Angus McFadyen

The Readiness for interprofessional learning scale: A possible more stable sub-scale model for the original version of RIPLS

The original version of the Readiness for Interprofessional Learning Scale (RIPLS) was published by Parsell and Bligh ([8]). Three sub-scales with acceptable or high internal consistencies were suggested, however two publications suggested different sub-scales. An investigation into how to improve the reliability for use of the RIPLS instrument with undergraduate health-care students commenced. Content analysis on the original 19 items involving experienced health-care staff resulted in four sub-scales. These sub-scales were then used to formulate a possible model within a structural equation model. The goodness of fit was assessed using a sample (n = 308) of new first year undergraduate students from 8 different health and social care programmes. The same data was fitted to each of the two original sub-scale models suggested by Parsell and Bligh ([8]) and the results compared. The fit of the new four sub-scale model appears superior to either of the original models. The new four factor model was then tested on subsequent data (n = 247) obtained from the same students at the end of their first year. The fit was seen to be even better at the end of the academic year.

Dry Eye Diagnosis

PURPOSE To determine the most effective objective tests, applied singly or in combination in the diagnosis of dry eye disease. METHODS Two groups of subjects--41 with dry eye and 32 with no ocular surface disease--had symptoms, tear film quality, evaporation, tear turnover rate (TTR), volume and osmolarity, and meibomian gland dropout score assessed. RESULTS The subjects with dry eye had TTR, tear evaporation, and osmolarity significantly different from that of healthy normal subjects. Cutoff values between the groups were determined from distribution curves for each aspect of tear physiology, and the effectiveness of the cutoff was determined from receiver operator characteristic (ROC) curves. Values of 12%/min for TTR, 33 g/m(-2)/h for evaporation, and 317 mOsmol/L for osmolarity were found to give sensitivities, specificities, and overall accuracies of 80%, 72%, and 77%; 51%, 96%, and 67%; and 78, 78%, and 79%, respectively when applied singly as diagnostic criteria in dry eye. In combination, they yielded sensitivities, specificities, and overall accuracy of 100%, 66%, and 86% (in parallel) and 38%, 100%, and 63% (in series), respectively. Discriminant function analysis incorporating these three factors in an equation allowed diagnosis with a sensitivity of 93%, specificity of 88%, and overall accuracy of 89%. CONCLUSIONS Tear osmolarity is the best single test for the diagnosis of dry eye, whereas a battery of tests employing a weighted comparison of TTR, evaporation, and osmolarity measurements derived from discriminant function analysis is the most effective.

A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39

Abstract Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.

The Interdisciplinary Education Perception Scale (IEPS): An alternative remodelled sub-scale structure and its reliability

The original 4 sub-scale version of the Interdisciplinary Education Perception Scale (IEPS) was published by Luecht et al. ([15], Journal of Allied Health, 181 – 191). There appears however to be a lack of evidence of the stability of the original instrument and of the test-retest reliability of the items and sub-scales when used with undergraduates. Given that during its development only 143 subjects completed the questionnaire which contained 18 items the generalizability of the instrument should perhaps have been investigated further. The Interprofessional Learning Group (IPL) at Glasgow Caledonian University has been using both the IEPS and the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, [19], Medical Education, 33, 95 – 100) to monitor changes in attitudes and perceptions of undergraduate students from eight different health and social care programmes. This paper reports the development of an alternative sub-scale model for the IEPS based on a sample of 308 students. Various aspects of the reliability of this revised model based on a subsequent data set of 247 students are also reported. This revised model appears to be stable for use with undergraduate students yielding Cronbach Alpha values for two of the sub-scales greater than 0.80 and test-retest weighted kappa values for items being fair to moderate.

