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Person-centred care and the diverse array of contexts within which healthcare assistants work necessitate a commitment to being conscientious, self-aware and willing to raise issues of concern about vulnerable and sick patients and their families and carers. For the purposes of the article, tacit knowledge is defined as the intuitive knowledge that is not easy to articulate through dialogue or rational justification in the context of healthcare provision. It depends on a level of sensory awareness or feeling that transcends the need for formalised knowledge in terms of its potential impact on practice. Person-centred care and the diverse array of care contexts within which HCAs work necessitate a commitment to being conscientious, self-aware and willing to raise issues of concern about vulnerable and sick patients and their families and carers. The transferable skillset needed to undertake this role extends beyond the functional training that HCAs receive. Tacit knowledge cannot be readily articulated, but its implementation in practice lies at the heart of every human interaction. The article raises awareness of tacit knowledge and its implications for the context of healthcare provision.

In the context of a study of how being a practitioner from the context of business and management affected and interacted with the concepts of student identity and experience, it was necessary to design a research protocol that could effectively explore how academic study affected practitioner identity and practice. This case study illustrates the complex decision-making processes and practicalities of how consensus workshops were embedded into a specific idiographic methodology in the context of interpretative phenomenological analysis. The challenges involved in designing a study that could effectively explore the experiences of interaction between practitioner and student identity were numerous, and it is hoped that by illuminating these challenges others might be encouraged to adopt these methods within their own research. This particular case study is illustrative of Helen Charlton’s research with part-time postgraduate Human Resource Management students who worked and studied in tandem. Challenges of design incorporated a consideration of how best to highlight the duality of working and studying in the lives of Human Resource Management students. Further research considerations identified that it would also be necessary to identify mechanisms by which experiences of dual working and studying affected Human Resource Management students at an individual level and in the context of their respective academic communities.

Background Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. Methods This review will use the ‘best fit’ framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. Discussion Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. Systematic review registration PROSPERO CRD42017083306 Electronic supplementary material The online version of this article (10.1186/s13643-018-0752-3) contains supplementary material, which is available to authorized users.

The construction and labeling of a relatively disparate set of university information technology systems as the “Nurse Navigator System” were routed in the principles of broader design research where methodologies of teaching, learning, and assessment were used to drive educational innovation within and between clinical and academic teaching. In terms of pragmatic design and appearance, this was straightforward; however, the theoretical basis of the design was more complex and rooted in core pedagogic design principles. Responding to the outcome of the initial evaluation of the system was therefore critical in the iterative developmental design of the Nurse Navigator System. Evaluation necessitated the collation of data which could tangibly and qualitatively examine whether expectations of such a conglomerate set of information technology criteria were realistic in practice. This pilot period of adjustment was recognized as a time to allow for configuring, fine-tuning, and assessment of purposefulness to the student cohort using it and in keeping with the need to co-construct learning and resource needs of students in practice. Evaluating the effectiveness of the preliminary pedagogic design of the Nurse Navigator System necessitated reliable indicators of engagement and learning. This research methods case study provides an overview of the qualitative evaluation of the impact of the new Nurse Navigator System using anecdote circles as an alternative to Focus Groups.

This case study provides insight into the author’s use of anecdote circles as an alternative to focus groups with international postgraduate nursing students. The method was used as a means of evaluating the individual and collective perceptions that 15 students had of using LEGO® SERIOUS PLAY® as a method of facilitating their capacity for reflection and critical reflexivity. This case study explores the practical issues of using anecdote circles and highlights key challenges of using the method in practice. It also provides insight into the contextual and situational background of conducting the anecdote circles and why the approach was rationalized as being the most appropriate form of evaluation with this group of students as well as why the generic transferability of anecdote circles to other disciplines and settings is a valuable adjunct to traditional qualitative research methods. As part of an overarching participatory action research methodology used for the iterative evaluation of educational impact with these postgraduate students, anecdote circles were also rationalized as a means of providing a strategic alternative to focus groups in capturing the conceptually deeper perceptions students had about using LEGO SERIOUS PLAY as a means of facilitating their capacity for reflection and critical reflexivity. Their capacities for these two concepts have the potential to facilitate and explore student capacity for affective learning around care and compassion, subjects which have been topical in light of the Francis Report and the Cavendish Review.

This article provides an overview of the impact of transformative learning and how as a teaching strategy for HCAs it can enable mechanisms of self-reflection and critical introspection via means other than written reports, such as metaphors, storytelling, the exploration of life histories and their direct involvement in social action. By exploring the seminal theory of Mezirow, transformative education is framed as a mechanism of educating students that reproduces the ambiguity, and uncertainty they will face in everyday healthcare practice. Discussion around the tensions between objectivity and affective engagement explores the processes by which students consciously reframe their thinking. The article ends with an insight into a small-scale research project on metaphors as a mechanism of visually stimulating self-expression. The value of transformative learning is contextualised, amid recommendations from the Cavendish Review (2013) and the Frances Report (2013) . The new regulatory framework for HCA education provides an ideal foundation for the development of the notion of meaning-making in education. The article also provides an overview of how staff can best facilitate transformative education in practice.

