Process evaluation of a kindergarten-based intervention for obesity prevention in early childhood: the Toybox study Malaysia

BACKGROUND

Toybox is a kindergarten-based intervention program that targets sedentary behavior, snacking and drinking habits, as well as promoting physical activity in an effort to improve healthy energy balance-related behaviors among children attending kindergartens in Malaysia. The pilot of this program was conducted as a randomized controlled trial (RCT) involving 837 children from 22 intervention kindergartens and 26 control kindergartens respectively. This paper outlines the process evaluation of this intervention.

METHODS

We assessed five process indicators: recruitment, retention, dosage, fidelity, and satisfaction for the Toybox program. Data collection was conducted via teachers' monthly logbooks, post-intervention feedback through questionnaires, and focus group discussions (FGD) with teachers, parents, and children. Data were analyzed using quantitative and qualitative data analysis methods.

RESULTS

A total of 1072 children were invited. Out of the 1001 children whose parents consented to join, only 837 completed the program (Retention rate: 88.4%). As high as 91% of the 44 teachers and their assistants engaged positively in one or more of the process evaluation data collection methods. In terms of dosage and fidelity, 76% of parents had received newsletters, tip cards, and posters at the appropriate times. All teachers and their assistants felt satisfied with the intervention program. However, they also mentioned some barriers to its implementation, including the lack of suitable indoor environments to conduct activities and the need to make kangaroo stories more interesting to captivate the children's attention. As for parents, 88% of them were satisfied with the family-based activities and enjoyed them. They also felt that the materials provided were easy to understand and managed to improve their knowledge. Lastly, the children showed positive behaviors in consuming more water, fruits, and vegetables.

CONCLUSIONS

The Toybox program was deemed acceptable and feasible to implement by the parents and teachers. However, several factors need to be improved before it can be expanded and embedded as a routine practice across Malaysia.

Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education

BACKGROUND

Healthcare professionals are involved in an array of patient- and medicine-related stewardship activities, for which an understanding and engagement with antimicrobial stewardship (AMS) is important. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities.

AIM

To provide UK national consensus on a common set of antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education.

METHODS

A modified Delphi approach comprising two online surveys delivered to a UK national panel of 21 individuals reflecting expertise in prescribing and medicines management with regards to the education and practice of nurses and midwives, pharmacists, physiotherapists, and podiatrists; and antimicrobial prescribing and stewardship. Data collection took place between October and December 2017.

FINDINGS

A total of 21 participants agreed to become members of the expert panel, of whom 19 (90%) completed round 1 questionnaire, and 17 (89%) completed round 2. Panelists reached a consensus, with consistently high levels of agreement reached, on six overarching competency statements (subdivided into six domains), and 55 individual descriptors essential for antimicrobial stewardship by healthcare professionals.

CONCLUSION

Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.

Fetal imaging prompts maternal diagnosis: autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder. Ultrasound (US) findings can include enlarged echogenic kidneys in utero and cysts in multiple organs in adults. Though a highly penetrant disease, due to varied clinical expression and the typical late onset of symptoms, reproductive-aged women may not know their carrier status. We present two cases in which fetal US findings suggested ADPKD and additional evaluation identified likely maternal ADPKD as well.

Understanding osteoporosis and fractures: an introduction to the use of qualitative research

BACKGROUND

Qualitative research has been recognized in recent years as a field of inquiry used to understand people's beliefs, attitudes, behaviors, culture or lifestyle. While quantitative results are challenging to apply in everyday practice, the qualitative paradigm can be useful to fill in a research context that is poorly understood or ill-defined. It can provide an in-depth study of interactions, a way to incorporate context, and a means to hear the voices of participants. Understanding experiences, motivation, and beliefs can have a profound effect on the interpretation of quantitative research and generating hypotheses. In this paper, we will review different qualitative approaches that healthcare providers and researchers may find useful to implement in future study designs, specifically in the context of osteoporosis and fracture.

METHODS

We will provide insight into the qualitative paradigm gained from the osteoporosis literature on fractures using examples from the database Scopus. Five prominent qualitative techniques (narratives, phenomenology, grounded theory, ethnography, and case study) can be used to generate meanings of the social and clinical world.

