Experiences of living with overweight/obesity and early type 2 diabetes in Singapore-a qualitative interview study.

OBJECTIVES: To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN: Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING: Primary care clinics located in northern and central Singapore. PARTICIPANTS: 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS: The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION: An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.

How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57.

Background: Empathy and compassion are important in healthcare delivery, and are necessary qualities in medical students. Aims: To explore medical students', patients' and educators' perceptions of what affects empathy and the expression of compassion; and to address gaps in knowledge, attitudes and skills on how education affects empathy and the expression of compassion in medical students. Methods: The seven steps by Noblit and Hare were used for this meta-ethnography. Databases were searched for studies in English, published from 2007 to 2017 with outcomes of empathy and compassion. Key themes and concepts were identified, and accounts from the studies were used to build interpretations. Findings: Thirty-three qualitative studies were included and four main themes were derived: seeing the patient as a person; appreciating the elements of empathy and compassion; navigating in the training environment; and being guided by ideals. Interactions between the patient, the medical student and training environment which affect the development of empathy and compassion are illustrated in a conceptual model. Conclusions: This meta-ethnography extends our understanding of how medical education affects the expression of empathy and compassion in medical students. The results provide important considerations for medical educators and faculty developers in further developing and improving medical curricula.

Considering Face, Rights, and Goals: A Critical Review of Rapport Management in Facilitator-Guided Simulation Debriefing Approaches.

STATEMENT: The rapport between facilitators and learners contributes to a conducive learning environment during simulation debriefing, but a theory to guide rapport management (RM) is lacking. The RM model is a potentially relevant conceptual framework because it describes three interrelated components of rapport-face, rights, and goals-which, when threatened, affect the rapport between interactants. This critical review explores how studies in the simulation debriefing literature describing postevent facilitator-guided debriefing approaches can be viewed through the lens of the RM model. All 34 identified studies alluded to at least one component of rapport, with less than half alluding to all three. There is preliminary evidence that the management of all three components of rapport during debriefing may contribute to improving short-term learning outcomes. Future studies could explore how the RM model can be used to guide debriefing approaches in various contexts and clarify why or how these approaches work.

Factors influencing the implementation, adoption, use, sustainability and scalability of mLearning for medical and nursing education: a systematic review protocol.

BACKGROUND: mLearning is increasingly presented as an attractive novel educational strategy for medical and nursing education. Yet, evidence base for its effectiveness or factors which influence use, success, implementation or adoption are not clear. We aim to synthesise findings from qualitative studies to provide insight into the factors (barriers and facilitators) influencing adoption, implementation and use of mobile devices for learning in medical and nursing education. The review also aims to identify factors or actions which are considered to optimise the experience and satisfaction of educators and learners in using mobile technologies for medical and nursing education and to identify strategies for improving mLearning interventions for medical and nursing education. METHODS: A systematic search will be conducted across a range of databases for studies describing or evaluating the experiences, barriers, facilitators and factors pertaining to the use of mLearning for medical and nursing education. The framework synthesis approach will be used to organise and bring different components of the results together. The confidence in the qualitative review findings will be assessed using the CERQual approach. DISCUSSION: This study will contribute to the planning and design of effective mLearning and the development of mLearning guidelines for medical and nursing education. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016035411.

Exploring the mobility preferences and perceived difficulties in using transport and driving with a sample of healthy and outpatient older adults in Singapore.

BACKGROUND/AIM: While activity engagement is important to older adults, limitations in ability can affect transport mode choice and subsequent activity participation. Therefore, this study aimed to explore the mobility preferences and difficulties in using public transport and driving with a sample of older adults in Singapore, with specific reference to accessing everyday activities. METHODS: One hundred and sixty-two persons aged 50 years and over were recruited through a community event, and an outpatient occupational therapy department. They self-completed structured questionnaire forms which were analysed using parametric and non-parametric statistics, including t-tests and ANOVAs. RESULTS: The majority of the participants were in the paid workforce and no significant differences were found between gender and the importance of transport for access to various activities, but a significant association was found for age and use of transport for going to work, F(5,101) = 3.07, P = 0.01. The majority of the drivers drove at least once a day, and 19% of them reported having noticed declines in their driving capabilities in the past four years, and indicated driving less often because of these concerns. CONCLUSIONS: This study explored public transport and car use among a sample of older adults in Singapore to access desired activities. It identified difficulties with both public and private transportation use, such as difficulty maintaining balance/obtaining a seat, and concerns with decreased ability to respond quickly to traffic situations. This study has highlighted that transportation methods should be considered in occupational therapy practice with older adults.

Validity of the Occupational Therapy-Drive Home Maze Test for right and left handed test takers.

The Occupational Therapy-Drive Home Maze Test (OT-DHMT) is part of the OT-DORA Battery used in licensing recommendations for older and/or functionally impaired drivers. Previously published research has been conducted to investigate the predictive validity, inter-rater reliability and establish norms for this timed test with normal and cognitively impaired drivers. Anecdotal evidence from this research indicated there could be a bias against right-handers (dextrals) who may need to lift their hand to view the maze, thus increasing the time taken. Therefore this study investigated the validity of the OT-DHMT when administered to left and right handed individuals. The OT-DHMT was individually administered to a new sample of 144 healthy drivers aged 18-69 years. From this, 34 participant pairs were matched for age and gender, according to their dexterity. The results show that there were no significant differences in time taken when completing the maze test, for participants who complete the test with either writing hand t(33)=1.59, p=0.12 (95%CI: -0.63 to 5.08). While further testing is required with samples from different cultures and with more participants aged 30-69 and 70 years and over to extend generalizability of these findings, the results suggest the OT-DHMT is suitable to be administered and scored using the methods published as part of the OT-DORA Battery.

Normative data, preliminary inter-rater reliability and predictive validity of the Drive Home Maze Test.

OBJECTIVE: The Drive Home Maze Test has been developed as part of a clinic-based driver assessment battery. This article reports normative data and preliminary inter-rater reliability for this test together with predictive validity for a clinical sample. SUBJECTS AND SETTING: 223 individuals contributed to the normative data. Of these, data from 42 clients undergoing driver assessment as part of their rehabilitation or health care plan were used to ascertain the predictive validity of the Drive Home Maze Test for on-road driving performance (Pass/ Fail). MAIN MEASURE: The Drive Home Maze Test was developed for occupational therapy driver assessors to use with all older and/ or functionally impaired drivers prior to on-road testing. The test assesses a person s executive function, attention and visuoconstructive skills. RESULTS: The normative data indicated that time taken and number of errors on the maze increases with age. Performance on this test was strongly indicative of driver assessment outcome using the regression model: ln(Odds of failing on road) = 5.9451 + 2.7047 (log10 time taken to complete the maze). Excellent preliminary inter-rater reliability was also found using Ordinary Least Products linear regression analysis to test for bias between two raters for time taken and number of errors on the maze, with values ranging from r = 0.858 to 0.999. CONCLUSIONS: The Drive Home Maze Test provides useful information concerning a person's cognitive skills prior to undertaking an on-road assessment. Time taken to complete this test is indicative of the outcome of an on-road driver assessment.