The healthcare workforce is estimated to be strategically underpinned by the contribution of a vast number of HCAs who provide front line care to patients and their families and carers. Published statistics reveal that migrant workers constitute a considerable percentage of the HCA workforce. Because of this, the need to support their capacity to provide effective and high-quality care is of paramount importance to workforce development. Alongside this, within the context of educational provision, is the need to promote the avoidance of stereotyping how people from certain international and cultural backgrounds learn. This avoids homogenising international students indiscriminately in the context of learning and teaching where the individuality they bring to healthcare provision is neither acknowledged nor valued. The capacity for the vast majority of international students to develop professionally and personally is at present largely understated in the proposals to develop healthcare assistant education. By supporting international colleagues in their roles, their commitment and sense of belonging will increase, thus impacting on the capacity of the healthcare workforce to recruit and retain valuable people with valuable skills and the personal capacity to provide compassionate care. This paper provides an overview of the issues for consideration in supporting migrant healthcare workers and the benefits this can bring to the whole HCA workforce in practice.

This article provides an underpinning knowledge base of heart failure (HF) for HCAs who, as an integral part of their daily workload, care for people living and dying with the condition. As a condition that rivals cancer in terms of mortality rate and impact on quality of life, heart failure warrants consideration in terms of how best HCAs might help people maximise their potential to lead as functional and purposive life as they possibly can, following a diagnosis. The personal challenges associated with a diagnosis might also necessitate contemplation of action by HCAs in ensuring they can best support healthcare practitioners whose role entails conveying detailed and life-changing information to patients and their families and carers. This is an invaluable part of the scope of HCA practice in a complex condition that can manifest in a number of very different clinical ways. The article starts with an overview of what heart failure is, how it is clinically diagnosed and how it is managed in practice and concludes with an overview of how the HCA might best support patients and their families and carers in practice.

This article is written both for facilitators of HCA education, as well as for HCAs who might be encountering the notion of authentic physical learning spaces for the first time, or who have as yet not recognised the significance of how and where students learn in relation to the application of theoretical knowledge. As the HCA workforce moves towards professional regulation, with the imminent arrival of the Care Certificate ( Health Education England et al, 2015 ), the consideration of appropriate physical learning environments is a fundamental part of educational provision. In optimal academic learning environments, emphasis is placed directly on the need to frame and define learning in the midst of patient-centred care and interprofessional working, both clinically and academically. Authentic physical learning environments underpin the credibility of academic provision and this article showcases the modernisation of the sciences complex at the University of Sunderland, where educational focus remains firmly rooted in the potential employability of students and the credibility of the academic awards validated by the institution. In conjunction with on-campus provision of learning opportunity, work placement and work-based learning also represent a means of situating and framing educational provision at the front line of patient care.

This article is written for both HCAs and their educators and provides a brief overview of interprofessional education (IPE)—also known as ‘interprofessional learning (IPL)’—of relevance to the HCA workforce. The notion of IPE has been popularised in recent years, with the need for healthcare practitioners to build capacity within and between different professional disciplines. The motivation for this is often that IPE and the improved multidisciplinary teamwork (MDT) it contributes to can have a direct, positive impact on the quality of patient-centred care. When HCAs are in the process of returning to education after a considerable time, they might not be familiar with the notions of IPE or MDT, or even have considered the relevance of either to the care they provide to patients and their families and carers. This article provides an insight into and an explanation of both IPE and MDT, using worked examples from practice. It also places value on the experiential learning that HCAs bring to the context of IPE for others. The everyday work and interaction at the front line of patient care of HCAs places them in an ideal position to share accounts of their experience from practice, so that others might learn from them. Finally, a key set of learning objectives in relation to IPE is presented, so that when HCAs contemplate their own IPE learning, whether formal or informal, they are better equipped to consider key elements that might be of direct relevance to their own contribution to practice.

This article is written for both HCAs and their educators and outlines some of the major approaches to developing education and training for the HCA workforce. Referring to major policy recommendations and how this might be translated into working curricula for HCAs, there is discussion of the presuppositions around vocational and academic training for the HCA workforce and how parallel issues in industry have been addressed in practice. E-learning is debated as a mechanism of integrating emergent technology into HCA curricula via the facilitation of learning in both simulation and delivery of academic content. The impact of this on HCA learning in practice is considered. Finally, a set of key objectives for HCAs is identified and the article concludes with an outline of potential innovation for HCA education when regulation of this sector of the healthcare workforce is formalised in the near future

Establishing the factors resultant from the regulation of healthcare assistant (HCA) practice will be the ongoing focus of research for several years. One of the most obvious, from a sociological perspective, is the concept of ‘McDonaldisation’. Since bureaucratic management styles dominate in the National Health Service (NHS), there is relevance to considering the impact of the theory to practice for HCAs, at a time of distinct strategic and emergent change for the role of the HCA in relation to political and legislative drivers, such as the Care Certificate. This article makes accessible and explores the impact of McDonaldisation on the role of the HCA and the identity of this huge sector of the healthcare workforce in hospital and community settings. By presenting both positive and negative aspects of McDonaldisation, core recommendations are made, based on the potential of HCAs as an often undervalued and overlooked sector of the healthcare sector to further develop. The article first outlines what McDonaldisation is, for those HCAs who may not be familiar with the term, and encourages reasoned debate about what bureaucracy and change might potentially mean in practice, in terms of positive and negative impact. The article concludes with recommendations for the implementation of McDonaldisation, where possible positive impacts can be identified. It provides a critical lens for HCAs in circumstances where McDonaldisation could have a potentially negative or constraining impact on HCA practice.