DISCUSSION AND CONCLUSION

We have highlighted how these strategies are implemented in qualitative research on osteoporosis and fractures and are anchored to specific methodological practices. We focus on studies that explore patient psychosocial experiences of diagnosis and treatment, cultural boundaries, and interprofessional communication. After reviewing the research, we believe that action research, that is not frequently used, could also effectively be used by many professions to improve programs and policies affecting those dealing with osteoporosis issues.

Body mass, frequency of eating and breakfast consumption in 9-13-year-olds

BACKGROUND

Unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. However, debate remains around the precise eating behaviours that lead to these conditions. The present study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass index (BMI, kg m(-2) ) of youth in the UK.

METHODS

A total of 264 (133 boys and 131 girls) participants, aged 10-13years, completed self-report measures of dietary intake via 3-day food/drink diaries (Friday to Sunday). Trained researchers recorded height and weight to calculate the BMI. Diaries were analysed using dietplan 6 nutritional analysis software (Forestfield Software, Horsham, UK) and multivariate linear regression was used to examine any association between breakfast consumption, frequency of eating and BMI.

RESULTS

No relationship existed between BMI Z-score, eating frequency and breakfast consumption. However, frequent breakfast consumers had significantly lower mean (SD) BMI Z-scores [0.18(1.06) versus 0.57(1.23)] and higher intakes of iron, calcium and vitamin E than those who did not eat breakfast regularly. Those aged ≥11years consumed breakfast less frequently [0.92(0.20)] and were less likely to eat regularly [4.6(1.4)] than those aged ≤10years.

CONCLUSIONS

Older boys were the least likely to eat regularly and the least likely to consume breakfast. Promoting the importance of regular eating, particularly breakfast consumption to these boys, may be essential to ensure healthier, long-term eating patterns. Furthermore, the lower breakfast intakes in 11-13-year-olds and higher BMI Z-scores of those who did not eat breakfast regularly should be monitored.

Physical activity and dietary intake of children aged 9-11 years and the influence of peers on these behaviours: a 1-year follow-up

BACKGROUND

This study investigated physical activity and dietary intake of children aged 9-11 years, and the influence of peers on these behaviours over a 2-year period.

METHODS

A total of 106 (64 girls; 42 boys) children were investigated annually, over 2 years. Measures included physical activity (sealed pedometer), self-report measures of dietary intake and physical activity, and a peer influence questionnaire. Anthropometric measures of height and weight were also obtained.

RESULTS

The findings reveal insufficient energy intakes, physical activity levels and fruit and vegetable consumption but high intakes of saturated fat and sodium, over time, in both boys and girls. Both male calcium and female iron intakes were also of concern. Throughout the survey, peers were found to influence physical activity behaviour but not dietary intake.

CONCLUSIONS

The fact that youth consistently failed to meet established nutrition and physical activity recommendations highlights the importance of promoting physical activity and healthy eating to children younger than 9 years of age. The finding that peers significantly influence physical activity behaviour over time should be considered when designing new physical activity interventions aimed at young people.

No effect of donepezil on striatal dopamine release in mild to moderate Alzheimer's disease

OBJECTIVE

Work in experimental animals suggests that an interaction with dopaminergic networks might explain some of the therapeutic effects of the cholinesterase inhibitor class of drugs. This study aimed to test whether acute (single 5 mg) or 4-8 weeks (5-10 mg) of treatment with oral donepezil would elicit measurable striatal dopamine (DA) release in patients with mild to moderate Alzheimer's disease. A second aim was to establish whether any increase in DA levels would be associated with improvements in cognitive and motor function.

METHODS

Percentage change in [(11)C]-raclopride (RAC) binding potential (BP(ND)) between baseline and treatment conditions was used to provide a measure of DA release. Repeated measures ANOVA was used to determine the effect of treatment on [(11)C]-RAC BP(ND) and neuropsychological test performance.

RESULTS

Contrary to our prediction there was no significant change in [(11)C]- RAC BP(ND) after acute or a mean of 6 weeks (range 4-12) of treatment with donepezil. Although motor speed (finger tapping) improved following 4-12 weeks of treatment with donepezil (F(1,19) = 8.7, p = 0.009), this was not associated with the degree of change in [(11)C]-RAC BP(ND).

CONCLUSIONS

Our findings provide no evidence that striatal DA levels are altered during the first 3 months of donepezil treatment. However, we cannot rule out the possibility that extrastriatal effects may be occurring.

