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Objective The Cancer and Aging Research Group (CARG) score was developed to predict severe chemotherapy-induced toxicity risk in older adults; validation study results have varied. The Tolerance of Anti-cancer Systemic Therapy in the Elderly study sought to evaluate the CARG score prospectively in a chemotherapy-naïve UK population.Methods and analysis This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line chemotherapy for any solid organ malignancy or setting. Baseline demographics and established frailty measures were recorded. Follow-up data including toxicity and hospital admissions were collected retrospectively. Baseline CARG score predictive ability was assessed.Results 339 patients were recruited from 19 centres; median age 73 years (range 65–92), 51.9% male and 54.9% gastrointestinal primary. At baseline, 85% of patients were of Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0–1, with median Rockwood Clinical Frailty Scale (CFS) 3 (range 0–8).314 (92.6%) patients had follow-up data; 69 (22.3%) patients experienced Common Terminology for Cancer Adverse Events grade ≥3 toxicity and 84 (27%) required hospital admission during treatment.Increasing CARG risk groups had increased grade ≥3 toxicity (low 19.6%, medium 22.2%, high 28.2%); however, this was non-significant with no evidence of robust predictive performance. Predictive performance of CFS and ECOG PS was superior to CARG. Importantly, patient and clinician perceptions of toxicity risk differed significantly.Conclusions In older UK patients with cancer commencing chemotherapy, baseline frailty was prevalent. CARG score did not robustly discriminate or predict high-grade toxicity risk. ECOG and CFS showed superior, although limited, ability to predict and discriminate. This study highlights the need for the development of tools that better predict toxicity in this population.

Partnering with people most affected by mental health problems can transform mental health outcomes. Citizen science as a research approach enables partnering with the public at a substantial scale, but there is scarce guidance on its use in mental health research. To develop best practise guidelines for conducting and reporting research, we conducted a systematic review of studies reporting mental health citizen science research. Documents were identified from electronic databases (n = 10), grey literature, conference proceedings, hand searching of specific journals and citation tracking. Document content was organised in NVIVO using the ten European Citizen Science Association (ECSA) citizen science principles. Best practise guidelines were developed by (a) identifying approaches specific to mental health research or where citizen science and mental health practises differ, (b) identifying relevant published reporting guidelines and methodologies already used in mental health research, and (c) identifying specific elements to include in reporting studies. A total of 14,063 documents were screened. Nine studies were included, from Australia, Belgium, Canada, Denmark, Netherlands, Spain, the UK, and the United States. Citizen scientists with lived experience of mental health problems were involved in data collection, analysis, project design, leadership, and dissemination of results. Most studies reported against some ECSA principles but reporting against these principles was often unclear and unstated. Best practise guidelines were developed, which identified mental health-specific issues relevant to citizen science, and reporting recommendations. These included citizen science as a mechanism for empowering people affected by mental health problems, attending to safeguarding issues such as health-related advice being shared between contributors, the use of existing health research reporting guidelines, evaluating the benefits for contributors and impact on researchers, explicit reporting of participation at each research stage, naming the citizen science platform and data repository, and clear reporting of consent processes, data ownership, and data sharing arrangements. We conclude that citizen science is feasible in mental health and can be complementary to other participatory approaches. It can contribute to active involvement, engagement, and knowledge production with the public. The proposed guidelines will support the quality of citizen science reporting.

Abstract Background People experiencing homelessness have unique health needs and barriers to medical and behavioral health care (mental health, substance use disorder, and overall well-being) compared to housed people. It remains unclear why many people experiencing homelessness do not access care when community-based homeless health care resources are available at low or no cost. This qualitative study examined perspectives of people experiencing homelessness and staff members at community-based homeless health and service organizations in San Francisco’s Mission District on unmet medical and behavioral health needs and barriers to accessing care. Methods We conducted 34 interviews between September and November 2020: 23 with people experiencing homelessness and 11 with staff at community-based homeless health and service organizations in the Mission District. Qualitative interviews were transcribed, coded, and analyzed using the Framework Method on NVivo Qualitative Data Analysis Software. Results Both staff and homeless participants reported unmet and common health needs of mental illness, physical injury and disability, food and nutrition insecurity, and substance use disorder. Barriers to care included negative prior health care experiences, competing priorities, and provider turnover. Recommendations for improving services included building more trust with people experiencing homelessness by training clinic staff to treat patients with respect and patience and expanding clinical outreach and health education programs. Conclusions People experiencing homelessness face many different health needs and barriers to care, some of which community-based organizations have the ability to address. These findings can help inform future strategies for homeless health care programs to identify and target the specific unmet health needs and barriers to care of people experiencing homelessness in their communities.