The test-retest reliability of a revised version of the Readiness for Interprofessional Learning Scale (RIPLS)

The original version of the Readiness for Interprofessional Learning Scale (RIPLS) was published by Parsell and Bligh in [16]. The only aspect of reliability considered by the authors was the internal consistency. A revised version for use with undergraduate students was published in 2005 (McFadyen et al., [14]). That paper also reported internal consistency of the revised version. Subsequently a sample from one professional group (n = 65) was used to assess test-retest reliability, over a one week period, of each of the 19 items and of the sub-scale totals, using Weighted Kappa and the intra-class correlation (ICC) respectively, and these results are reported in the present paper. The test-retest reliability of the individual items using Weighted Kappa was satisfactory, with the exception of two items (Items 11 and 12). The ICC results for the sub-scale totals were all in excess of 0.60 with the exception of sub-scale two. This revised version of RIPLS would appear to have good reliability in three of its sub-scales but further research, with larger samples, is required before the fourth sub-scale can be reliably assessed.

Determination of Amoebicidal Activities of Multipurpose Contact Lens Solutions by Using a Most Probable Number Enumeration Technique

ABSTRACT Six multipurpose contact lens solutions [All-in-One, All-in-One (Light), ReNu MultiPlus, Optifree Express, Complete, and Solo-care soft] were tested for their efficacies against Acanthamoeba castellanii trophozoites and cysts by using a most probable number (MPN) technique for amoebic enumeration. Against trophozoites, All-in-One, ReNu Multiplus, and Optifree Express achieved total kill (log reduction of >3) after the manufacturers minimum recommended disinfection time (MMRDT), with the remaining solutions failing to reach a log reduction of 1. After 24 h of exposure, all solutions proved trophozoiticidal, achieving, with the exception of Complete (log reduction of 3.13), total kill. Against cysts, All-in-One gave a log reduction of >3 within the MMRDT, with all other solutions failing to achieve a log reduction of 1. After 24 h of exposure, All-in-One achieved total kill of cysts (log reduction of 3.74), ReNu MultiPlus gave a log reduction of 3.15, and the remaining solutions reached log reductions of between 1.09 and 2.27. The MPN technique provides a simple, reliable, and reproducible method of amoebic enumeration that depends on simply establishing the presence or absence of growth on culture plates inoculated with a series of dilutions and determining the MPN of amoebae present from statistical tables. By use of this technique, two of the multipurpose solutions tested, ReNu MultiPlus and Optifree Express, demonstrated effective trophozoiticidal activities within the recommended disinfection times; however, only All-in-One proved effective against both trophozoites and cysts over the same time period. This MPN technique, which uses axenically produced trophozoites and mature, double-walled cysts, has the potential to form the basis of a national standard for amoebicidal efficacy testing of multipurpose contact lens disinfecting solutions.

The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study

Objective: To establish the effects of a 12-week, community-based group exercise intervention for people moderately affected with multiple sclerosis. Design: Randomized controlled pilot trial. Setting: Two community leisure centres. Participants: Thirty-two participants with multiple sclerosis randomized into intervention or control groups. Intervention: The intervention group received 12 weeks of twice weekly, 60-minute group exercise sessions, including mobility, balance and resistance exercises. The control group received usual care. Main outcome measures: An assessor blinded to group allocation assessed participants at baseline, after eight weeks and after 12 weeks. The primary outcome measure was 25-foot (7.6 m) walk time, secondary outcomes assessed walking endurance, balance, physical function, leg strength, body mass index, activity levels, fatigue, anxiety and depression, quality of life and goal attainment. Results: The intervention made no statistically significant difference to the results of participants’ 25-foot walk time. However the intervention led to many improvements. In the intervention group levels of physical activity improved statistically between baseline and week 8 (P < 0.001) and baseline and week 12 (P = 0.005). Balance confidence results showed a significant difference between baseline and week 12 (P = 0.013). Good effect sizes were found for dynamic balance (d = 0.80), leg strength (d = 1.33), activity levels (d = 1.05) and perceived balance (d = 0.94). Conclusion: The results of the study suggest that community-based group exercise classes are a feasible option for people moderately affected with multiple sclerosis, and offer benefits such as improved physical activity levels, balance and leg strength.

Interprofessional attitudes and perceptions: Results from a longitudinal controlled trial of pre-registration health and social care students in Scotland.