Background This case study was undertaken in Ireland as part of the European DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub. Two national interventions were chosen based on predetermined selection criteria: a Healthy Eating Programme (HEP) to encourage primary schoolchildren to consume more fruit and vegetables, and a Travel to School Programme, (TSP) to promote sustainable modes of transport, car-pooling and public transport use in primary and secondary schools. The HEP is EU and government funded, the TSP entirely government funded. TSP adopts a flexible approach where schools can set their travel targets. School coordinators (teachers) cascade both programmes to classroom teachers. Methods Seven of eight schools invited to participate based on predetermined criteria took part in the study. Face-to-face interviews (n=15) were conducted with teachers, project managers and key stakeholders using a topic guide developed by the international DEDIPAC team and informed by a prior systematic umbrella review of conditions influencing implementation. Data were coded in NVIVO using a common categorization matrix and thematic analysis carried out using parameters of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework. Results Good working relationships were critical to adoption, successful implementation and sustainability in line with findings from case studies in other EU countries. Organisational and leadership ability of coordinators was key to successful delivery. Incentives and rewards acted as motivators to engage children’s interest, which motivated teacher and parent involvement. Particular challenges faced by the TSP included a lack of funding security and timetable constraints within secondary schools. HEP was based on well-funded external research with clearly defined core components and has been frequently externally evaluated. TSP core components were broad rather than specific, implementation was flexible and there was a lack of agreement among stakeholders on how targets were set and the accuracy of these. Conclusion Good relationships, organisational and leadership ability, and secure funding were key conditions for implementation, sustainability and dissemination of promising public health interventions. The findings have informed the DEDIPAC-KH Pan European Toolbox set up for researchers and practitioners who want to develop, evaluate or implement multicomponent interventions on physical activity, sedentary behaviour or dietary behaviour.

The aims of this study were to compare time trends in ovarian cancer incidence and mortality in populations with (1) similar genetics but different health care systems (Ireland and Northern Ireland [NI]) and (2)different genetics but similar health care system (Israeli Jews and Arabs) and to interpret the results.Age-standardized rates of ovarian cancer incidence and mortality for 1994-2013 in the 3 countries were obtained from national cancer registries and national statistics. Time trends in incidence, mortality, and incidence-to-mortality ratio were assessed by linear regression models applied to each country and between populations (Ireland-NI, Ireland-Israeli Jews, Israeli Jews-Arabs). Joinpoint analysis was used to calculate the annual percentage change (APC).Ovarian cancer incidence and mortality rates in 1994 were similar in the countries studied. Thereafter a reduction in incidence and mortality was observed in Ireland (incidence APC1994-2013 = -0.75%, P0.05; mortality APC1994-2013 = -0.67%, P0.05), NI (incidence APC1998-2013 = -1.5%, P0.05; mortality APC2005-2013 = -3.8%, P0.05), and Israeli Jews (incidence APC1994-2013 = -2.2%, P0.05; mortality APC1994-2013 = -1.2%, P0.05). Trends in Israeli Arabs remained stable. Significant incidence trend differences between Ireland and Israeli Jews (P = 0.009) and between Israeli Jews and Arabs (P = 0.004) were observed. The only significant trend difference for mortality was between Israeli Jews and Arabs (P = 0.038). Incidence-to-mortality ratios showed stable trends in all groups except for Israeli Jews (APC1994-2013 = -1.0%, P0.05).Time trends in ovarian cancer incidence (decreasing) and mortality (decreasing) were similar in Ireland, NI, and Israeli Jews, following global trends, with a more prominent incidence decline in Israeli Jews. Decreasing mortality trends are driven by falling incidence in the countries studied rather than improved survival.

\ud \ud Background\ud \ud There is an increasing presence of patient-led social media, mobile apps and patient support technology, but little is known about the role of these in the support of bariatric surgery patients in the UK. This study aimed to seek the views of allied health professionals (AHPs) working in bariatric surgical teams to understand their current perceptions of the role of social media, mobile apps and patient-support technology within bariatric surgery in the UK.\ud Methods\ud \ud A confidential, printed survey was distributed to the AHPs at the British Obesity and Metabolic Surgery Society (BOMSS) 7th Annual Scientific Conference in January 2016. An email to AHPs who did not attend the conference was sent requesting voluntary participation in the same survey on-line through Survey Monkey® within two weeks of the conference.\ud \ud \ud Results\ud \ud 95 responses in total were received, which was a 71% response rate (n= 134). Responses were from Nurses (34%, n= 46), Dietitians (32%, n=32), Psychologists (16%, n=12) and 1 Nutritionist, 1 Physiotherapist, 1 Patient Advocate, 1 surgeon and 9 respondents did not fill in their title.\ud Conclusion\ud \ud The use of social media and mobile apps by patients is increasing, with AHPs concerned about misinformation; advice may differ from what is given in clinic. Technologies, e.g. telehealth and videoconferencing are not widely used in bariatric surgery in the UK. AHPs are unclear about the role of technologies for bariatric surgical patient support. Further discussions are needed to understand the potential of technology with AHPS supporting/facilitating patients as this becomes more commonplace.