Midlife Neuroticism and the age of onset of Alzheimer's disease

BACKGROUND

There may be important public health implications of increasing our knowledge of factors associated with age of dementia onset. The pre-morbid personality domain of Neuroticism constituted an interesting and theoretically plausible, yet uninvestigated, candidate for such an association. We aimed to examine whether midlife Neuroticism was associated with earlier age of onset of Alzheimer's disease (AD).

METHOD

This was a case-comparison study of 213 patients with probable AD. Detailed clinical information was collected for all patients including age of onset of dementia symptoms. One or two knowledgeable informants rated each patient's midlife personality retrospectively using the Neuroticism, Extraversion, Openness Five-Factor Inventory (NEO-FFI) questionnaire. The relationship between midlife Neuroticism and age of dementia onset was evaluated using both correlational analysis and backward linear regression analysis.

RESULTS

Midlife Neuroticism predicted younger age of dementia onset in females but not in males. The association found in females was independent of pre-morbid history of affective disorder.

CONCLUSIONS

This finding and its potential mechanism warrant further investigation.

Interprofessional education: effects on professional practice and health care outcomes

BACKGROUND

Patient care is a complex activity which demands that health and social care professionals work together in an effective manner. The evidence suggests, however, that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way to improve collaboration and patient care.

OBJECTIVES

To assess the effectiveness of IPE interventions compared to education interventions in which the same health and social care professionals learn separately from one another; and to assess the effectiveness of IPE interventions compared to no education intervention.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 1999 to 2006. We also handsearched the Journal of Interprofessional Care (1999 to 2006), reference lists of the six included studies and leading IPE books, IPE conference proceedings, and websites of IPE organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client and/or healthcare process outcomes.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed the eligibility of potentially relevant studies, and extracted data from, and assessed study quality of, included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. Consequently, the results are presented in a narrative format.

MAIN RESULTS

We included six studies (four RCTs and two CBA studies). Four of these studies indicated that IPE produced positive outcomes in the following areas: emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; management of care delivered to domestic violence victims; and mental health practitioner competencies related to the delivery of patient care. In addition, two of the six studies reported mixed outcomes (positive and neutral) and two studies reported that the IPE interventions had no impact on either professional practice or patient care.

AUTHORS' CONCLUSIONS

This updated review found six studies that met the inclusion criteria, in contrast to our first review that found no eligible studies. Although these studies reported some positive outcomes, due to the small number of studies, the heterogeneity of interventions, and the methodological limitations, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. More rigorous IPE studies (i.e. those employing RCTs, CBA or ITS designs with rigorous randomisation procedures, better allocation concealment, larger sample sizes, and more appropriate control groups) are needed to provide better evidence of the impact of IPE on professional practice and healthcare outcomes. These studies should also include data collection strategies that provide insight into how IPE affects changes in health care processes and patient outcomes.

A best evidence systematic review of interprofessional education: BEME Guide no. 9

BACKGROUND AND REVIEW CONTEXT: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review identified, collated, analysed and synthesised the best available contemporary evidence from 21 of the strongest evaluations of IPE to inform the above proposition. In this way we sought to help shape future interprofessional education and maximize the potential for interprofessional learning to contribute to collaborative practice and better care.

OBJECTIVES OF THE REVIEW

To identify and review the strongest evaluations of IPE. To classify the outcomes of IPE and note the influence of context on particular outcomes. To develop a narrative about the mechanisms that underpin and inform positive and negative outcomes of IPE.

SEARCH STRATEGY

Bibliographic database searches as follows: Medline 1966-2003, CINAHL 1982-2001, BEI 1964-2001, ASSIA 1990-2003 which produced 10,495 abstracts. Subsequently, 884 full papers were obtained and scrutinized. In addition, hand searching (2003-5 issues) of 21 journals known to have published two or more higher quality studies from a previous review.

TOPIC DEFINITION AND INCLUSION CRITERIA

Peer-reviewed papers and reports included in the review had to be formal educational initiatives attended by at least two of the many professional groups from health and social care, with the objective of improving care; and learning with, from and about each other.

