Building an evidence base for osteopathy: Trials and tensions. A qualitative study of the experience of clinicians engaging in research.

BACKGROUND: Engaging in clinical research includes confronting challenges about the uncertainty around outcomes and ramifications the results may have on practice. This is pertinent for osteopathy where little is known about the experiences of osteopaths involved in clinical trials. The aim of this study was to explore the lived experience of osteopaths who participated in a randomised controlled trial for infantile colic. The study was informed by a principles-based approach to clinical ethics and their application to practice. DESIGN: Qualitative study using semi-structured interviews and reflexive thematic analysis. SETTING: An international two-arm pragmatic randomised controlled trial (the CUTIES trial) to evaluate the effectiveness of osteopathic care for infantile colic. METHODS: A principles-based approach to clinical ethics and their application to practice for osteopaths asked to make decisions about participating in a clinical trial was used. Osteopaths from the UK and Australia who completed the CUTIES trial training were invited to be interviewed about their experiences, regardless of whether they went on to recruit infants in the trial. Interviewees were asked about their reasons for wanting to participate in the CUTIES trial, why they decided to continue or not to continue in the trial and, for those who completed the trial, their personal experiences as participants in the trial. Data were analysed using reflexive thematic analysis. RESULTS: Nine osteopaths were interviewed. Three themes were identified from the data: Paradigm dilemma - observed clinical outcomes vs scientific evidence for mechanism of effects; trial-related ethical dilemmas; and trial outcome dilemmas. CONCLUSION: Participating in the CUTIES trial required osteopaths to overcome clinical ethical dilemmas for the benefit of patients, the research, and the profession.

Factors that influence the scope of practice of the chiropractic profession in Australia: a thematic analysis.

Scope of practice has been defined as the activities that an individual health care practitioner is allowed to undertake within a specific profession. The chiropractic profession in Australia does not currently have a documented scope of practice. Informed discussions around scope of practice are hampered by a paucity of literature in this area. Acknowledging this void in the literature, we chose to investigate the factors that influence scope of practice of the chiropractic profession. A knowledge of the factors will facilitate discussion on the topic and help the profession to work towards establishing a scope of practice.Aim The aim of this study was to identify the factors that influence scope of practice of chiropractic in Australia from the perspective of 4 stakeholder groups within the profession.Methods This study employed semi-structured, online-interviews. Open-ended questions, guided by a flexible interview protocol, and augmented by supplemental questions, probes and comments, were used to gather data on the research question. Data were analysed using reflexive thematic analysis.Results Six factors that influenced scope of practice of chiropractic were identified in this study: education, evidence (research-derived and practice-based), political influence, community expectations, entrepreneurial business models, and geographical location.Conclusion Knowledge of the factors that influence scope of practice of chiropractic in Australia is important for establishing a scope of practice for the profession. This knowledge is also of value to a range of stakeholders including patients, health care providers (within and outside the profession), professional associations, and policymakers.

Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review.

OBJECTIVE: Clinical Practice Guidelines (CPGs) aim to support management of hip and knee osteoarthritis (OA), but recommendations are often conflicting and implementation is poor, contributing to evidence-to-practice gaps. This systematic review investigated the contextual and methodological factors contributing to conflicting recommendations for hip and knee OA. METHOD: Our systematic review appraised CPGs for managing hip and knee OA in adults ≥18 years (PROSPERO CRD42021276635). We used AGREE-II and AGREE-REX to assess quality and extracted data on treatment gaps, conflicts, biases, and consensus. Heterogeneity of recommendations was determined using Weighted Fleiss Kappa (K). The relationship between (K) and AGREE-II/AGREE-REX scores was explored. RESULTS: We identified 25 CPGs across eight countries and four international organisations. The ACR, EULAR, NICE, OARSI and RACGP guidelines scored highest for overall AGREE-II quality (83%). The highest overall AGREE-REX scores were for BMJ Arthroscopy (80%), RACGP (78%) and NICE (76%). CPGs with the least agreement for pharmacological recommendations were ESCEO and NICE (-0.14), ACR (-0.08), and RACGP (-0.01). The highest agreements were between RACGP and NICE (0.53), RACGP and ACR (0.61), and NICE and ACR (0.91). Decreased internal validity determined by low-quality AGREE scores(<60%) in editorial independence were associated with less agreement for pharmacological recommendations. CONCLUSION: There were associations between guideline quality and agreement scores. Future guideline development should be informed by robust evidence, editorial independence and methodological rigour to ensure a harmonisation of recommendations. End-users of CPGs must recognise the contextual factors associated with the development of OA CPGs and balance these factors with available evidence.

Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care?

INTRODUCTION: Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. METHOD: A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). RESULTS: The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. CONCLUSION: To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.

Australian National Complementary Medicine Workforce Survey: A Profile of Practitioners and Their Practices.

Introduction: Recent years have seen rapid changes to traditional, complementary, and integrative medicine (TCIM) practices in Australia associated with increased interest in TCIM during the COVID-19 pandemic and reorganization of practice delivery methods. This study aimed to update the understanding of the current TCIM workforce in Australia. Methods: Representatives of six TCIM professional organizations developed a survey for e-mail distribution to members. The anonymous online Qualtrics survey was based on previous surveys to identify workforce trends over time. Survey data were analyzed descriptively using Qualtrics and STATA statistical software (version 16). Results: Responses were recorded from 1921 participants. Respondents were predominantly female (79.7%); 71.8% were aged over 45 years. Remedial massage therapists represented 32.1% and naturopaths represented 23.7% of respondents. Highest qualifications were diplomas (37.7%), bachelor's degrees (28.9%), and advanced diplomas (21.8%). Metropolitan locations accounted for 68.1% of practices. Solo private practice was the main practice setting (59.8%); 13.8% practiced in group private practice with TCIM practitioners; and 10.6% practiced with allied health practitioners. Approximately three quarters of respondents (73.9%) saw 0-5 new clients per week; 42.2% had 0-5 follow-up consultations per week. Collaboration rates with TCIM practitioners, other non-TCIM practitioners, and general medical practitioners (GPs) were 68.7%, 24.4%, and 9.2%, respectively. A total of 93% did not suspect an adverse event from their treatment in the past year. Businesses of 75.9% of respondents were reportedly affected by the pandemic. Discussion: Comparisons with previous surveys show ongoing predominance of female practitioners, an aging workforce, a high proportion of remedial massage and naturopathy practitioners, and an increasingly qualified TCIM workforce. There was little change in the very low number of adverse events suspected by practitioners, number of consultations per week, and low levels of income of most TCIM practitioners compared with the average income in Australia. Respondents collaborated at similar rates as in the past; however, more with TCIM practitioners than with GPs.

Healthcare professionals' experiences and perceptions of artificial intelligence in regional and rural health districts in Australia.

INTRODUCTION: A greater understanding of Australian healthcare professionals' perceptions of artificial intelligence (AI) is needed to identify the challenges ahead as this new technology finds its way into healthcare delivery. OBJECTIVE: The aim of this study was to identify healthcare professionals' perceptions of AI, their understanding of this technology, their education needs and barriers they perceived to its implementation. DESIGN: Healthcare professionals in eight local health districts in New South Wales Australia were surveyed using the Shinners Artificial Intelligence Perception (SHAIP) tool. FINDINGS: The study surveyed 176 participants from regional (59.5%), rural (36.4%) and metropolitan (4.0%) healthcare districts in Australia. Only 27% of all participants stated they are currently using AI in the delivery of care. The study found that Age, Discipline, Use of AI and Desire for Education had a significant effect on perceptions of AI, and that overall healthcare professionals believe AI will impact their role and they do not feel prepared for its use. The study showed that understanding of AI is varied and workforce knowledge is seen as the greatest barrier to implementation. More than 75% of healthcare professionals desire education about AI, its application and ethical implications to the delivery of care. CONCLUSION: The development of education is needed urgently to prepare healthcare professionals for the implementation of AI.

Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels.

