The value of Master’s Degree Programmes in Health Professions Education: a Scoping Review

Introduction: There are increasing numbers of Master’s Degree Programmes in Health Professions Education (MHPE) and the value to their students and graduates is not well understood. We conducted a scoping review to explore what is known about the value of MHPE programmes to their students and graduatesMethods: A scoping review was conducted using Arksey and O’Malley’s five-stage framework. PubMed, CINAHL, Cochrane, BEI, ERIC and EThOS databases were searched in addition to cited reference searching. Original research with an evaluation and published in the English language were included. Results: Nineteen studies were included. Studies were based in a variety of locations on five continents, and included in-person, distance and blended learning. Students and graduates of MHPE programmes self-reported development of their pedagogical knowledge, confidence and credibility in their role as an educator, and educational scholarship. Enhanced career opportunities and opportunities for collegial interactions and networks were also reported. Important barriers included struggling with the time and financial commitments required for studying on a MHPE programme. Conclusions: There are a variety of dimensions of value of MHPE programmes to their students and graduates. Important practical recommendations for MHPE programme providers and employers include providing opportunities for the development of networks, and support for the time and financial commitments required for studying. <br/

Biosocial and disease conditions are associated with good quality of life among older adults in rural eastern Nepal: Findings from a cross-sectional study

Background The ageing population in most low-and middle-income countries is accompanied by an increased risk of non-communicable diseases culminating in a poor quality of life (QOL). However, the factors accelerating this poor QOL have not been fully examined in Nepal. Therefore, this study examined the factors associated with the QOL of older adults residing in the rural setting of Nepal. Methods Data from a previous cross-sectional study conducted among older adults between January and April 2018 in in rural Nepal was used in this study. The analytical sample included 794 older adults aged ≥60 years, selected by a multi-stage cluster sampling approach. QOL was measured using the Older People’s Quality of Life tool; dichotomized as poor and good QOL. Other measures used included age, gender, ethnicity, religion, marital status, physical activity, and chronic diseases such as osteoarthritis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and depression. The factors associated with QOL were examined using mixed-effects logistic regression. Results Seven in ten respondents (70.4%) reported a poor QOL. At the bivariate level, increasing age, unemployment, intake of alcohol, lack of physical activity as well as osteoarthritis, COPD and depression were significantly associated with a lower likelihood of a good QOL. The adjusted model showed that older age (AOR = 0.50, 95% CI: 0.28–0.90), the Christian religion (AOR = 0.38, 95% CI: 0.20–0.70), and of an Indigenous (AOR: 0.25; 95% CI: 0.14–0.47), Dalit (AOR: 0.23; 95% CI: 0.10–0.56), and Madheshi (AOR: 0.29; 95% CI: 0.14–0.60) ethnic background were associated with lower odds of good QOL. However, higher income of >NRs 10,000 (AOR = 3.34, 95% CI: 1.43–3.99), daily physical activity (AOR: 3.33; 95% CI: 2.55–4.34), and the absence of osteoarthritis (AOR: 1.9; 95% CI: 1.09–3.49) and depression (AOR: 3.34; 95% CI: 2.14–5.22) were associated with higher odds of good QOL. Conclusion The findings of this study reinforce the need of improving QOL of older adults through implementing programs aimed at addressing the identified biosocial and disease conditions that catalyse poor QOL in this older population residing in rural parts of Nepal

CORK study in cystic fibrosis: sustained improvements in ultra-low-dose chest CT scores after CFTR modulation with ivacaftor

Background: Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of CFTR modulation on multiple modalities of patient assessment. Methods: Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. Results: Significant improvements in FEV1, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). Conclusions: Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota

Recognising cultural diversity in children's hospitals : managers, staff and families