DATA COLLECTION, ANALYSIS AND SYNTHESIS

Standard systematic review procedures were applied for sifting abstracts, scrutinizing full papers and abstracting data. Two members of the team checked each abstract to decide whether the full paper should be read. A third member was consulted over any discrepancies. Similarly, each full paper was read by at least two members of the team and agreement sought before passing it to one member of the team (SR) for data abstraction. Other members of the team checked 10% of the abstraction records. Coding into a Statistical Package for Social Scientists (SPSS) data base led to collection of different outcome measures used in the primary studies via the common metric of an adapted Kirkpatrick's four-level model of educational outcomes. Additionally, a narrative synthesis was built after analysis of primary data with the 3-P model (presage-process-product) of education development and delivery.

HEADLINE RESULTS

Government calls for enhanced collaboration amongst practitioners frequently leads to IPE that is then developed and delivered by educators, practitioners or service managers. Staff development is a key influence on the effectiveness of IPE for learners who all have unique values about themselves and others. Authenticity and customization of IPE are important mechanisms for positive outcomes of IPE. Interprofessional education is generally well received, enabling knowledge and skills necessary for collaborative working to be learnt; it is less able to positively influence attitudes and perceptions towards others in the service delivery team. In the context of quality improvement initiatives interprofessional education is frequently used as a mechanism to enhance the development of practice and improvement of services.

Re-examining the evaluation of interprofessional education for community mental health teams with a different lens: understanding presage, process and product factors

This paper revisits the formative evaluation of a pilot project that offered in-service interprofessional education (IPE), which is designed to enhance the collaborative practice, to two UK community mental health teams (CMHTs). While the IPE was well received and resulted in some improvements in team functioning, wider successes were elusive. Specifically, collaborative action plans were not implemented, and the pilot programme was ultimately not rolled out to other CMHTs. The purpose of this paper is to test the usefulness of the presage-process-product (3P) framework for analysis as a means to untangle the complex web of factors that promoted and inhibited success in this initiative. The framework, which captures key features of the initiative as a dynamic system, proved effective, yielding new insights, making connections clearer and highlighting the critical importance of presage. We argue that use of the 3P model during the development of in-service IPE could ensure that planning oversights are minimized, thereby improving outcomes.

The effect of social demographic factors, snack consumption and vending machine use on oral health of children living in London

OBJECTIVE

To investigate the effect of socio-economic status, sugar, snack consumption and vending machine use on the prevalence and severity of caries (DMF) in children.

DESIGN

An observational study was carried out in a dental practice in inner city London. Sixty children were asked to complete a questionnaire and a three day food and drink diary. After a dental examination the number of decayed (D), missing (M) or filled (F) teeth provided a DMF score. Anova and Pearsons correlations were used to analyse the data statistically.

RESULTS

Children from social groups I and II consumed significantly less (P < 0.05) sugar, confectionery, crisps and used a vending machine less often than children from other social groups. Children from Social groups I, II and III had significantly lower DMF scores. The average DMF from social group I children was 0.5 +/- 0.6, whilst group IV children had the greatest incidence and a DMF of 4.6 +/- 0.8. Significant correlations were identified between DMF and sugar, confectionery and crisp consumption and vending machine use, and a negative correlation between DMF and vegetable consumption.

CONCLUSIONS

Socio-economic status and access to vending machines were found to have a significant effect on sugar intakes, foods choices, and dental health. The removal of vending machines from schools or at least installing 'healthy' vending machines is recommended. Health promotion programmes that account for social groups and snacking habits that are cost effective are required.

Migrant status, age, gender and social isolation in very late-onset schizophrenia-like psychosis

BACKGROUND

Data from two retrospective first contact studies suggest that the risk of developing very-late onset schizophrenia-like psychosis (SLP) may be raised in older migrant than British-born populations resident in the UK.

OBJECTIVE

To investigate whether the relative excess of SLP observed amongst younger and male migrants in the above studies might have been explained by differences in the age-gender structures of migrant and British-born denominator populations. A secondary aim was to examine the associations of migrant group status and gender with markers of social isolation.

METHOD

Eighty-six new referrals of SLP to the Mile End (1997-2003) and Maudsley (1995-2000) hospitals were identified from two retrospective case note studies. Local census data were used to estimate the denominator populations and to calculate rate ratios for migrant and British-born cases of SLP. Case notes were re-examined, to assess markers of social isolation in migrant and British-born patients.