This study made use of a controlled longitudinal design to assess the impact on pre-registration health and social care students of an interprofessional intervention on the attitudes to and perceptions of interprofessional ideals. Evaluation, over four years, of Nursing, Occupational Therapy, Podiatry, Prosthetics and Orthotics, Physiotherapy and Radiography students was performed using the adapted versions of the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). Baseline samples of the control and experimental groups were 260 and 313 respectively. Support for Interprofessional Education (IPE) appears high but possibly idealistically so initially. Restricted Maximum Likelihood (REML) models were used to assess intervention effects as well as any possible profession or time effects. The intervention was found to have had a significant effect on five of the measured sub-scales and the professions were found to react in a significantly different way on four of the sub-scales. The inclusion of a control group has confirmed previous findings from other studies but also highlights the possible effects of the general learning and teaching methodologies employed within various professions as well as the need for research into the influence of the timing, duration, style and content of clinical placement periods.

Inputs and Outputs of the Lacrimal system: Review of Production and Evaporative Loss

Meta-analyses were carried out of studies of tear production (by fluorophotometry, tear turnover rate[TTR]) and evaporation (from capture of fluid loss from the eye). TTR was reduced in dry eye relative to normal at 9.26 +/- 5.08%/min (0.54 +/- 0.28 μl/min) vs 16.19 +/- 5.1%/min (1.03 +/- 0.39 μl/min); with values of 7.71 +/- 1.02 %/min (0.4 +/- 0.10 μl/min) in aqueous deficiency dry eye (ADDE) and 11.95 +/- 4.25%/min (0.71 +/- 0.25 l/min) in evaporative dry eye (EDE). Evaporation was increased in dry eye at 21.05 +/- 13.96 x 10(-7)g/cm(2)/s (0.21 +/- 0.13 μl/min) vs 13.57 +/- 6.52 x 10(-7)g/cm(2)/s (0.14 +/- 0.07 μl/min) in normals; with values of 17.91 +/- 10.49 x 10(-7)g/cm(2)/s (0.17 +/- 0.1 μl/min) in ADDE and 25.34 +/- 13.08 x 10(-7)g/cm(2)/s (0.26 +/- 0.16 μl/min) in EDE. Evaporation rate from tear film thinning was also considered, and possible reasons and consequences for the much higher rates thereby reported are discussed. A new statistical approach determined diagnostic efficacy of cut-offs for dry eye derived from the meta-analyses; sensitivities and specifications ranging from 69.5 to 98.6% and 58.7 to 96.8% (TTR) and 45.5 to 61.2% and 79.8 to 90.6% (evaporation). Indices of tear dynamics were reconsidered, and ratios of evaporation and TTR suggest that an increase of between 2 and 3 times may be associated with dry eye.

Physical activity and quality of life: A study of a lower-limb amputee population:

This cross-sectional descriptive study was initiated to investigate the relationship between physical activity and perceived quality of life in a lower-limb amputee population. The objective was to show which aspects of physical activity were most strongly linked to quality-of-life factors in this special patient group. The outcome measurements were two questionnaires: a section of the Trinity Amputation and Prosthetic Experience Scales (TAPES) and the World Health Organization Quality-of-Life Scale (WHOQOL-Bref). The former measures activity restriction and has Athletic, Functional, and Social subscales. The latter includes Physical, Psychological, Social, and Environmental domains, and measures the individuals perception of their quality of life. The two questionnaires were sent by post to 75 male and female participants with either trans-tibial or trans-femoral amputation who were receiving prosthetic care from a Glasgow-based rehabilitation and mobility centre and who met the inclusion criteria. All participants were over 18 years of age (mean age 66 years). In total, 25 participants returned the questionnaires—a response rate of 33%. According to analysis, 8 of the 12 relationships found were statistically significant. There was a very strong correlation between scores on the social elements of each questionnaire. The correlations between scores on the functional and athletic elements of the TAPES questionnaire and scores on the social element of the WHOQOL-Bref questionnaire were less strong. Our findings support the need for greater acknowledgement by healthcare professionals involved in the care of those with amputation about the importance of the patients social relationships with friends and family. Education about the importance of increasing and maintaining a level of physical activity conducive to health benefits should be implemented within a supportive sociable environment for the patient with lower-limb amputation.