BACKGROUND: Social media platforms such as YouTube can be used to educate people of reproductive age about healthy and nonrisky sexual and reproductive health (SRH) practices and behaviors. However, there is a paucity of evidence to ascertain the authenticity of sexuality and SRH content on Kinyarwanda YouTube, making it difficult to determine the extent to which these topics are covered, the characteristics of available videos, and the themes covered by these videos. OBJECTIVE: The aims of this study were (1) to determine the extent to which YouTube channels in Kinyarwanda-language videos address sexuality and SRH issues, identify the general characteristics of the available videos (type of video, when published, intention for the audience, and content focus), and the aspects of sexuality and SRH covered; and (2) to identify the themes covered by retrieved Kinyarwanda videos, and the extent to which the channels have been used to communicate issues of sexuality and SRH during the COVID-19 pandemic. METHODS: Using a content analysis approach, we searched Kinyarwanda YouTube channels to analyze videos about sexuality and SRH. The adopted framework for data collection from social media platforms builds on three key steps: (1) development, (2) application, and (3) assessment of search filters. To be included, an audio and/or visual video had to be in Kinyarwanda and the video had to be directed to the general public. Descriptive statistics (frequency and percentages) were computed to characterize the basic characteristics of retrieved channels, portrayal of the videos, and presentation of sexuality and SRH themes that emerged from retrieved videos. Further analysis involved cross-tabulations to explore associations between the focus of the channel and the date when the channel was opened and the focus of the channel and who was involved in the video. RESULTS: The YouTube search retrieved 21,506 videos that tackled sexuality and SRH topics. During the COVID-19 pandemic, there was a 4-fold increase (from 7.2% to 30.6%) in channels that solely focused on sexually explicit content. The majority of the 1369 retrieved channels (n=1150, 84.0%) tackled the topic of sexuality, with sexually explicit content predominantly found in the majority of these videos (n=1082, 79%), and only 16% (n=287) of the videos covered SRH topics. CONCLUSIONS: This is the first study to analyze the use of YouTube in communicating about sexuality and SRH in the Kinyarwanda language. This study relied on videos that appeared online. Further research should gather information about who accesses the videos, and how channel owners and individuals involved in the videos perceive the impact of their videos on the Rwandan community's sexuality and SRH.

Chiropractic Profession Attrition: A Narrative Review of Studies Over the Past 30 Years.

Objective: The purpose of this review was to investigate and discuss the available literature regarding chiropractic profession attrition. Methods: For this narrative review, searches for peer-reviewed observational and experimental papers published from January 1991 to December 2021 were conducted in the following 5 databases: MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Scopus, and Web of Science. Keywords included "chiropractic," "attrition," and "burnout, professional." Studies related to student or patient dropouts were excluded. Results: Three of 108 identified papers met the inclusion criteria. Two studies that measured attrition rates reported between 4.5% and 27.8%. These ranges are limited to 1982 to 1991 graduates of Life College of Chiropractic West and individuals issued a California chiropractic license in 1991. The remaining study that investigated the attitudes of nonpracticing chiropractors proposed multifactorial causes leading to attrition. The 3 included studies used retrospective observational design. Conclusion: The literature is limited, and factors linked to attrition or career mobility remain inconclusive. A better understanding of chiropractic profession attrition rates is needed to offer insights into the profession's practice environment, education, and professional outcomes. Accurate information on attrition may assist with workforce modeling and help prepare for the projected increase in musculoskeletal health care demand.

A Novel Nutrient Intervention of Probiotics, Glutamine, and Fish Oil in Psychological Distress: A Concurrent Multiple Baseline Design.

Objectives: The aim of this study was to investigate whether a combination of nutrients designed to promote gut and brain health also lowers psychological distress. The hypothesis is that a probiotic with fish oil, and glutamine supplement will reduce psychological distress. Design: A multiple baseline design was used to collect data from seven naturopathic patients in private naturopathic clinics in Australia. Patients were between 18 and 65 years of age, and had a Kessler-10 (K10) score between 16 and 30 and symptoms associated with mild gastrointestinal discomfort experienced several times most weeks for 3 months. They were randomized into one of three pathways to stagger the introduction of the intervention. Interventions: Participants received either a supplement incorporating a probiotic formulation (including Lactobacillus rhamnosus), a glutamine powder formulation, and fish oil, or matched placebos. The primary outcome measure was psychological distress as measured by the K10 scale of psychological distress. Results: The data showed a general trend toward lower K10 scores during the active phase compared with the baseline phase, with a marked reduction in the variances between phases. After controlling for time and baseline values, no significant difference between the phases for the K10 and the Perceived Stress Scale was found, but there was still a significant reduction in symptoms on the Gastrointestinal Symptom Rating Scale. Conclusions: A combination of a probiotic formulation, a glutamine powder formulation, and fish oil did not affect psychological distress and perceived stress, but had a significant beneficial effect on gastrointestinal symptoms in patients with high distress and concurrent gut symptomology. Clinical trial registration number: ACTRN12620000928910.

Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths.

INTRODUCTION: There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. METHODS: A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. RESULTS: Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). CONCLUSION: This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

The step in time study: A feasibility study of a mobile app for measuring walking ability after massage treatment in patients with osteoarthritis.

BACKGROUND: Massage therapy is a popular intervention for those suffering osteoarthritis, however, there is a paucity of evidence to support its effectiveness in osteoarthritis. A simple measure that could potentially assess the benefits of massage treatment is walking speed which is a predictor of mobility and survival length, particularly in ageing populations. The primary aim of the study was to assess the feasibility of using a phone app to measure walking ability in people with osteoarthritis. METHODS: This feasibility study used a prospective, observational design to collect data from massage practitioners and their clients over a 5-week period. Feasibility outcomes included practitioner and client recruitment and protocol compliance. The app MapMyWalk was used to record average speed for each walk. Pre-study surveys and post-study focus groups were conducted. Clients received massage therapy in a massage clinic and were instructed to walk in their own local community for 10 min every other day. Focus group data were analysed thematically. Qualitative data from clients' pain and mobility diaries were reported descriptively. Average walking speeds were graphed for each participant in relation to massage treatments. RESULTS: Fifty-three practitioners expressed interest in the study, 13 completed the training, with 11 successfully recruiting 26 clients, 22 of whom completed the study. 90% of practitioners collected all required data. A strong motivation for participating practitioners was to contribute to evidence for massage therapy. Client compliance with using the app was high, but low for completing pain and mobility diaries. Average speed remained unchanged for 15 (68%) clients and decreased for seven (32%). Maximum speed increased for 11 (50%) clients, decreased for nine (41%) and remained unchanged for two (9%). However, data retrieved from the app were unreliable for walking speed. CONCLUSIONS: This study demonstrated that it is feasible to recruit massage practitioners and their clients for a study involving mobile/wearable technology to measure changes in walking speed following massage therapy. The results support the development of a larger randomised clinical trial using purpose-built mobile/wearable technology to measure the medium and long-term effects of massage therapy on people with osteoarthritis.

Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network.

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.

Empowerment in naturopathy: A qualitative analysis of practitioner perspectives.

OBJECTIVE: This research aims to explore the role of empowerment in naturopathic consultations with patients with chronic pain. METHODS: Seven naturopaths were interviewed for up to 60 min online. A reflexive thematic analysis approach was used to code initial concepts. Through repeated immersion in the data, codes were clustered, refined and iteratively developed into overarching themes. RESULTS: Four major themes emerged from the data analysis: (i) establishing a therapeutic relationship, (ii) the therapeutic relationship as a mechanism for transformation, (iii) facilitating shared decision-making, and (iv) practitioner critical reflection. Participants identified that initial consultations were important for establishing rapport, identifying the causes of chronic pain, triggers of acute flare-ups and making sure the patient felt understood. Subsequent consultations focused on empowering patients through education, promotion of self-care and increasing self-awareness. Empowerment was manifest through all consultations by using active listening, education, and engagement with patients in a respectful manner that prioritised their treatment preferences in management plans. CONCLUSIONS: The findings highlight the central role of empowerment in naturopathic consultations with patients with chronic pain. Patients were supported to become active agents in decisions about their health care, consistent with person-centred models of care. This in turn promoted patient empowerment. Critical self-reflection on the part of practitioners was integral to their empowering approach. The combination of patient empowerment and critical self-reflection suggest that a framework of empowerment may be useful for advancing our understanding of naturopathy practice in Australia.

Nurses and midwives reporting of workplace violence and aggression: an integrative review.