Despite efforts to increase the implementation of active teaching and learning in higher education, teaching approaches based on information transfer are still dominant. The slow adoption has been attributed to reluctance on the part of teachers. Active digital pedagogies, such as the flipped classroom, transfer the responsibility for learning to the students, thus challenging the traditional role of the teacher. The purpose of this study was to investigate how flipped classroom supervision is aligned with conceptions of teaching among teachers working in undergraduate physiotherapy education. Data were collected through a focus-group interview with three teachers who had recently participated in flipped classroom supervision and were analysed using qualitative thematic analysis. Supervision in the flipped classroom was viewed mostly positively by the physiotherapy teachers interviewed. The less defined teaching role and the increased social interaction constituted the most radical departure from their previous experiences in traditional teaching environments. The teachers found that the teaching and learning environment enhanced the quality of students’ work. There was no indication that the student-centred pedagogies conflicted with the teachers’ conceptions of teaching and learning. The findings do not support the idea that the existing teaching culture represents a barrier to technology-supported education.

IntroductionMultiple stakeholders have recently called for greater research on the barriers to citizenship and community belonging faced by people with mental health challenges. Citizenship has been defined as a person’s access to the rights, roles, responsibilities, resources and relationships that help people feel a sense of belonging. Factors that may impact citizenship include financial precarity; intersecting forms of marginalization and oppression (e.g., racism); and the mental health care people receive. Research has yet to examine experiences of citizenship among youth with mental health challenges. To address this gap, this study will examine how youth experience citizenship; predictors of citizenship; how citizenship shapes recovery; and the degree to which youth are receiving citizenship-oriented care.MethodsThe research objectives will be evaluated using a multiphase mixed methods research design. Quantitative data will be collected cross-sectionally using validated self-report questionnaires. Qualitative data will be collected using a hermeneutic phenomenological method using semi-structured interviews and focus groups.AnalysesMultiple stepwise regression analyses will be used to determine predictors of citizenship and if of citizenship predict recovery. Pearson correlations will be computed to determine the relationship between participants’ perceived desire for, and receipt of citizenship-oriented care. Phenomenological analysis will be used to analyze qualitative data. Findings will then be mixed using a weaving method in the final paper discussion section.ConclusionFindings from this study may support the development of citizenship-oriented healthcare in Canada.

Abstract Background The immune system undergoes a myriad of changes with age. While it is known that antibody-secreting plasma and long-lived memory B cells change with age, it remains unclear how the binding profile of the circulating antibody repertoire is impacted. Results To understand humoral immunity changes with respect to age, we characterized serum antibody binding to high density peptide microarrays in a diverse cohort of 1675 donors. We discovered thousands of peptides that bind antibodies in age-dependent fashion, many of which contain di-serine motifs. Peptide binding profiles were aggregated into an “immune age” by a machine learning regression model that was highly correlated with chronological age. Applying this regression model to previously-unobserved donors, we found that a donor’s predicted immune age is longitudinally consistent over years, suggesting it could be a robust long-term biomarker of humoral immune ageing. Finally, we assayed serum from donors with autoimmune disease and found a significant association between “accelerated immune ageing” and autoimmune disease activity. Conclusions The circulating antibody repertoire has increased binding to thousands of di-serine peptide containing peptides in older donors, which can be represented as an immune age. Increased immune age is associated with autoimmune disease, acute inflammatory disease severity, and may be a broadly relevant biomarker of immune function in health, disease, and therapeutic intervention.

Introduction The number of older adults diagnosed with cancer is increasing. Older adults are more likely to have pre-existing frailty, which is associated with greater chemotherapy-related toxicity. Early identification of those at risk of toxicity is important to reduce patient morbidity and mortality. Current chemotherapy toxicity prediction tools including the Cancer and Ageing Research Group (CARG) tool exist but are not in routine clinical use and have not been prospectively validated in a UK population. This study is the first prospective study to investigate the CARG tool in a UK population with cancer.Methods and analysis Tolerance Of Anticancer Systemic Therapy In the Elderly is a prospective observational study of patients, aged ≥65 years, commencing first-line (any indication) chemotherapy for a solid-organ malignancy. Patients receiving other systemic anticancer agents or radiotherapy will be excluded. The primary objective will be to validate the ability of the CARG score to predict grade 3+ toxicity in this population. Secondary objectives include describing the feasibility of screening for frailty, as well as the prevalance of frailty in this population and assessing patient and clinician perception of chemotherapy toxicity risk. 500 patients will be recruited over a two year period. Baseline assessments will be recorded. At the end of the 6-month follow-up period, toxicity data will be retrospectively collected. A descriptive analysis of the recruited population will be performed. The validity of the CARG model will be analysed using receiver-operating characteristic curves and calculation of the area under the curve (c-statistic).Ethics and dissemination The study has received ethical approval from the East of Scotland Research Ethics Service 20/ES/0114. Results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