As leader for an MSc Nursing module titled ‘Teaching, Learning and Leadership’, I wanted to facilitate international students in their reflection of learning across this module. Ultimately though, I wished to capture the degree to which education could have a transformative impact on the personal and professional development of my students by recording their reflections on the process of producing metaphors detailing their learning journeys. I would help them achieve this by aiding them to produce a reflexive visual narrative about their experience of learning. One thing I had to consider was education as a process of socially facilitating students in both their personal and professional development, so I opted for using metaphorical journeys as a means of students expressing their perceptions of this transformative change. I then used autoethnography as a methodological framework for capturing their reflections as an alternative method of reflection to those typically adopted in nurse education. This case study provides an insight into this approach, whereby particular emphasis was placed on acknowledging the controversial debates surrounding the potential use of autoethnography as a scientifically robust mechanism of capturing critical introspection. This approach also framed how the process of developing metaphors could provide a means of expressing individual insights and issues that would not be captured otherwise and was then formulated into a cogent discussion providing insight for educators considering an autoethnographic approach in their own work and for those interested in using metaphors in storytelling in the context of visual reflective narrative.

This article provides a basic insight into the teaching and learning strategies most likely to be encountered by HCA staff, following the impending regulation of the HCA workforce. Understanding processes of teaching and learning affords HCAs the opportunity of reflecting on how they learn, as well as the strategic content of what they are learning. This means that HCAs will be better placed to evaluate their educational experiences, consider what their own individual learning styles might be and also reflect on how their lifelong learning might be shaped by the learning opportunities afforded to them. Following a brief discussion of approaches to pedagogic practice, the article provides an insight into social constructivism and its inherent link to problem-based learning, social learning and the impact that all three have on how mentorship infrastructures are shaped in practice. The article also incorporates a consideration of learning domains, so that HCAs might become more familiar with the differentiation of types and styles of learning.

The female gender has become a fundamental determinant of mental health and wellbeing. Gender has a direct influence on the degree of control women have over their ability to govern their own mental health status, and is of significance in defining susceptibility, vulnerability and exposure to the risk of decline in mental health and wellbeing over a lifetime trajectory.

This article provides healthcare assistants (HCAs) with an insight into the sociological theories that underpin how ‘old age’ as a concept is constructed by society and how this can influence the way that older people are perceived as a result. The theories discussed offer consideration from both a historical and a comparative standpoint in order to stimulate thinking and discussion of emotive topics such as ageism. It also allows HCAs to engage in critical reflection on their own contribution to healthcare practice so that they can develop best practice and seek to change aspects of their interaction with older people that might not before have been considered. The article emphasises the relevance of this to HCAs by giving examples from practice, to demonstrate how these sociological theories impact on the everyday ability to provide care.

This article explores the practical application of interpretive and transcendental philosophy by giving examples of Heideggarian and Husserlian phenomenological approaches, respectively. The paper provides an historical context for the philosophical basis of phenomenological approaches to research in the healthcare sciences and frames this within the context of the need for a robust approach to evidence based qualitative research. Two examples of phenomenology are used to illustrate the differing approaches to the discipline and their relative usefulness to healthcare practice. A consideration of the association of scientific rigour and discipline is discussed in relation to the worth of research and a discussion of the willingness to depart from ‘sedimented’ views as an integral part of Gestalt methodology is briefly described. The progression of phenomenology from philosophy to method is demonstrated through an engagement with modern implementers of phenomenological research methods such as Benner and Greatrex-White. It concludes with a discussion of the concept of a knowledge society.

The way older adults move is significantly different and progressively changing as part of an overall decline in physiological and mechanical function in the normal ageing process. The aim of the article is to provide an insight into how positioning of the skeleton and the musculoskeletal system contribute to an older person's capacity to remain independent and mobile, two key factors in their overall health and wellbeing. Certain medical conditions can greatly influence the capacity people have to move; and they can become identifiable not as individuals but as the diseases they have been characterised by in their outward physical appearance. Many HCAs will have no previous knowledge of the terminology of human walking and this article offers a basic introduction to how the gait cycle works and how this changes in ageing. Posture and stability are two pivotal elements to successful ambulation and these are considered alongside the overall concept of movement in older people. From a practical perspective, it offers a means of HCAs being compassionate and understanding about the ease of movement older people live with on a day-to-day basis.

OBJECTIVES: One of the hallmarks of severe pneumonia and associated acute lung injury is neutrophil recruitment to the lung. Leptin is thought to be up-regulated in the lung following injury and to exert diverse effects on leukocytes, influencing both chemotaxis and survival. We hypothesized that pulmonary leptin contributes directly to the development of pulmonary neutrophilia during pneumonia and acute lung injury. DESIGN: Controlled human and murine in vivo and ex vivo experimental studies. SETTING: Research laboratory of a university hospital. SUBJECTS: Healthy human volunteers and subjects hospitalized with bacterial and H1N1 pneumonia. C57Bl/6 and db/db mice were also used. INTERVENTIONS: Lung samples from patients and mice with either bacterial or H1N1 pneumonia and associated acute lung injury were immunostained for leptin. Human bronchoalveolar lavage samples obtained after lipopolysaccharide-induced lung injury were assayed for leptin. C57Bl/6 mice were examined after oropharyngeal aspiration of recombinant leptin alone or in combination with Escherichia coli- or Klebsiella pneumoniae-induced pneumonia. Leptin-resistant (db/db) mice were also examined using the E. coli model. Bronchoalveolar lavage neutrophilia and cytokine levels were measured. Leptin-induced chemotaxis was examined in human blood- and murine marrow-derived neutrophils in vitro. MEASUREMENTS AND MAIN RESULTS: Injured human and murine lung tissue showed leptin induction compared to normal lung, as did human bronchoalveolar lavage following lipopolysaccharide instillation. Bronchoalveolar lavage neutrophilia in uninjured and infected mice was increased and lung bacterial load decreased by airway leptin administration, whereas bronchoalveolar lavage neutrophilia in infected leptin-resistant mice was decreased. In sterile lung injury by lipopolysaccharide, leptin also appeared to decrease airspace neutrophil apoptosis. Both human and murine neutrophils migrated toward leptin in vitro, and this required intact signaling through the Janus Kinase 2/phosphatidylinositol-4,5-bisphosphate 3-kinase pathway. CONCLUSIONS: We demonstrate that pulmonary leptin is induced in injured human and murine lungs and that this cytokine is effective in driving alveolar airspace neutrophilia. This action appears to be caused by direct effects of leptin on neutrophils.

