Search

Introduction Pre-registration interprofessional rural immersion programmes provide students with first-hand insight into challenges faced in rural clinical practice and can influence future practice intentions. The impact of short rural and hauora Māori interdisciplinary placements on early healthcare careers is unknown. Aim Explore whether a 5-week rural interprofessional education programme influenced graduates' choices to work in primary care, rurally, and with Māori patients. Methods We conducted a survey-based, non-randomised trial of graduates from eight healthcare disciplines who did (n  = 132) and did not (n  = 479) attend the Tairāwhiti interprofessional education rural programme with hauora Māori placements. Participants were surveyed at 1-, 2-, and 3-years' post-registration. Self-reported practice location and vocation were analysed with mixed-model logistic regression. Free-text comments were analysed with Template Analysis. Results We did not identify any measurable impact on rural or community workforce participation at 3-years' post-registration. Free-text analysis indicated that a short rural interprofessional immersion placement had long-term self-perceived impacts on desire and skills to work in rural locations, and on desire and ability to work with Māori and embrace Māori models of health. Discussion Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers. Three-years' post-graduation may be too early to determine whether rural placements help to address rural health workforce needs. Reports from rural placement participants of increased ability to care for people from rural backgrounds, even when encountered in a city, suggest that assessment of practice location may not adequately capture the benefits of rural placement programmes.

Objective: To assess whether a preregistration interprofessional education (IPE) programme changed attitudes towards teamwork and team skills during health professionals' final year of training and first 3 years of professional practice., Design: Prospective, longitudinal, non-randomised trial., Setting: Final year health professional training at three academic institutions in New Zealand., Participants: Students from eight disciplines eligible to attend the IPE programme were recruited (617/730) prior to their final year of training. 130 participants attended the IPE programme; 115 intervention and 372 control participants were included in outcome analysis., Intervention: The 5-week Tairāwhiti IPE (TIPE) immersion programme during which students experience clinical placements in interdisciplinary teams, complete collaborative tasks and live together in shared accommodation., Main Outcome Measures: Data were collected via five surveys at 12-month intervals, containing Attitudes Towards Healthcare Teams Scale (ATHCTS), Team Skills Scale (TSS) and free-text items. Mixed-model analysis of covariance, adjusting for baseline characteristics, compared scores between groups at each time point. Template analysis identified themes in free-text data., Results: Mean ATHCTS scores for TIPE participants were 1.4 (95% CI 0.6 to 2.3) points higher than non-TIPE participants (p=0.002); scores were 1.9 (95% CI 0.8 to 3.0) points higher at graduation and 1.1 (95% CI -0.1 to 2.4) points higher 3 years postgraduation. Mean TSS scores for TIPE participants were 1.7 (95% CI 0.0 to 3.3) points higher than non-TIPE participants (p=0.045); scores were 3.5 points (95% CI 1.5 to 5.5) higher at graduation and 1.3 (95%CI -0.8 to 3.5) points higher 3 years postgraduation. TIPE participants made substantially more free-text comments about benefits of interprofessional collaboration and perceived the TIPE programme had a meaningful influence on their readiness to work in teams and the way in which they performed their healthcare roles., Conclusions: TIPE programme participation significantly improved attitudes towards healthcare teams and these changes were maintained over 4 years., Competing Interests: Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The stemness-associated markers OCT4, NANOG, SOX2, KLF4 and c-MYC are expressed in numerous cancer types suggesting the presence of cancer stem cells (CSCs). Immunohistochemical (IHC) staining performed on 12 lung adenocarcinoma (LA) tissue samples showed protein expression of OCT4, NANOG, SOX2, KLF4 and c-MYC, and the CSC marker CD44. In situ hybridization (ISH) performed on six of the LA tissue samples showed mRNA expression of OCT4, NANOG, SOX2, KLF4 and c-MYC. Immunofluorescence staining performed on three of the tissue samples showed co-expression of OCT4 and c-MYC with NANOG, SOX2 and KLF4 by tumor gland cells, and expression of OCT4 and c-MYC exclusively by cells within the stroma. RT-qPCR performed on five LA-derived primary cell lines showed mRNA expression of all the markers except SOX2. Western blotting performed on four LA-derived primary cell lines demonstrated protein expression of all the markers except SOX2 and NANOG. Initial tumorsphere assays performed on four LA-derived primary cell lines demonstrated 0-80% of tumorspheres surpassing the 50 µm threshold. The expression of the stemness-associated markers OCT4, SOX2, NANOG, KFL4 and c-MYC by LA at the mRNA and protein level, and the unique expression patterns suggest a putative presence of CSC subpopulations within LA, which may be a novel therapeutic target for this cancer. Further functional studies are required to investigate the possession of stemness traits.