Abstract Introduction Open Online Courses (OOCs) are increasingly presented as a possible solution to the many challenges of higher education. However, there is currently little evidence available to support decisions around the use of OOCs in health professions education. The aim of this systematic review was to summarise the available evidence describing the features of OOCs in health professions education and to analyse their utility for decision-making using a self-developed framework consisting of point scores around effectiveness, learner experiences, feasibility, pedagogy and economics. Methods Electronic searches of PubMed, Medline, Embase, PsychInfo and CINAHL were made up to April 2019 using keywords related to OOC variants and health professions. We accepted any type of full text English publication with no exclusions made on the basis of study quality. Data were extracted using a custom-developed, a priori critical analysis framework comprising themes relating to effectiveness, economics, pedagogy, acceptability and learner experience. Results 54 articles were included in the review and 46 were of the lowest levels of evidence, and most were offered by institutions based in the United States (n = 11) and United Kingdom (n = 6). Most studies provided insufficient course detail to make any confident claims about participant learning, although studies published from 2016 were more likely to include information around course aims and participant evaluation. In terms of the five categories identified for analysis, few studies provided sufficiently robust evidence to be used in formal decision making in undergraduate or postgraduate curricula. Conclusion This review highlights a poor state of evidence to support or refute claims regarding the effectiveness of OOCs in health professions education. Health professions educators interested in developing courses of this nature should adopt a critical and cautious position regarding their adoption.

Abstract Background The purpose of the study was to describe the design, implementation and evaluation of a flipped classroom teaching approach in physiotherapy education. The flipped classroom is a blended learning approach in which students receive digital lectures as homework, while active learning activities are used in the classroom. Flipped classroom teaching enables a learning environment that aims to develop higher-order cognitive skills. Methods The study design was a historically controlled, prospective, cohort study. An eight week theoretical course on musculoskeletal disorders was redesigned, moving from a conventional approach to a flipped classroom model. Pre-class learning material consisted of about 12 h of video lectures and other digital learning resources that were split up over the duration of the course. In-class activities consisted of seven full-day seminars where students worked in groups in order to solve problem-based assignments. The assignments were designed to reflect authentic clinical problems and required critical thinking and reasoning. Outcomes were measured with course-grades and compared with historical controls of conventional teaching, using descriptive statistics. Self-perceived learning outcomes and students’ experiences were also collected in a survey. Results Fifty-one students passed the course exam, two failed and one did not attend (n = 54). The share of students with Excellent, Very good and Good (ABC) performances increased by more than 10% relative to any previous year. In addition, Satisfactory, Sufficient and Failed performances (DEF) decreased by more than 10%. Almost two thirds of the students preferred the flipped classroom approach as compared with conventional teaching. Interaction with peers and educators, and flexibility, were the most positive factors that were reported by students. Long seminars, time-constraints and low motivation with respect to preparation and educators’ roles were the most common complaints. Conclusions A flipped classroom approach in physiotherapy education resulted in improved student performances in this professional programme, when compared with conventional teaching. Students responded positively to the collaborative learning environment, especially with respect to the associated autonomy and flexibility. There were indicators that all groups did not work optimally and that accountability to other group members did not always ensure pre-classroom preparations.

Background: There is anecdotal evidence that physiotherapy clinicians increasingly are using medical apps and health-related apps as part of their clinical practice, and in some cases, even ‘prescribing apps’ to patients. However, there is limited information on how South African physiotherapists use, and what they think about, the integration of mobile apps in their practice. Objectives: This study aimed to describe the use of smartphone apps as part of clinical practice in a small group of South African physiotherapists. Method: This study made use of a cross-sectional, descriptive design and a self-administered questionnaire to survey practitioners. The population included all 1300 physiotherapists who were registered with the Orthopaedic Manipulative Physiotherapists Group (OMPTG) of the special interest group of the South African Society of Physiotherapists (SASP), with a sample of 270 out of 1300 who responded (response rate = 21%). Descriptive data are presented using graphs, figures and percentages, and responses to open-ended questions are included in support of the themes. Results: The majority of the participants used apps as part of their practice (60%) but did not prescribe apps to patients. Most apps are used for administrative and communication purposes. Even clinicians who used apps themselves expressed concerns about prescribing them to patients, and there were clear misconceptions about the use of apps. Conclusion: Many clinicians in this study reported that there were real benefits to the use of smartphone apps as part of their practice. However, they raised concerns about the more general prescription of apps for clients. Clinical implications: Further research, education and collaboration amongst all stakeholders is necessary to produce guidelines for the use of apps in clinical practice.