RESULTS

Migrant patients were more likely to be male (odds ratio = 4.8; CI(odds) = 1.8-13.2) than British-born patients. The ratio of first contact rates for migrant compared to British-born populations were highest amongst men. There was a lower mean age of onset of SLP in migrant than British-born patients (t = 4.30, 95% CI = 3.78-10.27), which was largely explained by a higher mean age of illness onset in British-born women. There were no differences between migrant and British-born patients with respect to markers of social isolation. Male patients were more likely to have never married than women (odds ratio = 0.28; 95% CI odds = 0.09-0.89).

CONCLUSIONS

The age-gender structure of the background population is not sufficient to explain the socio-demographic differences between migrant and British-born patients with SLP. Male patients may be more socially isolated.

Psychosis and schizophrenia-like disorders in the elderly

Non-organic, non-affective psychoses that have their first onset in late life have been the subject of diagnostic dispute for many years. Do they represent the late manifestation of more typical schizophrenia but with a delayed onset? Are they cases of "symptomatic schizophrenia" in which some organic brain change associated with ageing gives rise to schizophrenic symptoms? A recent International Consensus established that while cases of schizophrenia are sometimes delayed in their onset to 40 to 59 years of age (late-onset schizophrenia), onset after the age of 60 years is generally associated with a different symptom profile and associated risk factors (very late-onset schizophrenia-like psychosis). In this paper we review the data on the very late-onset schizophrenia-like psychosis patient group and suggest research directions for the future.

Service contact and psychopathology in very-late-onset schizophrenia-like psychosis: the effects of gender and ethnicity

BACKGROUND

Epidemiological data on very-late-onset (>60 years) schizophrenia-like psychosis (SLP) are scarce. There are only two published follow-up studies.

OBJECTIVE

To examine the associations of gender and ethnicity with health service contact and psychopathology in SLP.

METHOD

We identified all new referrals of SLP to the Maudsley hospital between 1995-2000. Demographic details and information on the course of the illness were obtained from case notes. Those patients who agreed to take part were seen at home and assessed with respect to psychopathology and neurological side effects.

RESULTS

The median duration of illness at the time of assessment was 3 years (range 1-6 years). Male patients were more likely to be admitted to hospital compulsorily and to be lost to follow-up than female patients. Caribbean-born patients were more likely to refuse to take part than British-born patients. Of the 26 (48%) patients who were interviewed, 38% were experiencing paranoid symptoms, 94% of patients receiving medication were in regular contact with a community psychiatric nurse (CPN). Treatment response was dose related and was not increased by the use of a depot.

CONCLUSION

The effects of gender and ethnicity on outcome need to be further investigated through larger studies. High loss to follow-up amongst male patients may be indicative of a poor prognosis. Regular contact with a CPN may be more important than the use of a depot in maintaining treatment response.

Ageing and the nigrostriatal dopaminergic system

BACKGROUND

Brain dopamine has been the focus of numerous studies owing to its crucial role in motor function and in neurological and psychiatric disease processes. Whilst early work relied on postmortem data, functional imaging has allowed a more sophisticated approach to the quantification of receptor density, affinity and functional capacity. This review aims to summarise changes in the nigrostriatal dopaminergic system which accompany normal ageing.

METHODS

A literature search focussed on postmortem and neuroimaging studies of normal ageing within the nigrostriatal dopaminergic tract. The functional significance of age-related effects was also considered.

RESULTS

There are significant reductions in pre- and post-synaptic markers of brain dopamine activity during normal ageing: However the rate of decline (linear or exponential), the effects of gender and heterogeneity and the mechanisms by which these changes occur remain undetermined. Limited data suggest there is a significant association between postsynaptic receptor density and specific aspects of motor and cognitive function.

CONCLUSION

The identification of strategies to improve dopaminergic transmission may delay the onset of motor and cognitive deficits associated with normal ageing. In order to develop effective preventative strategies, the causative mechanisms underlying age-related changes and the interaction between synaptic structure and function need to be more clearly elucidated.

A systematic review of the effects of interprofessional education on staff involved in the care of adults with mental health problems

Interprofessional education (IPE) is commonly advocated in policy documentation as a means of enhancing collaboration between heath and social care staff. However, little is known about the effects of this type of education. This paper reports findings from a systematic review which was commissioned to search and begin assessing the quality of the published evidence relating to the effects of IPE on staff involved in the care of adults with mental health problems. Results from this study indicate that there is a current lack of rigorous evidence into the effects of IPE in this field. Conclusions from this work are made in connection to mental health policy and recommendations are offered for strengthening the evaluation of IPE.