Background: Group A Streptococcus (GAS) can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). Historically, ARF has been considered a consequence of preceding GAS pharyngitis, but increasing evidence suggests that GAS skin infections may be a driver. Data on the primary care burden of GAS skin infection are limited. This paper aims to describe and compare the prevalence and distribution of GAS detection in skin swabs and ARF rates in the Auckland population., Methods: This cross-sectional study used all laboratory skin swab data from people who had a skin swab taken as a result of a consultation with a health professional in the Auckland region (2010-2016). Initial primary hospitalisations for ARF were identified and all data were linked using unique patient identifiers to patient's age, prioritised ethnicity, sex, and socio-economic status., Findings: 377,410 skin swabs from 239,494 individuals were included. 12·8% of swabs were GAS positive, an annual incidence of 4·8 per 1,000 person-years. Māori and Pacific Peoples under 20 years of age had markedly higher GAS detection in skin swabs (RR 4·0; 95% CI 3·9-4·2: RR 6·8; 95% CI 6·6-7·0) and significantly higher ARF rates (RR 30·3; 95% CI 19·5-46·9: RR 69·7 95% CI 45·8-106·1) compared with European/Other ethnicities., Interpretation: The observation that GAS detection was markedly higher in Māori and Pacific Peoples provides a potential explanation for the marked ethnic differences in ARF. These findings support a greater focus on addressing the burden of skin infection in NZ, including as ARF prevention., Funding: The first author received a training stipend from the New Zealand College of Public Health Medicine (NZCPHM) during her Masters of Public Health., Competing Interests: The authors have no conflict of interest to declare., (© 2021 The Authors. Published by Elsevier Ltd.)

Background: Self-monitoring is an important component of clinical practice. It is underpinned by the framework of self-efficacy which is concerned with judgments of how well one believes one can achieve or perform a task. This research aimed to develop criteria for adequate self-monitoring, then to measure patterns of self-monitoring, and to explore how these patterns relate to a student's year in a medical course and to patterns of knowledge., Methods: Analysis of individuals' levels of correctness in answering assessment items and their certainty in correctness may be used to inform assessments of ability to self-monitor. Two criteria were proposed and applied to define adequate self-monitoring. Firstly, increasing proportions correct with increasing levels of certainty. Secondly, having a proportion correct for high certainty responses that was not lower than cohort levels. Student responses in progress tests comprising multiple-choice questions (MCQs) and associated certainty were analysed. Criteria for the presence of adequate self-monitoring and for adequate knowledge were applied to the results of each of four tests conducted over 2 years, and used to categorise patterns of self-monitoring and knowledge., Results: Data from 3 year group cohorts totalling 737 students were analysed. The majority (58%) of students demonstrated adequate knowledge and met both criteria for adequate self-monitoring across all four tests. The most advanced year group cohort had the highest rates of adequate knowledge and the highest rates of meeting both self-monitoring criteria. The patterns of self-monitoring were the same as the patterns of knowledge across the four tests for 454 students, but for the remaining 283 the patterns of self-monitoring and knowledge differed., Conclusion: Analysis of responses to item level certainty has informed development of a definition of adequate self-monitoring that may be applied to individual student's responses from a single test, and to track the adequacy of a student's self-monitoring over time. Patterns of self-monitoring tend to match patterns of knowledge, but not in all cases, suggesting the self-monitoring measure could provide additional information about student ability.