The public perception of multiple personality disorder (MPD) is of a sudden, irreversible and severe change in mental health. In fact, MPD is usually slow of onset and, with the right care, people can go on to live fulfilling lives after an episode of MPD. Diagnosis is a long and complex process and it is reasonable for HCAs to raise issues of concern about patient behaviour with a qualified healthcare practitioner. A basic awareness of the 5 types of symptoms can improve how and why the HCA or AP interacts with people living with MPD; these signs and symptoms may differ significantly in intensity and pattern and vary over time.

Background Attention is turning toward increasing the quality of websites and quality evaluation to attract new users and retain existing users. Objective This scoping study aimed to review and define existing worldwide methodologies and techniques to evaluate websites and provide a framework of appropriate website attributes that could be applied to any future website evaluations. Methods We systematically searched electronic databases and gray literature for studies of website evaluation. The results were exported to EndNote software, duplicates were removed, and eligible studies were identified. The results have been presented in narrative form. Results A total of 69 studies met the inclusion criteria. The extracted data included type of website, aim or purpose of the study, study populations (users and experts), sample size, setting (controlled environment and remotely assessed), website attributes evaluated, process of methodology, and process of analysis. Methods of evaluation varied and included questionnaires, observed website browsing, interviews or focus groups, and Web usage analysis. Evaluations using both users and experts and controlled and remote settings are represented. Website attributes that were examined included usability or ease of use, content, design criteria, functionality, appearance, interactivity, satisfaction, and loyalty. Website evaluation methods should be tailored to the needs of specific websites and individual aims of evaluations. GoodWeb, a website evaluation guide, has been presented with a case scenario. Conclusions This scoping study supports the open debate of defining the quality of websites, and there are numerous approaches and models to evaluate it. However, as this study provides a framework of the existing literature of website evaluation, it presents a guide of options for evaluating websites, including which attributes to analyze and options for appropriate methods.

Background High-fidelity simulation is integral to health professional training. The effect of interdisciplinary training on levels of confidence in obstetric emergencies is less well explored. Aim To evaluate the impact of a multidisciplinary training project in obstetric emergency skills and drills on the confidence of staff. Methods A mixed-methods approach was used to evaluate the self-reported confidence levels of obstetrics staff. A total of 69 staff voluntarily attended emergency skills and drills training with a birthing simulator manikin. The programme used four emergency scenarios that had potential for poor maternal outcomes. A debrief followed each scenario and confidence levels were self-reported before and after each training session. Findings There were significant (PConclusion This model is of significant use in interdisciplinary obstetric emergency care training. Training had a direct effect on the staff's perceived confidence and encouraged critical reflection on professional practice in emergency obstetrics.

Background Childhood obesity is an urgent global concern with a complex multifactorial aetiology. Infant feeding behaviours are a potential target for childhood obesity prevention. However, evidence for the effectiveness of interventions to improve infant feeding behaviours is inconsistent, and knowledge of how interventions have been implemented, what aspects work, and why, is lacking. This review aimed to synthesise qualitative evidence about parents' and health-care professionals' views and experiences of infant feeding interventions, and identify factors influencing intervention implementation. Methods A systematic review and synthesis of qualitative evidence was conducted. CINAHL, Medline, PsycINFO, Embase, and SCOPUS were searched from database inception to Sept 25, 2017, for English-language qualitative studies reporting the implementation of infant feeding interventions from the perspectives of health-care workers, parents, or both. 4794 studies were screened using a-priori inclusion and exclusion criteria. Two reviewers independently extracted data and judged quality. A framework synthesis was conducted and GRADE-CERQual was used to assess confidence in findings. This review is registered with PROSPERO, number CRD42016039652. Findings Of 4794 screened studies, 13 UK, US, and Australian-based studies were included. Supportive relationships and environments were integral to the successful implementation of infant feeding interventions for both health-care professionals and parents. Issues with capacity (ie, time and resources) negatively influenced implementation by health-care professionals; for parents, a focus on practical elements and sustainability beyond the intervention was crucial to ensure success. Interpretation This review provides valuable information to enable informed and robust decisions about future infant feeding interventions and policy development, ensuring that these decisions are guided by stakeholder experiences and are cognisant of previous implementation challenges or successes. Methodologically, this study provides an innovative example of using qualitative evidence synthesis to explore factors influencing intervention implementation and engagement from both provider and participant perspectives. This review provides deeper insight into potential interactions between provider and participant experiences, and a comprehensive holistic overview of factors that are important to consider for future infant feeding interventions. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026.

