5 research outputs found

    A Contestable Professional Development Fund: Interpretations of the Applicant Experience

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    This research was undertaken to understand health workers lived experience of applying for contestable professional development funding in the health sector. It responds to the World Health Organizations’ (WHO) call for further inquiry into professional development funding (WHO, 2013). In this thesis, the literature on the landscape of professional development in Aotearoa New Zealand is considered in relation to the investment in national health workforce development. A comparison with global averages is explored as the background to barriers and enablers to health workers participation in professional development. Financial matters emerge as a significant and consistent barrier to engagement. The thesis research consists of a qualitative study using Interpretative Phenomenological Analysis with an existential phenomenological lens. It is idiographic, making meaning of the lived experience of staff at Waitemata District Health Board in Auckland, New Zealand, as they apply to the organisation’s Professional Development Fund (PDF). The study also explores views of the PDF as a system in the specific context, and the outcomes of the PDF on staff engagement and career development. Consistent with Interpretative Phenomenological Analysis, the research was carried out with an insider view of the organisation since the researcher is a staff member of the District Health Board, an eligible applicant to the fund and a past PDF committee member. This has assisted in a double interpretation, making meaning of the participants’ meaning-making, and in seeing more clearly the practical and theoretical implications of the research findings. The study findings provide insight into workplace attitudes and behaviours towards contestable funding, the particular impact on lives at work and at home, the professional aspirations of adult learners, and the tension between professional expectations and financial limitations. An interesting outcome of this research is the importance of usability in electronic application processes, particularly the need for clarity, time efficiency and a focus on the user experience. Crucially, the findings emphasise the importance of investment in health workers’ professional development and support the re-orientation of funding prioritisation towards the needs of workers. Although participants acknowledged the constrained financial landscape in the public sector, they identified the investment in continued professional development as critical for their career progression and satisfaction. Ultimately it seems that prioritising the needs of staff improves worker morale and wellbeing, in turn contributing to organisational success. Although the PDF is contextually specific, it is one example of typical contestable funding mechanisms accessed for activities such as professional development and performance-based research. This means the findings have implications across workforce development in both health and academia, and can offer insight to inform the development or review of similar funding mechanisms

    Health Workforce Planning: an urgent need to link islands of expertise

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    This article provides a snapshot of the legislative framework for, and ministries and agencies involved in or with influence over, theeducation of the health and disability workforce, including examples of disconnection between the wider health and education sectors.Particular challenges occur between health professional regulators, education providers and clinical (placement) providers because their respective areas of expertise tend to be siloed, thus reducing the capacity for a coordinated and holistic perspective. Four potential ‘bridges’ for linking these ‘islands’ of expertise are suggested. The current period of institutional reforms in the health and education sectors presents an opportunity to refine the structures and systems for workforce education and planning, thereby facilitating a more flexible, responsive and resilient workforce which is better equipped to engage with, and improve outcomes for, the wider community

    Clinical Features and HLA Association of 5-Aminosalicylate (5-ASA)-induced Nephrotoxicity in Inflammatory Bowel Disease.

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    BACKGROUND AND AIMS: Nephrotoxicity is a rare idiosyncratic reaction to 5-aminosalicylate (5-ASA) therapies. The aims of this study were to describe the clinical features of this complication and identify clinically useful genetic markers so that these drugs can be avoided or so that monitoring can be intensified in high-risk patients. METHODS: Inflammatory bowel disease patients were recruited from 89 sites around the world. Inclusion criteria included normal renal function prior to commencing 5-ASA, ≥50% rise in creatinine any time after starting 5-ASA, and physician opinion implicating 5-ASA strong enough to justify drug withdrawal. An adjudication panel identified definite and probable cases from structured case report forms. A genome-wide association study was then undertaken with these cases and 4109 disease controls. RESULTS: After adjudication, 151 cases of 5-ASA-induced nephrotoxicity were identified. Sixty-eight percent of cases were males, with nephrotoxicity occurring at a median age of 39.4 years (range 6-79 years). The median time for development of renal injury after commencing 5-ASA was 3.0 years (95% confidence interval [CI] 2.3-3.7). Only 30% of cases recovered completely after drug withdrawal, with 15 patients requiring permanent renal replacement therapy. A genome-wide association study identified a suggestive association in the HLA region (p = 1×10(-7)) with 5-ASA-induced nephrotoxicity. A sub-group analysis of patients who had a renal biopsy demonstrating interstitial nephritis (n = 55) significantly strengthened this association (p = 4×10(-9), odds ratio 3.1). CONCLUSIONS: This is the largest and most detailed study of 5-ASA-induced nephrotoxicity to date. It highlights the morbidity associated with this condition and identifies for the first time a significant genetic predisposition to drug-induced renal injury
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