Purpose: Acute radiation cystitis affects the quality of life of many prostate cancer patients. A previous pilot study suggested that cranberry capsules may decrease some of the symptoms of acute radiation cystitis. Here we further test their effectiveness in a multicentre double blinded placebo-controlled clinical trial., Material and Methods: A total of 108 prostate cancer patients were recruited at three New Zealand hospitals between September 2016 and January 2019. Out of this cohort, 101 patients provided datasets for analysis (51 men on cranberry capsules and 50 men on beetroot-containing placebo capsules). Patients took two capsules each morning during RT and for 2 weeks after completion of RT. Three measures were used to assess cystitis severity: modified RTOG, O'Leary interstitial cystitis scale and a sensitive novel radiation induced cystitis assessment scale (RICAS). Cystitis severity was scored at baseline and weekly thereafter during RT and for two weeks after completion of RT. Radiation protocols were stratified to conventional fractionation or hypo-fractionated radiation therapy (CHHiP) to the prostate or radiation to the prostate bed., Results: Cranberry capsules performed significantly worse than placebo capsules with respect to day time frequency and bladder control, using the more sensitive RICAS scale. No significant difference in cystitis severity was seen between patients receiving hypofractionation and those receiving conventional fractionation to the prostate gland., Conclusion: Cranberry capsules were not superior to beetroot-containing placebo capsules in managing radiation cystitis in our prostate patient cohort. RICAS may be a useful tool for measuring radiation cystitis in future studies., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Communication has an essential role in the therapeutic relationship between a patient and healthcare professionals (HCPs) with terminology playing an important role. The terminology used by HCPs can significantly impact on an individual's perceptions of weight and experience of stigma. This is the first quantitative research study in Aotearoa New Zealand to explore weight-related terminology., Method: A self-completion questionnaire was administered to a convenience sample of adults aged 18 years and over, residing in New Zealand across four different geographical regions (Auckland, Wellington, Christchurch and Dunedin) in 2016., Results: Seven hundred and seventy-five participants completed questionnaires, with 330 identifying as HCPs or HCP students, 440 as lay persons and five not specified. 'Weight' or 'high BMI' were the most preferred terms for describing excess adiposity for participants. The term 'bariatric' is poorly understood in New Zealand. There was dissonance in responses relating to the terms considered most blaming and those considered to be motivating terms to lose weight., Conclusion: The terms 'weight' or 'high BMI' are the terms most commonly preferred across this and other surveys, although neither term is meaningful in describing accurately the clinical relevance of the person's size during the HCP-patient interaction. Whichever term is selected, HCP-patient conversations need to be respectful, appropriate and support meaningful non-stigmatising dialogue., Competing Interests: Nil.

Aims: There is inequitable distribution of health risks, exposures, resources and outcomes by ethnicity. This may be contributed to by health professional bias. The aim of this study was to investigate the relationship between ethnicity of patients, within written assessment case scenarios, and medical students' response correctness and certainty., Methods: Otago Medical School students sit a 150 MCQ progress test with item level response certainty. Patient ethnicity for 60 MCQ case scenarios was varied between two ethnic groups (New Zealand European, Māori) and none specified. Analysis of responses by patient ethnicity was undertaken to compare: odds of correctness; level of certainty; correctness for level of certainty and also by year groups and ability., Results: One thousand one hundred and three students sat the test. There was no significant difference in odds of correctness or level of certainty by the ethnicity of the patient case scenario. These did not differ significantly by year groups or ability groups, or for correctness by level of certainty., Conclusions: No systematic differences in correctness or certainty of student responses to case scenarios by patient ethnicity were detected. Further exploration is warranted, including incorporating more ethnicity descriptors, analysis of incorrect answers, analyses for patterns responses over time by individual students, and selecting questions where varying patient ethnicity is expected to alter the correct response or difficulty., Competing Interests: Nil.