Background Modifiable parental feeding behaviours are implicated in the development of childhood obesity. A lack of outcome standardisation across trials of infant feeding interventions limits examination of intervention effects and mechanisms of change. Core outcome sets (COS) are an agreed-upon minimum set of outcomes that should be measured in trials of a specific health condition. The aim of this research was to develop an infant feeding core outcome set to be evaluated in trials of infant feeding interventions to prevent childhood obesity. Methods Development of the infant feeding COS was conducted in four stages. First, a systematic review identifying all infant feeding outcomes in the extant literature was done. The databases Embase, Medline, CINAHL, CENTRAL, and PsycINFO, were searched for English-language papers, from database inception to Feb 1, 2017, using search terms related to infants (eg, infant), early feeding (eg, complementary feeding), and study design (eg, randomised controlled trial, cohort). Second, a small-group expert stakeholder meeting was held to clarify and discuss identified outcomes. Third was an international e-Delphi outcome prioritisation survey. Fourth, a consensus meeting of expert stakeholders was held. Expert stakeholders included researchers, health-care professionals, parents, and child-care professionals. Findings The systematic review identified 82 infant feeding outcomes. Outcomes were discussed and clarified with 13 stakeholders at the small-group meeting. The e-Delphi study was completed by 79 international stakeholders who rated outcomes for importance of inclusion in the COS. Seven expert stakeholders participated in the consensus meeting. 26 of the identified outcomes from the following nine domains were identified as crucial for inclusion in the COS: breast and formula feeding, introduction of solids, parent feeding practices and styles, parent knowledge and beliefs, practical feeding, food environment, dietary intake, perceptions of infant behaviour and preferences, and child weight outcomes. Interpretation The developed COS is the minimum that should be measured and reported in trials of infant feeding interventions to prevent childhood obesity. Use of this COS will facilitate better synthesis and understanding of intervention effects and is essential to inform development and evaluation of future infant feeding interventions to prevent childhood obesity. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026, Irish Research Council New Foundations Award, Health Research Board Trials Methodology Research Network Summer Student Scholarship.

The process of clinical history-taking is an integral part of clinical practice for most healthcare practitioners registered with professional regulatory bodies. The adjunct role of the healthcare assistant within the context of clinical history-taking has been an invaluable addition to the holistic care and wellbeing of patients at their initial consultations with practitioners. Whether they assist in the reassurance of the patient, their families or carers, the healthcare assistant provides a presence, which necessitates their understanding of the clinical history-taking process, alongside a consideration of their holistic health and wellbeing. This article provides an insight into the clinical history-taking process, alongside the essential factors influencing holistic wellbeing.

This article provides healthcare assistants with some clear definitions of concepts in ageing that they can consider in their everyday practice. By defining ageing and its obvious link to the process of biological senescence (the normal process of biological ageing, which all living organisms experience from the moment their lives begin), HCAs are introduced to the characteristic signs of functional decline—which often epitomises the view we have of older people—and the normal physical degenerative trajectory towards death. Physical characteristics of the ageing process are discussed in relation to the physiological signs of ageing as a gradual deterioration in function and capacity to respond to environmental stress. This is interlinked with the complex medical histories with which elderly people often present in healthcare practice. Specific considerations of working with older patients such as polypharmacy (the use of multiple medications), and general health problems, are then discussed and the notion of ageism as a discriminatory practice is briefly explored.

Objectives This study was designed to develop food and liquid cariogenicity indices and to preliminarily test their utility using dietary data from a study of children with and without severe early childhood caries (S-ECC), defined as 3 + smooth surface carious lesions, including at least one pulpally involved tooth. Methods Data were collected in a diverse cohort of low-income preschool-aged children made up of 454 children with S-ECC and 429 caries-free children who presented for care at pediatric dental clinics in Washington, DC, Columbus, OH, and Cincinnati, OH. The cariogenicity indices were used to score dietary data from a Food Frequency Questionnaire (FFQ) and a 24-hour recall (24HR). Results There were no statistically significant differences in mean food cariogenicity scores between groups. The liquid cariogenicity score was higher in the S-ECC group as compared with caries-free children (24HR: 5.28 versus 4.66, respectively, P

Compiling a portfolio as an integral part of professional practice is now an expected norm of continuing professional development for the vast majority of those employed in healthcare settings. The need for HCAs to demonstrate their achievements and to annotate the scope of their development within the clinical and professional environment necessitates the clear articulation of engagement with everyday practice. This article deals with the core elements of portfolio construction and how best HCAs might demonstrate their individual contribution, progressive development and commitment to working with patients and their families and carers; as well as their interaction with peers and colleagues in the context of health.

The process of mentorship has become one of the most topical issues in healthcare practice in recent years. This article addresses the contextual significance of the mentoring relationship alongside the core developments in relationship between the mentor and mentee. Emphasis is placed on the need to manage time effectively. The definition of what professional practice within the context of mentorship actually means is also explored. The implications of effective communication to the mentoring relationship are also discussed and key characteristics of a mutually beneficial mentorship relationship are defined. The documentation and record-keeping process is also highlighted as a mechanism by which processes of governance can be adhered to in formalising the mentoring relationship. The article ends with a brief resumé of how feedback on the mentorship process can provide the degree of critical reflexivity necessary for professional development as a healthcare assistant and also the significance of a contextual significance analysis of what has been achieved during the relationship.

