Tools for faculty assessment of interdisciplinary competencies of healthcare students: an integrative review

Increasingly, interprofessional teamwork is required for the effective delivery of public health services in primary healthcare settings. Interprofessional competencies should therefore be incorporated within all health and social service education programs. Educational innovation in the development of student-led clinics (SLC) provides a unique opportunity to assess and develop such competencies. However, a suitable assessment tool is needed to appropriately assess student progression and the successful acquisition of competencies. This study adopts an integrative review methodology to locate and review existing tools utilized by teaching faculty in the assessment of interprofessional competencies in pre-licensure healthcare students. A limited number of suitable assessment tools have been reported in the literature, as highlighted by the small number of studies included. Findings identify use of existing scales such as the Interprofessional Socialization and Valuing Scale (ISVS) and the McMaster Ottawa Scale with Team Observed Structured Clinical Encounter (TOSCE) tools plus a range of other approaches, including qualitative interviews and escape rooms. Further research and consensus are needed for the development of teaching and assessment tools appropriate for healthcare students. This is particularly important in the context of interprofessional, community-partnered public health and primary healthcare SLC learning but will be of relevance to health students in a broad range of clinical learning contexts

Identification, assessment and management of mood disorders in clients by osteopathic practitioners in New Zealand

Background: Mood disorder with its high global prevalence rate is a major public health issue imposing a considerable burden on the community. Early detection and intervention of mood disorders in the primary care setting can help prevent the progression of illness. An osteopath, being a primary care practitioner, may play an important role in early identification and appropriate management of clients with mood disorders. Objectives: Exploration and description of how osteopaths (in New Zealand): 1. Identify mood disorders in clients, 2. Assess mood disorders in clients, and 3. Manage mood disorders in clients. 4. Exploration and description of previous education osteopathic practitioners have had previously of psychological issues such as mood disorders, and 5. Identification of further education needs. Methods: The present study was done using a descriptive/explorative survey design combining quantitative and qualitative methods for data collection and analyses. A total of 216 New Zealand registered osteopaths whose email addresses were publicly available were invited to complete the online survey. Descriptive and inferential analytical techniques were used to analyse the quantitative data. Qualitative data were analysed thematically. Results: Out of 216 participants invited to participate in the study, 62 (29%) completed the survey. The preferred assessment tools include questioning the clients, tissue palpation and cranial rhythm, with least preference for mood disorder questionnaires. However, there exists a clinical dilemma among osteopathic practitioners in managing clients with mood disorders. A majority of the practitioners reported of having had no specific education content regarding mood disorders and felt that further education in this regard would be of value to their practice. Conclusion: Osteopathic practitioners in New Zealand who participated in the present study reported that they ‘often’ come across clients with a history of mood disorders. With an apparent lack of specific education in identifying, assessing and managing clients with mood disorders, a clinical dilemma seems to exist among practitioners with regard to treating clients with mood disorders. Given that osteopaths are primary care practitioners, the perceived gap in education may impact on their ability to identify, assess and manage clients with mood disorders. Hence further knowledge and education with regard to mood disorders is recommended

Neuro-endocrine and Sympathetic Influences of Thoracic Spinal Manipulation – A Mechanistic Study

Thoracic spinal manipulation (SM) is a routinely used intervention in clinical practice. While the clinical benefits of SM have been well established, the exact mechanism through which SM results in clinical benefits has been of research interest. A narrative review of literature indicated that SM has an influence at the peripheral, spinal and supraspinal levels, including the autonomic nervous system (ANS), especially the sympathetic nervous system (SNS) and the endocrine system. Hence, a hypothesis was proposed that a thoracic SM would result in neuro-endocrinal changes. Keeping in mind the breadth of the literature, two systematic reviews were undertaken to determine the effects of SM on the (1) ANS and (2) biochemical markers. The first systematic review (5 studies) found support for a differential ANS response based on the region manipulated and moderate level evidence was established that a thoracic SM results in SNS response. The second review with meta-analysis (8 studies) established moderate level evidence in favour of SM in influencing various biochemical markers such as substance-P, neurotensin, cortisol and oxytocin. Based on the review (narrative and systematic) findings, a parallel group randomised controlled trial (RCT) was designed to investigate the neuroendocrine changes following a thoracic SM in healthy men. Near infrared spectroscopy (NIRS) parameters such as oxy-haemoglobin and tissue oxygenation index (TOI) were used as an index of SNS activity, heart rate variability (HRV) was used as an index of ANS activity, and salivary testosterone to cortisol (T/C) ratio was used as an index of HP axis activity. The findings from the study indicated that a thoracic SM has an effect on HPA axis activity as indicated by changes in salivary cortisol immediately and T/C ratio many hours following SM. A pattern of sympathetic response in the thoracic SM group was also noted. These findings provided important support to the hypothesis as noted in changes in the T/C ratio and NIRS parameters. A major strength was that there were no missing data or attrition of participants. A logical next step was to follow-up with a trial in symptomatic population. Achilles tendinopathy (AT) is a chronic condition in which the involvement of the neuroendocrine system has been established in its pathogenesis. Further, the anatomical location of the Achilles tendon and the prevalence of AT made it a suitable model to investigate the neuroendocrine effects of thoracic SM. Though the methodology of the pilot RCT was successful, a few methodological changes were necessary for Trial-2, such as (1) study design (cross-over study design); (2) Sample population (inclusion of both males and females); and (3) additional NIRS probe on Achilles tendon (measurement of tissue oxygenation of the Achilles tendon as well as calf muscle). The findings support the hypothesis that a thoracic SM results in changes in the neuro-endocrine system in people with AT. These changes were evident in the T/C ratio, salivary testosterone and TOI of the calf muscle. However, no changes were evident for salivary cortisol or HRV values or TOI of a tissue field that incorporated the tendon. This thesis adds to the knowledge around the mechanisms of SM. This may have important implications for manual therapy practice. The findings from the thesis have generated numerous questions which may be of interest of future studies