Lactobacillus rhamnosus is a type of bacteria known as a probiotic and is often used to support the health of the digestive system and vaginal flora. This type of bacteria has an important role, showing positive effects on female reproductive biology, particularly by maintaining the balance of microorganisms in the vagina, reducing the risk of infection, and strengthening the immune system to support maternal health during pregnancy. There are also studies showing that these probiotics prevent maternal obesity and gestational diabetes. Consuming probiotics containing Lactobacillus rhamnosus strains may support the intestinal health of breastfeeding mothers, but they may also contribute to the health of offspring. Therefore, this review focuses on the current available data for examining the effects of Lactobacillus rhamnosus strains on female reproductive biology and offspring health. A systematic search was conducted in the PubMed and Web of Science databases from inception to May 2024. The search strategy was performed using keywords and MeSH (Medical Subject Headings) terms. Inconsistent ratings were resolved through discussion. This review is strengthened by multiple aspects of the methodological approach. The systematic search strategy, conducted by two independent reviewers, enabled the identification and evaluation of all relevant literature. Although there is a limited number of studies with high heterogeneity, current literature highlights the important contribution of Lactobacillus rhamnosus probiotics in enhancing female reproductive health and fertility. Furthermore, the probiotic bacteria in breast milk may also support the intestinal health of newborn, strengthen the immune system, and protect them against diseases at later ages., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In a two-centre randomized placebo-controlled trial of Lactobacillus rhamnosus HN001 (HN001) (6 × 10 9 colony-forming units [cfu]) or Bifidobacterium lactis HN019 (HN019) (9 × 10 9 cfu) taken daily from 35-week gestation to 6 months' post-partum in mothers while breastfeeding and from birth to age 2 years in infants, we showed that HN001 significantly protected against eczema development at 2, 4 and 6 years and atopic sensitization at 6 years. There was no effect of HN019. We report here the findings for 11 year outcomes., Methods: At age 11 years, eczema was defined as previously using the UK Working Party's Diagnostic Criteria. Asthma, wheeze, hay fever and rhinitis were defined based on the International Study of Asthma and Allergies in Childhood (ISAAC) questions. Atopic sensitization was defined as one or more positive responses (mean wheal diameter ≥3 mm) to a panel of food and aeroallergens. Analysis was intention-to-treat using hazard ratios to assess probiotic effects on the 11-year lifetime prevalence and relative risks for point or 12-month prevalence at 11 years., Results: Early childhood HN001 supplementation was associated with significant reductions in the 12-month prevalence of eczema at age 11 years (relative risk [RR] = 0.46, 95% CI 0.25-0.86, P = 0.015) and hay fever (RR = 0.73, 95% CI 0.53-1.00, P = 0.047). For the lifetime prevalence, HN001 was associated with a significant reduction in atopic sensitization (hazard ratio [HR] = 0.71, 95% CI 0.51-1.00, P = 0.048), eczema (HR = 0.58, 95% CI 0.41-0.82, P = 0.002) and wheeze (HR = 0.76, 95% CI 0.57-0.99, P = 0.046). HN019 had no significant effect on these outcomes., Conclusion: This is the first early probiotic intervention to show positive outcomes for at least the first decade of life across the spectrum of allergic disease., (© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Background: In a randomized placebo-controlled trial, we previously found that the probiotic Lactobacillus rhamnosus HN001 (HN001) taken by mothers from 35 weeks of gestation until 6 months post-partum if breastfeeding and their child from birth to age 2 years halved the risk of eczema during the first 2 years of life. We aimed to test whether maternal supplementation alone is sufficient to reduce eczema and compare this to our previous study when both the mother and their child were supplemented., Methods: In this 2-centre, parallel double-blind, randomized placebo-controlled trial, the same probiotic as in our previous study (HN001, 6 × 10 9 colony-forming units) was taken daily by mothers from 14-16 weeks of gestation till 6 months post-partum if breastfeeding, but was not given directly to the child. Women were recruited from the same study population as the first study, where they or their partner had a history of treated asthma, eczema or hay fever., Results: Women were randomized to HN001 (N = 212) or placebo (N = 211). Maternal-only HN001 supplementation did not significantly reduce the prevalence of eczema, SCORAD ≥ 10, wheeze or atopic sensitization in the infant by 12 months. This contrasts with the mother and child intervention study, where HN001 was associated with reductions in eczema (hazard ratio (HR): 0.39, 95% CI 0.19-0.79, P = .009) and SCORAD (HR = 0.61, 95% 0.37-1.02). However, differences in the HN001 effect between studies were not significant. HN001 could not be detected in breastmilk from supplemented mothers, and breastmilk TGF-β/IgA profiles were unchanged., Conclusion: Maternal probiotic supplementation without infant supplementation may not be effective for preventing infant eczema., (© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Aim: Very preterm (VPT) children (≤32 weeks) have school readiness difficulties across multiple domains, but routine follow-up is often limited. We assessed the performance of VPT children on the Before School Check (B4SC), a community-based screening programme of school readiness at 4 years of age., Methods: VPT children discharged from Wellington and Auckland Neonatal Intensive Care Units (2005-2009) were compared to a national control cohort born during the same period. Outcome