This research examines how staff at two children's hospitals in metropolitan Sydney NSW negotiate cultural diversity with child patients and their families from culturally and linguistically diverse (CALD) backgrounds. It specifically investigates the impact of systemic constraints, health and multicultural policies and organisational, professional and individual cultures on the practice of hospital staff. In this research approach, the limitations of 'politics of recognition' theory are critically reviewed, as it focuses on difference and ethnic identity rather than on the way mainstream institutions can address disadvantage. The study involved hospital personnel across all levels and professional categories in a qualitative approach to analyse the discourses of working with cultural diversity. The approach consisted of structured surveys, in-depth interviews, focus groups and participant observation over a period of 22 months. This analysis was augmented by in-depth interviews with three multi-disciplinary health teams with responsibility for the care of children with chronic illness, within both hospitals. The interviews with hospital managers reveal that cultural diversity is peripheral to daily practice, as efficiency and evidence-based medicine are a priority. Mainstream Australian and western biomedical ways of working with patients and families are the norm, and systemic processes to identify and meet the needs of families from CALD backgrounds appear inadequate. There is also inadequate provision of institutional support for staff working with cultural diversity. One of the ways managers assist families from CALD backgrounds is through the use of culturally diverse staff; however, there is a lack of organisational systems in place to support the use of their skills. The way that doctors and nurses care for families demonstrates the effect of professional cultures of biomedicine and liberalism which operate to treat all families the same, and in an individualised way. These staff tried to accommodate cultural differences if, and when, they became unavoidable but in those situations they were reliant mostly on allied health staff. While staff lacked formal support, informal practices assisted staff in working with families from CALD backgrounds. Some managers and staff recognised the culturally different behaviour of families as normal for their background, applying a form of cultural relativism which made non-mainstream behaviour non-problematic. Allied health staff also recognised when families were disadvantaged in relation to the dominant institutional values and needed extra material support. My argument is that current health care practice for families from CALD backgrounds does not adequately take into consideration the broader social context of health care and multiculturalism in Australia, and this in turn influences the organisational and professional cultures of working with diversity, where cultural difference is outside mainstream health practice. Staff appeared to lack systemic support and this reduced their capacity to accommodate cultural diversity. They addressed inequities as an afterthought, rather than as core business of the organisation

Moving diversity from the periphery : diverse staff interactions in children's hospitals

Practices in health organisations in Australia predominantly reflect the Anglo-Australian mainstream culture, while the hospital workforce is typically culturally diverse. Management tends to view cultural diversity as peripheral to mainstream practice, and outside the core business of the health organisation. Staff from culturally and linguistically diverse (CALD) backgrounds are sometimes called upon ad hoc to 'deal with' families from CALD backgrounds, on the basis of their shared ethnicity. It would be preferable for management to develop policies and practices that ensure all staff have the cultural competency to work with all patients. In a research study at two children's hospitals in metropolitan Sydney (O'Callaghan 2013), interviews reveal that staff practices demonstrate a broader conception of diversity than might be expected, even though only some staff and patients share the same ethnicity. In many cases, staff draw successfully on their knowledge, skills and migration experience to assist families, even where the ethnicity of staff does not match the ethnicity of patients. The concepts of productive diversity and relational positioning help explain how staff members engage with diversity in the organisation. Productive diversity refers to the positive recognition of the diversity of staff in terms of "language skills, communication styles, international networks, country knowledge and life experience" (Cope and Kalantzis 1997, x). Relational positioning is based on the idea that identity is "situationally constructed and defined and at the crossroads of different systems of alterity" (Friedman 1998, 47). It is suggested that staff could relate to families using different parts of their identity and based on various axes of differentiation and oppression beyond ethnicity. The outcome would be a higher quality of care for all patients and greater staff satisfaction when treating patients

Mindfulness Program for Arabic Speaking Women: Arabic Mindfulness Intervention Phase 2