Purpose: To assess differences in prerequisites to blended learning such as technology use and Internet access in an international sample of physiotherapy students from Bangladesh, Belgium, Brazil, Luxembourg, Sudan, Switzerland and South Africa. Results: Students' digital technology experiences were generally low. They primarily used a smartphone and a laptop to connect to the Internet. However, there was a significant difference between institutions in owning a laptop and access to Internet. Most students preferred learning in environments that included some online components but had never used Twitter or written a blog post and wanted less social media in their learning environments. Conclusion: Physiotherapy students would prefer an increase in the use of digital tools in their learning. However, differences in technology use and access highlight the challenges inherent to offering international online courses. Therefore decisions around online and blended course design in health professions education must be made with caution. Keywords: Higher education, Physiotherapy, E-learning, Blended learning, Social media

Abstract Background Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks. Methods Fifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. Results The inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P

Background: The South African Department of Health identified the need to train a new cadre of community health worker (CHW) in the field of rehabilitation as part of their 2030 Health Plan that aims to improve primary healthcare (PHC) and community-based rehabilitation (CBR). Community health workers can be effectively utilised in CBR if their role is understood and their potential is not limited by professional protectionism and scepticism. A clear understanding of the scope of practice of a new cadre will minimise resistance by health professionals. Objectives: The aim of this study was to explore rehabilitation health professionals’ perception of the role of the new cadre, called rehabilitation care workers (RCWs), in South African healthcare. Methods: Q-methodology was used to gather and interpret the data. A convenient sample of 16 health professionals participated in the study. Participants ranked statements about the role of the RCWs from strongly agree to strongly disagree. Data were entered into PQMethod software program for statistical and factor analysis. Results: Two factors emerged. Participants loading onto Factors 1 and 2 were of the opinion that RCWs’ role would be to strengthen PHC and CBR and to promote participation of people with disabilities (PWD) in intermediate care and community. Conclusion: Rehabilitation health professionals’ positive perception of the new cadre is encouraging so that it could ensure their effective utilisation in CBR. Rehabilitation care workers were perceived as capable of enhancing the lives of PWD by ensuring inclusive development.

Background: The Department of Physiotherapy at the University of the Western Cape began accepting students with visual impairments (VIs) into the undergraduate physiotherapy programme in 1996. However, until recently, none had received a clinical rotation in any high care setting. Objectives: The aim of this study was to explore the experiences of all stakeholders involved in the process of placing a student with VI into the intensive care unit (ICU). Method: This case study used interviews with relevant stakeholders to explore their experiences of integrating the ICU placement into the student’s clinical programme. Interviews were recorded and transcribed, and then analysed thematically. Results: There was a certain amount of anxiety present, especially among clinical staff, before the placement began. Discussions among stakeholders at each stage of the process served to identify potential problems before they arose, and allowed staff to plan solutions in advance. Challenges were found in both the attitudes of staff, and in the clinical environment, some of which were relatively easy to address, while others will require significant investments of resources to resolve. Conclusion: Our findings suggest that it may be possible to successfully place students with VI into intensive care settings, and they can enjoy positive learning experiences, given an appropriate context and adequate support. However, care needs to be taken at every stage of the process to ensure that supporting structures are in place prior to, and during, the placement. Clinical implications: All stakeholders, including the students and the relevant clinical and academic staff, need to be actively involved in the process of planning for the clinical placement.

Randomised controlled trials (RCTs) are a valued research method in evidence-based practice in medical and clinical settings because they are associated with a particular ontological and epistemological perspective that is situated within a positivist world view. It assumes that environments and variables can be controlled to establish cause-effect relationships. However, current theories of learning suggest that knowledge is socially constructed, and that learning occurs in open systems that cannot be controlled and manipulated as would be required in a RCT. They recognise the importance and influence of context on learning, which positivist research paradigms specifically aim to counter. We argue that RCTs are inappropriate in education research because they force one to take up ontological and epistemological positions in a technical rationalist framework, which is at odds with current learning theory.