Neuro-endocrine and Sympathetic Influences of Thoracic Spinal Manipulation – A Mechanistic Study

Thoracic spinal manipulation (SM) is a routinely used intervention in clinical practice. While the clinical benefits of SM have been well established, the exact mechanism through which SM results in clinical benefits has been of research interest. A narrative review of literature indicated that SM has an influence at the peripheral, spinal and supraspinal levels, including the autonomic nervous system (ANS), especially the sympathetic nervous system (SNS) and the endocrine system. Hence, a hypothesis was proposed that a thoracic SM would result in neuro-endocrinal changes. Keeping in mind the breadth of the literature, two systematic reviews were undertaken to determine the effects of SM on the (1) ANS and (2) biochemical markers. The first systematic review (5 studies) found support for a differential ANS response based on the region manipulated and moderate level evidence was established that a thoracic SM results in SNS response. The second review with meta-analysis (8 studies) established moderate level evidence in favour of SM in influencing various biochemical markers such as substance-P, neurotensin, cortisol and oxytocin. Based on the review (narrative and systematic) findings, a parallel group randomised controlled trial (RCT) was designed to investigate the neuroendocrine changes following a thoracic SM in healthy men. Near infrared spectroscopy (NIRS) parameters such as oxy-haemoglobin and tissue oxygenation index (TOI) were used as an index of SNS activity, heart rate variability (HRV) was used as an index of ANS activity, and salivary testosterone to cortisol (T/C) ratio was used as an index of HP axis activity. The findings from the study indicated that a thoracic SM has an effect on HPA axis activity as indicated by changes in salivary cortisol immediately and T/C ratio many hours following SM. A pattern of sympathetic response in the thoracic SM group was also noted. These findings provided important support to the hypothesis as noted in changes in the T/C ratio and NIRS parameters. A major strength was that there were no missing data or attrition of participants. A logical next step was to follow-up with a trial in symptomatic population. Achilles tendinopathy (AT) is a chronic condition in which the involvement of the neuroendocrine system has been established in its pathogenesis. Further, the anatomical location of the Achilles tendon and the prevalence of AT made it a suitable model to investigate the neuroendocrine effects of thoracic SM. Though the methodology of the pilot RCT was successful, a few methodological changes were necessary for Trial-2, such as (1) study design (cross-over study design); (2) Sample population (inclusion of both males and females); and (3) additional NIRS probe on Achilles tendon (measurement of tissue oxygenation of the Achilles tendon as well as calf muscle). The findings support the hypothesis that a thoracic SM results in changes in the neuro-endocrine system in people with AT. These changes were evident in the T/C ratio, salivary testosterone and TOI of the calf muscle. However, no changes were evident for salivary cortisol or HRV values or TOI of a tissue field that incorporated the tendon. This thesis adds to the knowledge around the mechanisms of SM. This may have important implications for manual therapy practice. The findings from the thesis have generated numerous questions which may be of interest of future studies

The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis

Objective: A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. Data resources: MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. Trial selection: Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. Data extraction: Data extraction was conducted by two independent reviewers and the Cochrane Collaboration’s recommended method was used to assess the risk of bias of each included study. Results: A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I2 = 68%) (eight to 12 weeks’ duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. Conclusion: Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis

Data_Sheet_1_Exploring the option of student-run free health clinics to support people living with type 2 diabetes mellitus: a scoping review.PDF

Diabetes is a major cause of morbidity and premature mortality worldwide and now identified as a ‘public health emergency’ and a ‘modern and preventable pandemic’. Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. Student run free clinics (SRFCs) may play an important role in the prevention and management of T2DM. The primary objective of this scoping review was to investigate the opportunity for curriculum enhancement through the role and effectiveness of SRFCs in managing T2DM. Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to October 2022. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. The research team collectively created a data charting table/form to standardize data collection. A narrative synthesis was used to summarize the evidence. Six studies (total of 319 participants) that met our eligibility criteria were included in this scoping review. SRFCs can provide high-quality diabetic care, especially for uninsured and economically weaker population. Preliminary evidence further indicate that shared medical appointments and telehealth may facilitate diabetic care especially during times where access to care may be difficult (e.g., COVID lockdown). However, no study included in the review explored or discussed family centred/culturally sensitive interventions. Hence, such interventions should be made part of the curriculum in the future with students in SRFCs exposed to such an approach.</p

Data_Sheet_2_Exploring the option of student-run free health clinics to support people living with type 2 diabetes mellitus: a scoping review.PDF

Diabetes is a major cause of morbidity and premature mortality worldwide and now identified as a ‘public health emergency’ and a ‘modern and preventable pandemic’. Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. Student run free clinics (SRFCs) may play an important role in the prevention and management of T2DM. The primary objective of this scoping review was to investigate the opportunity for curriculum enhancement through the role and effectiveness of SRFCs in managing T2DM. Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to October 2022. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. The research team collectively created a data charting table/form to standardize data collection. A narrative synthesis was used to summarize the evidence. Six studies (total of 319 participants) that met our eligibility criteria were included in this scoping review. SRFCs can provide high-quality diabetic care, especially for uninsured and economically weaker population. Preliminary evidence further indicate that shared medical appointments and telehealth may facilitate diabetic care especially during times where access to care may be difficult (e.g., COVID lockdown). However, no study included in the review explored or discussed family centred/culturally sensitive interventions. Hence, such interventions should be made part of the curriculum in the future with students in SRFCs exposed to such an approach.</p