Conor Gilligan

A systematic review of the effectiveness of interprofessional education in health professional programs

OBJECTIVE The objective of this systematic review was to identify the best available evidence for the effectiveness of university-based interprofessional education for health students. BACKGROUND Currently, most health professional education is delivered in a traditional, discipline specific way. This approach is limited in its ability to equip graduates with the necessary knowledge, skills and attitudes for effective interprofessional collaboration and for working as part of a complex health care team. Interprofessional education is widely seen as a way to improve communication between health professionals, ultimately leading to improved patient outcomes. INCLUSION CRITERIA The review included all randomised controlled trials and quasi-experimental studies in which two or more undergraduate or post-graduate health professional groups are engaged in interprofessional education. REVIEW METHODS A three-stage comprehensive search of ten electronic databases as well as grey literature was conducted. Two independent reviewers assessed each paper prior to inclusion using the standardised critical appraisal instruments for evidence of effectiveness developed by the Joanna Briggs Institute. RESULTS Nine published studies consisting of three randomised controlled trials, five controlled before and after studies and one controlled longitudinal study were included in the review. CONCLUSION Students attitudes and perceptions towards interprofessional collaboration and clinical decision-making can be potentially enhanced through interprofessional education. However, the evidence for using interprofessional education to teach communication skills and clinical skills is inconclusive and requires further investigation. IMPLICATIONS FOR RESEARCH Future randomised controlled studies explicitly focused on interprofessional education with rigorous randomisation procedures, allocation concealment, larger sample sizes, and control groups, would improve the evidence base for interprofessional education.

Sustained phosphorylation of tyrosine hydroxylase at serine 40: a novel mechanism for maintenance of catecholamine synthesis

Tyrosine hydroxylase (TH) is the rate‐limiting enzyme in catecholamine synthesis. Its activity is known to be controlled acutely (minutes) by phosphorylation and chronically (days) by protein synthesis. Using bovine adrenal chromaffin cells we found that nicotine, acting via nicotinic receptors, sustained the phosphorylation of TH at Ser40 for up to 48 h. Nicotine also induced sustained activation of TH, which for the first 24 h was completely independent of TH protein synthesis, and the phosphorylation of TH at Ser31. Imipramine did not inhibit the acute phosphorylation of TH at Ser40 or TH activation induced by nicotine, but did inhibit the sustained responses to nicotine seen at 24 h. The protein kinase(s) responsible for TH phosphorylation at Ser40 switched from being protein kinase C (PKC) independent in the acute phase to PKC dependent in the sustained phase. Sustained phosphorylation and activation of TH were also observed with histamine and angiotensin II. Sustained phosphorylation of TH at Ser40 provides a novel mechanism for increasing TH activity and this leads to increased catecholamine synthesis. Sustained phosphorylation of TH may be a selective target for drugs or pathology in neurons that contain TH and synthesize dopamine, noradrenaline or adrenaline.

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing, pharmacy and medical students in Australian and New Zealand Universities

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students.

Parent attitudes, family dynamics and adolescent drinking: qualitative study of the Australian parenting guidelines for adolescent alcohol use

BackgroundParents play a critical role in their children’s introduction to alcohol. A range of parenting factors have been associated with the progression to risky drinking among adolescents, and have recently formed the basis of the Australian ‘Parenting Guidelines for Adolescent Alcohol Use’ designed to help parents delay or reduce their adolescents’ alcohol use.MethodsThis study aimed to explore the experiences and attitudes of parents of adolescents to gain insight into: (1) the extent to which the behaviours of parents follow the recommendations made in the guidelines; and (2) approaches to reduce hazardous drinking among adolescents. Thirty-two telephone and face-to-face interviews were conducted with parents, and the content of discussions was examined using thematic analysis.ResultsParents used approaches they thought would minimise harm and promote healthy development in their children. The guidelines address key areas of concern for parents but their adherence to these approaches is low in certain areas. Many parents provided some alcohol to their adolescents and often cited the social norm of drinking among their adolescents’ peers as a source of pressure to supply.ConclusionsFurther dissemination of the guidelines may be the first step in a public health strategy, but it is likely that parents will require support to effectively adopt the recommendations. Understanding the influences on parents’ beliefs about their children’s drinking and the functions of social networks in the creation of behavioural norms relating to alcohol consumption and supply may be necessary to address adolescent risky drinking.

Adolescent drinking patterns across countries: associations with alcohol policies

Early consumption of full servings of alcohol and early experience of drunkenness have been linked with alcohol-related harmful effects in adolescence, as well as adult health and social problems. On the basis of secondary analysis of county-level prevalence data, the present study explored the current pattern of drinking and drunkenness among 15- and 16-year-old adolescents in 40 European and North American countries. Data from the 2006 Health Behavior in School Children survey and the European School Survey Project on Alcohol and other Drugs were used. The potential role of alcohol control and policy measures in explaining variance in drinking patterns across countries was also examined. Policy measures and data on adult consumption patterns were taken from the WHO Global Information System on Alcohol and Health, Eurostat and the indicator of alcohol control policy strength developed by Brand DA, Saisana M, Rynn LA et al. [(2007) Comparative analysis of alcohol control policies in 30 countries. PLoS Med 4:e151.]. We found that a non-significant trend existed whereby higher prices and stronger alcohol controls were associated with a lower proportion of weekly drinking but a higher proportion of drunkenness. It is important that future research explores the causal relationships between alcohol policy measures and alcohol consumption patterns to determine whether strict policies do in fact have any beneficial effect on drinking patterns, or rather, lead to rebellion and an increased prevalence of binge drinking.

Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation

INTRODUCTION AND AIMS A significant level of misreport or error occurs during questionnaire-based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participants inclination to under-report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self-reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined. DESIGN AND METHODS Women attending two Aboriginal Medical services in Far North Queensland for antenatal care were invited to participate. Women completed an interviewer assisted questionnaire relating to their smoking status and a 24 h diary of their exposure to nicotine and consumption of alcohol. Urine samples were analysed for cotinine using an Enzyme Linked Immunosorbent Assay. RESULTS Cotinine analysis indicated that 17% of women who reported that they were non-smokers were likely to have misreported this status, or be exposed to high levels of passive smoke. The only significant predictors of cotinine level were self-reported nicotine exposure (including passive smoke) and number of cigarettes smoked in the previous 24 h. Other individual and environmental variables had no significant influence on cotinine level using this analysis technique. DISCUSSION AND CONCLUSIONS The level of potential error in smoking assessment among this group was substantial. Exposure to environmental tobacco smoke might explain part of this error, but the reasons for misreport can only be speculated. This rate of misclassification should be taken into consideration in routine screening of antenatal women in primary health care.

Social Networking Versus Facebook Advertising to Recruit Survey Respondents: A Quasi-Experimental Study

Background Increasingly, social contact and knowledge of other people’s attitudes and behavior are mediated by online social media such as Facebook. The main research to which this recruitment study pertains investigates the influence of parents on adolescent alcohol consumption. Given the pervasiveness of online social media use, Facebook may be an effective means of recruitment and intervention delivery. Objective The objective of the study was to determine the efficacy of study recruitment via social networks versus paid advertising on Facebook. Methods We conducted a quasi-experimental sequential trial with response rate as the outcome, and estimates of cost-effectiveness. The target population was parents of 13-17 year old children attending high schools in the Hunter region of New South Wales, Australia. Recruitment occurred via: method (1) social recruitment using Facebook, email-based, social networks, and media coverage followed by method (2) Facebook advertising. Results Using a range of online and other social network approaches only: method (1) 74 parents were recruited to complete a survey over eight months, costing AUD58.70 per completed survey. After Facebook advertising: method (2) 204 parents completed the survey over four weeks, costing AUD5.94 per completed survey. Participants were representative of the parents recruited from the region’s schools using standard mail and email. Conclusions Facebook advertising is a cost-effective means of recruiting parents, a group difficult to reach by other methods.

Public support for alcohol policies associated with knowledge of cancer risk

BACKGROUND Several options are advocated by policy experts to mitigate alcohol-related harms, although the most effective strategies often have the least public support. While knowledge of tobacco-related health risks predicts support for relevant public health measures, it is not known whether knowledge of alcohol health risks is similarly associated with the acceptability of policies intended to reduce alcohol consumption and related harms. This study aims to gauge public support for a range of alcohol policies and to determine whether or not support is associated with knowledge of a long-term health risk of alcohol consumption, specifically cancer. METHODS 2482 adults in New South Wales (NSW), Australia, participated in an online survey. Logistic regression analysis was used to examine the association between demographic data, alcohol consumption, smoking status, knowledge of alcohol as a risk factor for cancer and support for alcohol-related policies. RESULTS Most participants were supportive of health warnings, restricting access to internet alcohol advertising to young people, and requiring information on national drinking guidelines on alcohol containers. Almost half of participants supported a ban on sport sponsorship, while less than 41% supported price increases, volumetric taxation, or reducing the number of retail outlets. Only 47% of participants identified drinking too much alcohol as a risk factor for cancer. Knowledge of alcohol as a risk factor for cancer was a significant predictor of support for all policies, while level of alcohol consumption had a significant inverse relationship with policy support. CONCLUSION The finding that support for alcohol management policies is associated with awareness that drinking too much alcohol may contribute to cancer could assist in the planning of future public health interventions. Improving awareness of the long term health risks of alcohol consumption may be one avenue to increasing public support for effective alcohol harm-reduction policies.

Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care

Abstract Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates’ experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients’ wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals’ behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.

Interprofessional education for the quality use of medicines: designing authentic multimedia learning resources.

It is claimed that health care students who learn together will be better prepared for contemporary practice and more able to work collaboratively and communicate effectively. In Australia, although recognised as important for preparing nursing, pharmacy and medical students for their roles in the medication team, interprofessional education is seldom used for teaching medication safety. This is despite evidence indicating that inadequate communication between health care professionals is the primary issue in the majority of medication errors. It is suggested that the pragmatic constraints inherent in university timetables, curricula and contexts limit opportunities for health professional students to learn collaboratively. Thus, there is a need for innovative approaches that will allow nursing, medical and pharmacy students to learn about and from other disciplines even when they do not have the opportunity to learn with them. This paper describes the development of authentic multimedia resources that allow for participative, interactive and engaging learning experiences based upon sound pedagogical principles. These resources provide opportunities for students to critically examine clinical scenarios where medication safety is, or has the potential to be compromised and to develop skills in interprofessional communication that will prepare them to manage these types of situations in clinical practice.