The complexity of the eukaryotic parasite Trypanosoma (T.) cruzi manifests in its highly dynamic genome, multi-host life cycle, progressive morphologies and immune-evasion mechanisms. Accurate determination of infection or Chagas' disease activity and prognosis continues to challenge researchers. We hypothesized that a diagnostic platform with higher ligand complexity than previously employed may hold value.We applied the ImmunoSignature Technology (IST) for the detection of T. cruzi-specific antibodies among healthy blood donors. IST is based on capturing the information in an individual's antibody repertoire by exposing their peripheral blood to a library of >100,000 position-addressable, chemically-diverse peptides.Initially, samples from two Chagas cohorts declared positive or negative by bank testing were studied. With the first cohort, library-peptides displaying differential binding signals between T. cruzi sero-states were used to train an algorithm. A classifier was fixed and tested against the training-independent second cohort to determine assay performance. Next, samples from a mixed cohort of donors declared positive for Chagas, hepatitis B, hepatitis C or West Nile virus were assayed on the same library. Signals were used to train a single algorithm that distinguished all four disease states. As a binary test, the accuracy of predicting T. cruzi seropositivity by IST was similar, perhaps modestly reduced, relative to conventional ELISAs. However, the results indicate that information beyond determination of seropositivity may have been captured. These include the identification of cohort subclasses, the simultaneous detection and discerning of other diseases, and the discovery of putative new antigens.The central outcome of this study established IST as a reliable approach for specific determination of T. cruzi seropositivity versus disease-free individuals or those with other diseases. Its potential contribution for monitoring and controlling Chagas lies in IST's delivery of higher resolution immune-state readouts than obtained with currently-used technologies. Despite the complexity of the ligand presentation and large quantitative readouts, performing an IST test is simple, scalable and reproducible.

This is a two-phase study, the first was a literature review that aimed to identify a set of competencies for professional practice that would be relevant for the health care of People with disabilities (PwD). These competencies were then used to plan a thirty-hour multidisciplinary course for undergraduate health care students. The educational intervention led to improvements in the students’ learning experiences, including the development of empathy and knowledge related to the care of PwD, improved knowledge around accessibility, and an awareness of the need to humanize the care of PwD. Students reported enhanced learning experiences and an increase in knowledge related to the care of PwD, and also highlighted the need to humanize the care.

Transferring principles and practices to different sociocultural and professional contexts in the field of mental health can be very complex. Previous research on public health policy points to difficulties in different areas such as the understanding the new concepts, their applicability in different health systems, and suitable approaches to its effective implementation. The purpose of this article is to describe and analyze the process of transferring the concept of Citizenship, from its United States origins in mental health outreach work with persons who are homeless to Catalonia, Spain. We define Citizenship as promoting the rights, responsibilities, roles, resources and relationships of persons with mental illnesses, along with a sense of belonging that is validated by other citizens. The process of this transition involves embedding Citizenship in the mental health “first-person” (internationally known as Consumer/Survivor/Peer) movement in Catalonia. The paper includes a discussion of the concept of transference, including a case example of the adoption of the concept of mental health recovery in different countries. Following this, we describe the United States Citizenship model and key elements of its development. We then turn to Spain and the evolution of its mental health system, and then to Catalonia for a brief case history of transference of the principles and practices of Citizenship to that region. The “take home message” of this work is that concepts being brought from one sociocultural and national context to another, must focus on contextualization in the ‘adoptee’s’ practices, including the balance between personal involvement and professional rigor, the involvement of key actors, and ongoing evaluation of actions taken.

Background: In order to negotiate complex clinical environments successfully, healthcare professionals must be more than competent – they must demonstrate an ability to adapt to dynamic situations and continually improve performance. However, emphasis on knowledge and skills alone may ignore opportunities for professional development that enables students to become practitioners. Objectives: The aim of this study was to ascertain what clinical experts believe are the essential characteristics of capable healthcare professionals that go beyond academic and technical competencies. Method: This study used a nominal group technique (NGT) to gather data from a panel of South African and international clinical experts, using open-ended questions and qualitative data analysis to determine emergent themes. The NGT is an interpretive research method that can be used to explore poorly defined topics, in this case to develop an understanding of the characteristics of health professionals that go beyond knowledge and technical skill. Results: Panel members highlighted the importance of knowledge and skills for competent practice, but also explored other aspects of the learning process as part of developing professional identity. These included self-evaluation as part of professional development,building relationships with patients, and the importance of acknowledging students’emotional responses to the clinical environment. Panel members also discussed the challenge of inappropriate role-models in the clinical context, who may have a negative influence on the development of professional practice. Conclusion: By including the concept of capability alongside competency in undergraduate healthcare curricula clinical educators can help students develop a sense of being that emphasises professional growth alongside knowledge and technical skills.