measures included Parental Evaluation of Developmental Status (PEDS), parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T) and vision and hearing screening, and were related to perinatal and demographic characteristics obtained from the Australia and New Zealand Neonatal Network database., Results: Of 1105 VPT children, 920 were matched to the B4SC database, of whom 814 (88%) had one or more B4SC screening outcomes recorded. Compared with controls, VPT children were more likely to have abnormal PEDS (odds ratio (OR) = 1.79, 1.53-2.10), SDQ-P (OR = 1.82, 1.49-2.23), SDQ-T (OR = 1.51, 1.10-2.06), vision (OR = 2.00, 1.54-2.60) and hearing (OR = 1.95, 1.65-2.31) screen outcomes. While VPT children with an abnormal screen were more likely to be referred for further assessment, only 34%, 22%, 94% and 51% with abnormal PEDS, SDQ or vision and hearing screen, respectively, had evidence of appropriate referral. School readiness difficulties were significantly associated with birthweight z-score ≤ -1, vaginal delivery, significant cranial ultrasound abnormalities, younger maternal age, higher deprivation neighbourhood and ventilation ≥72 h., Conclusion: Community-based screening may be useful for identifying VPT children with school readiness difficulties, but low referral rates may limit the effectiveness of such programmes., (© 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Introduction: Interprofessional practice is recognised as an important element of safe and effective healthcare. However, few studies exist that evaluate how preregistration education contributes to interprofessional competencies, and how these competencies develop throughout the early years of a health professional's career. This quasiexperimental study will gather longitudinal data during students' last year of preregistration training and their first 3 years of professional practice to evaluate the ongoing development of interprofessional competencies and the influence that preregistration education including an explicit interprofessional education (IPE) programme may have on these., Methods and Analysis: Participants are students and graduates from the disciplines of dentistry, dietetics, medicine, nursing, occupational therapy, oral health, pharmacy and physiotherapy recruited before their final year of study. A subset of these students attended a 5-week IPE immersion programme during their final year of training. All data will be collected via five written or electronic surveys completed at 12-month intervals. Each survey will contain the Attitudes Towards Health Care Teams Scale and the Team Skills Scale, as well as quantitative and free-text items to explore vocational satisfaction, career trajectories and influences on these. Students who attend the IPE programme will complete additional free-text items to explore the effects of this programme on their careers. Quantitative analysis will compare scores at each time point, adjusted for baseline scores, for graduates who did and did not participate in the IPE programme. Associations between satisfaction data and discipline, professional setting, location and IPE participation will also be examined. Template analysis will explore free-text themes related to influences on career choices including participation in preregistration IPE., Ethics and Dissemination: This study has received approval from the University of Otago Ethics Committee (D13/019). Results will be disseminated through peer-reviewed publications, conferences and stakeholder reports. Findings will inform future IPE developments and health workforce planning., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Context: Measuring appropriateness of certainty of responses in a progress test using descriptors authentic to practice as reflection-in-action builds on existing theories of self-monitoring. Clinicians making decisions require the ability to accurately self-monitor, including certainty of being correct. Inappropriate certainty could lead to medical error. Self-assessment and certainty of assessment performance have been measured in a variety of ways. Previous work has shown that those with less experience are less accurate in self-assessment, but such studies looked at self-assessment using methods less authentic to clinical practice. This study investigates how correctness varies with certainty, allowing for experience and performance., Methods: Students in Years 2-5 were certain of their responses to two iterations of a progress test during one calendar year. Analyses compared correctness for certainty of response, test number, student year cohort and performance level, defined by criterion scores., Results: The odds of a correct response increased with student certainty for all subsets allowing for year group and ability, including student subsets with less experience and subsets in lower-performance groups., Conclusion: Unlike previous work showing poorer accuracy of self-assessment for those with less experience or ability, we postulate that our finding of similar increases in correctness with increasing certainty even in the less experienced and lower performance groups, relates to certainty descriptors being worded in a way that is authentic to clinical practice, and in turn related to reflection-in-action., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

The cardiovascular effects of equal doses (5 mg) of nebulised fenoterol, salbutamol and terbutaline were compared in 12 healthy individuals in a double-blind, placebo-controlled study. Measurements of heart rate, blood pressure, systolic time intervals, QTc interval and T-wave amplitude were made at baseline and at 15, 30, 45, 60 and 90 minutes after nebulisation. Fenoterol caused significantly greater chronotropic electrocardiographic and inotropic effects than either salbutamol or terbutaline. The peak effects after terbutaline occurred later than those after fenoterol or salbutamol. [ABSTRACT FROM PUBLISHER]