'Real life' clinical learning on an interprofessional training ward

This paper describes the multi-method evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students. Unique in the UK, and an extension of pioneering work in Sweden (Wahlström et al. 1997, Wahlstroöm & Sandén 1998), this interprofessional clinical placement allowed senior pre-qualifying students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop both their profession-specific skills in a real-world setting and the quality of their interprofessional teamwork. Student teams were supported by facilitators who led reflective sessions and acted as a resource for the students' problem-based learning. The training ward was evaluated by a multi-method approach, incorporating interviews, observations and questionnaires with students, patients and clinical staff. The evaluation findings have been grouped into a number of themes which offer an insight into the varying perspectives of training ward students, patients and staff. This paper pays particular attention to the nursing perspective of the interprofessional training ward pilot.

Interprofessional education: effects on professional practice and health care outcomes

BACKGROUND

As patient care becomes more complex, effective collaboration between health and social care professionals is required. However, evidence suggests that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way forward in this area.

OBJECTIVES

To assess the usefulness of IPE interventions compared to education in which the same professions were learning separately from one another.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE (1968 to 1998) and Cinahl (1982 to 1998). We also hand searched the Journal of Interprofessional Care (1992 to 1998), the Centre for the Advancement of Interprofessional Education Bulletin (1987 to 1998), conference proceedings, the 'grey literature' held by relevant organisations, and reference lists of articles.

SELECTION CRITERIA

Randomised trials, controlled before and after studies and interrupted time series studies of IPE interventions designed to improve collaborative practice between health/social care practitioners and/or the health/well being of patients/clients. The participants included chiropodists/podiatrists, complementary therapists, dentists, dietitians, doctors/physicians, hygienists, psychologists, psychotherapists, midwives, nurses, pharmacists, physiotherapists, occupational therapists, radiographers, speech therapists and/or social workers. The outcomes included objectively measured or self reported (validated instrument) patient/client outcomes and reliable (objective or validated subjective) health care process measures.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed the eligibility of potentially relevant studies.

MAIN RESULTS

The total yield from the search strategy was 1042, of which 89 were retained for further consideration. However none of these studies met the inclusion criteria.

REVIEWER'S CONCLUSIONS

Despite finding a large body of literature on the evaluation of IPE, these studies lacked the methodological rigour needed to begin to convincingly understand the impact of IPE on professional practice and/or health care outcomes.

Antropometric measurements and body composition of English and Malaysian footballers

This comparative study was conducted to determine the anthropometric measurements and body composition of football teams in the UK and Malaysia. A total of 32 footballers from two teams were studied. The teams were the St Mary's University team (UK) and the Selangor Reserved League team. The height and body weight of the subjects were measured using SECA digital balance with height attachment. Skinfold thickness measurements were taken using Harpenden skinfold callipers at four sites (biceps, triceps, subscapular and suprailiac) and the VO2max of the subjects was estimated by participation in a multi-stage 20m shuttle-run test. The UK team were significantly heavier (p<0.05), taller (p<0.05) and had a higher body fat content (p<0.05) than their Malaysian counterpart. There was no significant difference in VO2 max between the two teams, with the Malaysians recording a slightly higher VO2 max. With regard to playing position, the defenders were found to be the most physically robust and yet had the highest VO2 max, whilst the midfielders had the lightest body weights. More data on the body composition and nutritional status of Malaysian footballers would allow adjustments to be made to dietary intakes and training levels in order to obtain maximum performance throughout the football season.

Emerging themes: an exploratory research project of an interprofessional education module for medical, dental and nursing students

This paper will detail themes emerging from the first stage analysis of a project that was commissioned by the Department of Health. In evaluating the effectiveness of interprofessional teaching and learning opportunities for undergraduate medical, dental and nursing students, the project will also reveal wider institutional problems and opportunities in shared curriculum development. The research focuses on an existing Community Module within the medical and dental curriculum, which has incorporated BSc nursing students. Based on pre-module focus groups, semistructured interviews and an extract from a reflective project diary, the paper will describe the emerging themes of personal interest to the researchers concerning student perceptions and expectations of their shared learning. This early data suggests that in their first term at college, the students reveal inconsistencies in their stereotypical attitudes towards the 'status' of their intended professions. They also demonstrate attitudes that challenge traditional views. The students also offer similar discrepancies in their views on the value of interprofessional learning. It would be premature to draw any firm conclusions from this preliminary analysis of selected data. However, the analysis provides early evidence of the key cultural, professional and institutional issues central to the planning and implementation of interprofessional curricula.