Background The authors conducted a systematic review on this research question: "In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost-effectiveness of dental care?" Methods The authors searched 12 electronic databases for articles published through February 2012 and hand searched relevant articles. They assessed the risk of bias of included studies and extracted data. Results The authors screened 7,701 citations, resulting in 18 observational studies that met the inclusion criteria. They judged 13 of the studies to be at high risk of bias, five at moderate risk and one at low risk. The authors found no data regarding cost effectiveness, irreversible diagnostic procedures or diseases other than caries. Conclusions The authors concluded that the quality of the evidence was poor. They found that in select groups in which participants received irreversible dental treatment from teams that included midlevel providers, caries increment, caries severity or both decreased across time; however, there was no difference in caries increment, caries severity or both compared with those in populations in which dentists provided all irreversible treatment. In select groups in which participants had received irreversible dental treatment from teams that included midlevel providers, there was a decrease in untreated caries across time and a decrease in untreated caries compared with that in populations in which dentists provided all treatment. Clinical Implications Generalizability of results to populations other than those studied is limited owing to the age of some of the studies, as well as to clinical and methodological heterogeneity; consequently, the conclusions should be viewed with caution.

This paper outlines the emergence of Clarke's situational analysis as a fundamental and key progression of approaches to grounded theory (Clarke, 2006). Developed within the context of sociological inquiry to frame and contextualise perceived and actual reality, grounded theory became a seminal starting point for naturalistic inquiry. This paper provides an insight into several theoretical engagements with the technicalities of grounded theory and ultimately explicates where post-modernism has facilitated and aided construction of theoretical standpoints encompassing the dynamic nature of contemporary society. Key philosophers and modern theorists from the fields of Discourse and Actor Network Theory such as Foucault and Latour, Callan and Law, respectively, are used to further develop and illustrate the schemata which represent long traditions of interpretive inquiry and how they have progressed in recent years. The paper is a direct attempt to make fundamental aspects of interpretive inquiry open and accessible to healthcare practitioners.

Many healthcare assistants (HCAs) working within the context of gerontology will encounter patients with lengthy lists of prescribed and non-prescribed medication. While it is not within the scope of practice of an HCA to question the reason for patients to be following what might appear to be a relatively complex drug regimen, it can be useful for the HCA to understand the common implications of what is termed ‘polypharmacy’. This paper discusses the functional decline of the body as a natural part of the human physiology of aging and also the difficulties associated with managing polypharmacy in the elderly. It has also been written with the intention of building interprofessional capacity between the many HCAs associated with caring for elderly patients and for whom the HCA role is fundamental to high-quality healthcare provision. The paper examines those conditions and disease states in which polypharmacy is more common and more importantly reinforces the fact that there is no one disease process which is unique to the elderly; rather, they are more likely to endure co-existing disease processes as their physiological senescence occurs naturally as an integral part of human aging.

This study reports on the findings of a mixed methods study that was undertaken to establish student perceptions of academic learning environments and the perceived impact of these on their articulation of employability skills. This was so student perspectives on employability could be used to inform reflection on pedagogic practices for their educators in higher education. Using a purposive sample of 250 students based in a recently modernised Sciences Complex Building in a Higher Education Institution (HEI), the study was cross sectional and descriptive by design. The social learning spaces researched were perceived by participants to provide optimal academic learning environments for their development of knowledge, skills and professionalism through certain signature pedagogies as they progressed through their programmes of study. Students also expressed the view that their acquisition of functional skills were significantly more important than any personal attributes/characteristics that they brought to programmes. What also mattered was whether the importance of certain graduate skills to the workplace had been made explicit to them so that they could see the relevance of their studies to practice. In defining 'graduateness', in employability terms the research concluded that it was necessary to consider how it was shaped by the context of delivery of subject disciplines, stages of academic progression, and the use of social learning spaces, as they all had a significant impact on the perceptions students held about their potential employability upon completion of their academic programmes.

Maternal smoking accounts for 20%–30% of low birth weight (BW). Second-Hand Smoke (SHS) also negatively affects BW. This cohort study explored the differential effect of smoking patterns during pregnancy on infant BW. Smoking status for 652 self-reported smokers attending public ante-natal clinics was assessed at baseline (V1 first ante-natal visit), 28–32 weeks (V2) and one week after birth (V3). Multivariable generalised linear regression models tested smoking patterns (continuing to smoke, sustained quitting, partial quitting) on BW adjusting for household smoking and other co-variates. Total quitting showed a median increase of 288 g in BW (95% CI (confidence intervals): 153.1–423 g, p < 0.001), compared to partial quitting (147 g, (95% CI: 50–244 g), p < 0.003). In partial quitters, increased BW was observed only in females 218 g, (95% CI: 81–355 g), p = 0.002). Household SHS showed a specific negative influence on pre-term but not term BW. This study suggests that, for low-income women, quitting or partial quitting during pregnancy both have a positive influence on infant BW. Whether others in the household smoke is also important.

Introduction: Systematic assessments of Motivational Interviewing (MI) in smoking behavior have been rare to date. This study aimed to determine whether an integrated approach, involving staff training in MI techniques, was sufficient to affect change in smoking status or intensity in low-income pregnant and postpartum women. Methods: Overall, 500 consecutive smokers were recruited at first prenatal visit to public antenatal clinics. Following staff training, 500 more were recruited (intervention group). Data were recorded at 28‐32 weeks gestation, after birth, at 3‐4 and 7‐9months postpartum. The primary outcome measure was self-reported continued abstinence from smoking verified by urinary cotinine analysis. Changes in smoking intensity were also measured. Results: There was no significant difference in the proportion of smokers in the intervention and control groups who reported stopping smoking at 28‐32 weeks gestation (8.2% vs. 8.8%; p=.73), 1 week after birth (8.6% vs. 11.4%; p=.14), 3‐4months after birth (5.8% vs. 4.8%; p=.48), or 7‐9months after birth (5.2% vs. 4.0%; p=.36). Although more cases were nonsmoking at the second visit, 14.8% [95% CI=11.8‐18.5] vs. 13.1% controls [95% CI=10.3‐16.6], this was not statistically significant. Conclusions: MI delivered at a number of time points during pregnancy and up to 9months postpartum failed to affect quit rates. It may have had a small effect in preventing relapse among spontaneous quitters in late pregnancy though the validity of this remains uncertain.