Background: The experience of workplace violence and aggression is a common occurrence among the nursing and midwifery workforce, however, it is largely under-reported. Reasons for underreporting are not well understood.Aim: To review factors that influence nurses' and midwives' reporting of workplace violence and aggression from patients and visitors in hospital inpatient settings.Method: In this integrative review papers were identified through a search of electronic databases Embase, Emcare, PsychInfo, Medline, and CINAHL for literature between 2009 and 2020.Findings: Five papers met the inclusion criteria. Three themes were identified which influence reporting: organisational culture; accepting violence as part of the job; and type of violence.Discussion: Workplace policies supported by management and education programmes are required to improve the reporting of workplace violence and aggression by nurses and midwives.Conclusion: Workplace violence and aggression is under-reported by nurses and midwives in hospital inpatient settings. Reporting systems are not valued and nurses have come to accept workplace violence and aggression. Further research is required to explore strategies to improve workplace violence and aggression reporting culture and assess current education programmes using validated tools.

Best Evidence Osteoarthritis Care: What Are the Recommendations and What Is Needed to Improve Practice?

This article provides an overview of osteoarthritis (OA) management recommendations and strategies to improve clinical practice concordance with clinical guidelines. In many countries, the primary point of care for a person with OA is typically general practitioners and physiotherapists. Optimal primary care focuses on core OA treatments, namely education for self-management and lifestyle interventions encompassing increased physical activity, therapeutic exercise, and weight loss (if indicated). Quality indicators are used in clinical practice and research to determine the quality of care and in some settings, are used as knowledge translation tools to address existing evidence-to-practice gaps.

Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths.

BACKGROUND: Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. METHODS: The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. RESULTS: Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59-0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98-13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82-20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03-2.26), compared to osteopaths who do not refer to podiatrists. CONCLUSION: This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.

Exploring healthcare professionals' perceptions of artificial intelligence: Piloting the Shinners Artificial Intelligence Perception tool.

OBJECTIVE: There is an urgent need to prepare the healthcare workforce for the implementation of artificial intelligence (AI) into the healthcare setting. Insights into workforce perception of AI could identify potential challenges that an organisation may face when implementing this new technology. The aim of this study was to psychometrically evaluate and pilot the Shinners Artificial Intelligence Perception (SHAIP) questionnaire that is designed to explore healthcare professionals' perceptions of AI. Instrument validation was achieved through a cross-sectional study of healthcare professionals (n = 252) from a regional health district in Australia. METHODS AND RESULTS: Exploratory factor analysis was conducted and analysis yielded a two-factor solution consisting of 10 items and explained 51.7% of the total variance. Factor one represented perceptions of 'Professional impact of AI' (α = .832) and Factor two represented 'Preparedness for AI' (α = .632). An analysis of variance indicated that 'use of AI' had a significant effect on healthcare professionals' perceptions of both factors. 'Discipline' had a significant effect on Allied Health professionals' perception of Factor one and low mean scale score across all disciplines suggests that all disciplines perceive that they are not prepared for AI. CONCLUSIONS: The results of this study provide preliminary support for the SHAIP tool and a two-factor solution that measures healthcare professionals' perceptions of AI. Further testing is needed to establish the reliability or re-modelling of Factor 2 and the overall performance of the SHAIP tool as a global instrument.

Trauma informed care education for midwives: An integrative review.

BACKGROUND: Nearly half of new mothers describe their childbirth as traumatic. Perinatal trauma impacts both short and long-term biopsychosocial outcomes for mother and child. Midwife trauma-informed care education and practice is essential to mitigate this risk. OBJECTIVE: This review aimed to identify and describe the nature and extent of trauma informed care education provided for midwives and midwifery students. DESIGN: An integrative review. METHODS: Five databases (Medline, Embase, CINAHL, Psycinfo, and Emcare) were searched to identify primary research regarding trauma informed care education for midwives and midwifery students. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS: Three papers were identified. None of the papers were midwifery focused, with midwives representing a small proportion of the participants. Most midwives reported receiving no previous trauma informed care education and lacked confidence to provide quality care to women with lived trauma. Midwives reported trauma informed care education as essential and relevant for providing quality practice. Improvements in knowledge, skills and attitudes was demonstrated following trauma informed care education. More in-depth content and content delivered in multiple ways were recommended. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwives are well placed to deliver trauma informed care. Trauma informed care education for midwives is limited. Given the impact of perinatal trauma, further trauma informed care education and research is paramount.