Arabic-speaking communities in Australia underutilise mental health services for many reasons including language and cultural barriers, preferring to rely on family and community for support. Mental health professionals have few Arabic-language clinical tools at their disposal and suitable self-management resources are lacking. Mindfulness-based interventions are an effective treatment for depression, anxiety and stress. Previous research conducted in south-east Sydney demonstrated that the Arabic Mindfulness CD was a clinically effective and culturally acceptable intervention. In that study, Arabic-speaking community members were recruited individually and were mostly long-term residents living within a well-established migrant community. Following those promising findings, it was decided to test the translated and culturally-tailored intervention in a group setting and in a different geographical location, specifically with newly-arrived Arabic-speaking women from refugee-like backgrounds. The Mindfulness Program for Arabic-Speaking Women was run at Illawarra Multicultural Services in Wollongong in the second half of 2016. The intervention comprised a 5-week group program with the CD used to support homework activities. The evaluation incorporated a pre-post study with a wait-list control group. Clinical outcomes were assessed using the Depression Anxiety and Stress Scale (DASS21) which was completed at baseline and post-program, together with a questionnaire assessing knowledge and attitudes toward mindfulness. Qualitative measures, including participant written and verbal comments, were used to assess cultural acceptability. A total of 20 women participated in two programs: 12 in the first (intervention) group and 8 in the second (wait-list control) group. Their countries of birth included Iraq, Lebanon, Syria and Libya. All were of Muslim faith. Over half had lived in Australia for less than four years. Most reported a history of war-related trauma

Translating Health Coaching Training into Clinical Practice

Health coaching can benefit people with managing chronic conditions. It considers people’s motivations, is person-centred and has the capacity to promote healthy lifestyles and address chronic disease risk factors. However, how health coaching training is translated into routine clinical practice at unit and service levels has been under explored. A metropolitan local health district in Sydney, Australia provided coaching training to health professionals, but the extent to which coaching skills were translated into clinical practice was unknown. A redesign methodology was used to identify barriers and facilitators for training-to-practice translation. Survey and workshop findings indicated that participants were satisfied with the coaching training but found it challenging to apply in clinical practice. Identified opportunities to support the application of health coaching were tailored practical training, post training support, and consensus on the definition of health coaching. Solutions were to develop an internal practical training program, use consistent terminology, and embed organisational support. Adoption of health coaching needs to occur on three levels; individual, workplace and organisation to ensure effective health care delivery. This case study demonstrates the importance of evaluation and diagnostics of contextual barriers and enablers to inform translation into practice

Biosocial and disease conditions are associated with good quality of life among older adults in rural eastern Nepal: Findings from a cross-sectional study.

BackgroundThe ageing population in most low-and middle-income countries is accompanied by an increased risk of non-communicable diseases culminating in a poor quality of life (QOL). However, the factors accelerating this poor QOL have not been fully examined in Nepal. Therefore, this study examined the factors associated with the QOL of older adults residing in the rural setting of Nepal.MethodsData from a previous cross-sectional study conducted among older adults between January and April 2018 in in rural Nepal was used in this study. The analytical sample included 794 older adults aged ≥60 years, selected by a multi-stage cluster sampling approach. QOL was measured using the Older People's Quality of Life tool; dichotomized as poor and good QOL. Other measures used included age, gender, ethnicity, religion, marital status, physical activity, and chronic diseases such as osteoarthritis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and depression. The factors associated with QOL were examined using mixed-effects logistic regression.ResultsSeven in ten respondents (70.4%) reported a poor QOL. At the bivariate level, increasing age, unemployment, intake of alcohol, lack of physical activity as well as osteoarthritis, COPD and depression were significantly associated with a lower likelihood of a good QOL. The adjusted model showed that older age (AOR = 0.50, 95% CI: 0.28-0.90), the Christian religion (AOR = 0.38, 95% CI: 0.20-0.70), and of an Indigenous (AOR: 0.25; 95% CI: 0.14-0.47), Dalit (AOR: 0.23; 95% CI: 0.10-0.56), and Madheshi (AOR: 0.29; 95% CI: 0.14-0.60) ethnic background were associated with lower odds of good QOL. However, higher income of >NRs 10,000 (AOR = 3.34, 95% CI: 1.43-3.99), daily physical activity (AOR: 3.33; 95% CI: 2.55-4.34), and the absence of osteoarthritis (AOR: 1.9; 95% CI: 1.09-3.49) and depression (AOR: 3.34; 95% CI: 2.14-5.22) were associated with higher odds of good QOL.ConclusionThe findings of this study reinforce the need of improving QOL of older adults through implementing programs aimed at addressing the identified biosocial and disease conditions that catalyse poor QOL in this older population residing in rural parts of Nepal