Obesity is a growth-promoting process as evidenced by its effect on the timing of puberty. Although studies are limited, obesity has been shown to affect the timing of tooth eruption. Both the timing and sequence of tooth eruption are important to overall oral health. The purpose of this study was to examine the association between obesity and tooth eruption. Data were combined from three consecutive cycles (2001–2006) of the National Health and Nutrition Examination Survey (NHANES) and analyzed to examine associations between the number of teeth erupted (NET) and obesity status (BMI z-score >95th percentile BMI relative to the Centers for Disease Control and Prevention (CDC) growth reference) among children 5 up to 14 years of age, controlling for potential confounding by age, gender, race, and socioeconomic status (SES). Obesity is significantly associated with having a higher average NET during the mixed dentition period. On average, teeth of obese children erupted earlier than nonobese children with obese children having on average 1.44 more teeth erupted than nonobese children, after adjusting for age, gender, and race/ethnicity (P < 0.0001). SES was not a confounder of the observed associations. Obese children, on average, have significantly more teeth erupted than nonobese children after adjusting for gender, age, and race. These findings may have clinical importance in the area of dental and orthodontic medicine both in terms of risk for dental caries due to extended length of time exposed in the oral cavity and sequencing which may increase the likelihood of malocclusions.

This article has been developed for healthcare assistants (HCAs), for whom working with people with learning disabilities may pose significant barriers to high-quality healthcare provision, due to a straightforward lack of awareness of current policies and initiatives in health. It raises the fundamental issues to be addressed within the context of healthcare provision. These are of direct relevance to the improvement of services for people with learning disabilities, aiming for the empowerment and facilitation of care for these people. Emphasis is placed upon the need for equity in healthcare for all and the need to avoid the tendency of society to homogenise all individual people with learning disabilities into one group.

Patients with a diagnosis of mental illness are statistically less likely to access physical healthcare services, resulting in increased mortality rates and diminished quality of lifes. This article identifies interactions with healthcare providers as a fundamental mechanism whereby engagement with patients may make an impact on these statistics. It highlights key aspects of the need for capacity building in and between all professional healthcare disciplines and includes two theoretical bases to demonstrate the relevance of psychosocial interventions to pharmacy practice and policy.

Patients who have been formally diagnosed with a mental illness are much less likely to access the same healthcare for general health problems as other people. As a direct result of this, patients with mental health problems are statistically much more likely to die earlier of conditions such as cancer and common minor ailments. Clinical symptoms of disease are much more likely to remain uninvestigated, with increasing numbers of mental health patients remaining undiagnosed with type 2 diabetes mellitus, for instance. Ultimately, this leads to a diminished quality of life and a markedly decreased age of death. This article identifies the role of the healthcare assistant (HCA) as one means of engaging with people for whom mental illness may be an issue. The settings in which healthcare assistants work lend themselves to conversations and communication with people which might indicate that a patient with mental illness might need additional support and help. This process can ultimately be termed the ‘therapeutic alliance’. This article highlights key aspects of the need to build capacity within and between all professional healthcare disciplines in order to provide equity of care for all. It uses two theoretical standpoints, along with worked examples, to demonstrate the relevance of basic psychosocial interventions in the context of healthcare practice. The promotion of the concept of recovery is one that has the potential to aid in the removal of stigma for people with mental illness. Healthcare assistants are present during many patient assessment, diagnosis and management pathways and it is here that the concept of the therapeutic alliance could potentially be developed further so that patients with mental health problems might be better supported.

Incidence and prevalence of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) in pregnancy have increased significantly in the past 10 years. Evidence indicates that these increases can be categorically linked to parallel increases in the incidence of pre-pregnancy obesity and the diagnosis of Type 2 diabetes mellitus on a national and international level. This article addresses the potential role of assistant practitioners (APs) and healthcare assistants (HCAs) to further develop their professional role in advocating healthy eating to women who might be pregnant or contemplating pregnancy in the near future. Raising the awareness of GDM and IGT in women who are not currently pregnant, the author suggests, might be one mechanism by which presenting cases could potentially be reduced. The article discusses the likely long- and short-term prognostic outcomes for both the mother and the neonate during pregnancy, following a diagnosis of either GDM or IGT and the specific needs of this patient cohort both during pregnancy and following parturition, when the statistical likelihood of women progressing to Type 2 diabetes mellitus is significantly greater. The article concludes with the recognition that APs and HCAs have a unique social opportunity to empower women of childbearing age to be proactive in the management of their reproductive health specifically and their general health and wellbeing overall, in relation to the potential development of GDM and IGT in pregnancy.

For some military personnel, the reality of a return to civilian life can be marred with issues of mental health. The incidence and prevalence rates of depression and substance misuse in currently serving personnel and veterans is striking. This article serves to highlight the need for increasing awareness of issues pertaining to mental health in military personnel and veterans, which can be used as predictors of risk in the likelihood of attempted suicide or longer-term mental illness.