Behavioural misdiagnosis

This article explores the possibility that the behaviours of some clients with learning disabilities may be due to neurological dysfunction. It outlines some neurological explanation for behaviour previously labelled as challenging, and observes how this knowledge may affect our common understanding of people with learning disabilities.

Handling controlled substances: upgrading the system

To provide safe patient care and to meet legal standards, an automated medstation replaced the manual controlled substances system. Using the medstation streamlines documentation, captures patient charges and reduces floor stock's inventory carrying charges.

Continuous quality improvement as an ideal in hospital practice

Continuous quality improvement (CQI) is an important part of successfully managing change in health care. This article describes a CQI plan and process created to develop a comprehensive plan for a rapidly evolving organization. Four key components of the planning process are described: initial initiatives, customer service orientation, teamwork approach, and physician involvement. A case study is also included to illustrate how one CQI plan and process was implemented and evaluated.

Evaluation of new cultivars of triticale as dual-purpose forage and grain crops

Two newly registered cultivars of triticale, Tiga and Empat, were compared with existing commercial cultivars of triticale, cereal rye and forage oats, for grain yield and dry matter production. Their performance was evaluated at Armidale, New South Wales, over 3 years with varying defoliation regimes (uncut to grain yield, cut in late autumn, cut in autumn and winter, and cut in winter only). Phenological observations confirmed that Tiga and Empat were midseason cultivars, intermediate between Coolabah and Blackbutt oats. Autumn and winter forage production and organic matter digestibility of Tiga and Empat were equal to those obtained from Cooba and Blackbutt oats. Grain yields (up to 4.0 t/ha) of the highest yielding triticale cultivar (Empat) were equal to, or greater than, the best oats cultivar (Blackbutt). Generally, the highest winter growth rates, dry matter yield at maturity and grain yield were recorded from uncut plots, except in the early oats cultivar Coolabah which, in 1 experiment, lodged in spring if left undefoliated through autumn and winter. Cutting only in autumn had small effects (negative) on grain yields, but cutting in both autumn and winter reduced total dry matter yields at maturity by 30% and grain yields by 50%. Cutting only in winter resulted in higher vegetative forage yields than a double cut (autumn and winter), but the single winter cut subsequently produced lowest dry matter yields at maturity. The high grain yields of triticale were linked to rapid spring growth. Harvest indices of triticale cultivars were generally lower than those of the oat cultivars. The results indicate the potential of triticale, especially cv. Empat, as a dual-purpose forage and grain crop.

Necrolytic migratory erythema: association with neuroendocrine tumour with predominant insulin secretion

We report a case of necrolytic migratory erythema in association with a neuroendocrine tumour producing predominantly insulin. As far as we know this has not been observed before.

Crown gall oncogenesis: evidence that a T-DNA gene from the Agrobacterium Ti plasmid pTiA6 encodes an enzyme that catalyzes synthesis of indoleacetic acid

Stable incorporation of tumor-inducing (Ti) plasmid sequences, the T-DNA, into the genomes of dicotyledonous plants results in the formation of crown gall tumors. Previous genetic studies have suggested that the products of the genes encoding transcripts 1 and 2, which are encoded by the TL-DNA region of pTiA6, are responsible for inducing the auxin-independent phenotype of crown gall tissues. Here we report the construction of a plasmid, pMTlacT2, which directs the synthesis of the Mr 49,800 polypeptide encoded by the transcript 2 gene. Cell-free extracts prepared from Escherichia coli harboring this plasmid converted indoleacetamide to indoleacetic acid, the natural auxin of plants; extracts prepared from plasmidless strains of E. coli or strains harboring the cloning vehicle pBR322 did not carry out this reaction. We conclude that the transcript 2 gene of pTiA6 codes for an enzyme that participates in auxin biosynthesis, probably an indoleacetamide hydrolase.