were searched for studies. A set of inclusion/exclusion criteria were developed in collaboration with the advisory group and used to screen potentially relevant reports. Descriptive narrative mapping of a subset of the relevant studies. A coding tool was developed and applied to all UK studies. This described key elements of the research: the healthcare students participating in the study, the nature of the workplace-based learning, the study methods and the type of findings. As in other systematic maps the actual research findings of individual studies are not reported

Clinical implementation of a knowledge based planning tool for prostate VMAT

Abstract Background A knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency. Methods A historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as “optimal” and “sub-optimal” by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly. Results Plans identified as “sub-optimal” in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as “optimal” observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed. Conclusions The knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data

Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use

Background: Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia. Methods: The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison. Results: Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03-4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32-4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14-5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73-11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18-0.77) was associated with decreased odds of willingness to participate in a prison THN training. Conclusion: Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period

Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention

Purpose: Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships. Methods: Interviews (n=24) and two focus groups (n=13) were conducted as part of a process evaluation and included purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data. Results: Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention. Conclusion: Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used, in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured

Solid Friction from stick-slip to pinning and aging

We review the present state of understanding of solid friction at low velocities and for systems with negligibly small wear effects. We first analyze in detail the behavior of friction at interfaces between wacroscopic hard rough solids, whose main dynamical features are well described by the Rice-Ruina rate and state dependent constitutive law. We show that it results from two combined effects : (i) the threshold rheology of nanometer-thick junctions jammed under confinement into a soft glassy structure (ii) geometric aging, i.e. slow growth of the real arrea of contact via asperity creep interrupted by sliding. Closer analysis leads to identifying a second aging-rejuvenation process, at work within the junctions themselves. We compare the effects of structural aging at such multicontact, very highly confined, interfaces with those met under different confinement levels, namely boundary lubricated contacts and extended adhesive interfaces involving soft materials (hydrogels, elastomers). This leads us to propose a classification of frictional junctions in terms of the relative importance of jamming and adsoprtion-induced metastability.Comment: 28 page

The State of Research on Racial and Ethnic Discrimination in the Receipt of Health Care

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.30077

Incidence, severity, aetiology and type of neck injury in men's amateur rugby union: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>There is a paucity of epidemiological data on neck injury in amateur rugby union populations. The objective of this study was to determine the incidence, severity, aetiology and type of neck injury in Australian men's amateur rugby union.</p> <p>Methods</p> <p>Data was collected from a cohort of 262 participants from two Australian amateur men's rugby union clubs via a prospective cohort study design. A modified version of the Rugby Union Injury Report Form for Games and Training was used by the clubs physiotherapist or chiropractor in data collection.</p> <p>Results</p> <p>The participants sustained 90 (eight recurrent) neck injuries. Exposure time was calculated at 31143.8 hours of play (12863.8 hours of match time and 18280 hours of training). Incidence of neck injury was 2.9 injuries/1000 player-hours (95%CI: 2.3, 3.6). As a consequence 69.3% neck injuries were minor, 17% mild, 6.8% moderate and 6.8% severe. Neck compression was the most frequent aetiology and was weakly associated with severity. Cervical facet injury was the most frequent neck injury type.</p> <p>Conclusions</p> <p>This is the first prospective cohort study in an amateur men's rugby union population since the inception of professionalism that presents injury rate, severity, aetiology and injury type data for neck injury. Current epidemiological data should be sought when evaluating the risks associated with rugby union football.</p