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Mixed model estimation methods for the Rasch model.

Mixed models take the dependency between observations based on the same person into account by introducing one or more random effects. After introducing the mixed model framework, it is explained, by taking the Rasch model as a generic example, how item response models can be conceptualized as generalized linear and nonlinear mixed models. Common estimation methods for generalized linear and nonlinear models are discussed. In a simulation study, the performance of four estimation methods is assessed for the Rasch model under different conditions regarding the number of items and persons, and the degree of interindividual differences. The estimation methods included in the study are: an approximation of the integral over the random effect by means of Gaussian quadrature; direct maximization with a sixth-order Laplace approximation to the integrand; a linearized approximation of the nonlinear model employing PQL2; and finally a Bayesian MCMC method. It is concluded that the estimation methods perform almost equally well, except for a slightly worse recovery of the variance parameter for PQL2 and MCMC.

Data Interpretation, Statistical↗

Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.

BACKGROUND: The objective of this study was to understand the attitudes and preferences of risk-eligible women regarding use of tamoxifen for breast cancer risk reduction. METHODS: A cross-sectional, mixed-methods interview study was conducted at a university medical center and at community sites. Participants were women who had an estimated 5-year breast cancer risk > or = 1.7% and no prior breast cancer. Interviews were conducted in English or Spanish. The interview included a 15-minute, standardized educational session on the potential benefits and harms of tamoxifen followed by close-ended and open-ended questions about participants' inclinations to take tamoxifen and factors important to their decision. A demographic questionnaire, a test on knowledge of potential benefits and harms of tamoxifen, and an interview evaluation were included. RESULTS: Two hundred fifty-five women completed interviews. Their estimated mean 5-year breast cancer risk was 2.8%; and their mean self-perceived 5-year risk was 32.7%. After the educational intervention, 45 women (17.6%) were inclined to take tamoxifen. Very high risk women (> 3.5%) were no more inclined to take it than women with lower risk (1.7-3.5%). In a multivariable analysis, lower income, confidence in the effectiveness of tamoxifen, and concern about fractures were associated with being inclined to take it; concern about pulmonary embolism, dyspareunia, cataracts, and low self-perceived breast cancer risk were associated negatively with taking tamoxifen. Participants expressed concerns about adverse effects. CONCLUSIONS: Less than 20% of women were interested in tamoxifen after education about potential benefits and harms, despite a very high self-perceived breast cancer risk. Candidate chemoprevention agents must have few potential adverse effects to achieve widespread acceptance.

Adult↗

Drug-protein conjugates: haptenation of 1-methyl-10 alpha-methoxydihydrolysergol and 5-bromonicotinic acid to albumin for the production of epitope-specific monoclonal antibodies against nicergoline.

Two types of monoclonal antibodies were used for the determination of nicergoline in biological matrices. The antibodies were prepared with the hydrolysis products 5-bromonicotinic acid and 1-methyl-10 alpha-methoxydihydrolysergol after hemisuccinoylation to haptens. The current amide bond-generating methods (mixed anhydride-, carbodiimide-, carbodiimide/sulfo-N-hydroxysuccinimide-, and dicyclohexylcarbodiimide/N-hydroxysuccinimide methods) were used in bovine serum albumin (BSA)-coupling techniques and yielded conjugates that were haptenated to varying extents. The conjugates exhibiting 23 mol of 1-methyl-10 alpha-methoxydihydrolysergol (MMD) or 41 mol of 5-bromonicotinic acid (BNA) per mole of BSA were used for both immunization of mice and for coating the wells of the microtiter plates to select hybridomas and investigate specificity of the obtained antibodies. The results of hapten-inhibition ELISA using antigen-coated wells indicate that the supernatant of MMD-specific hybridoma exhibited 50% inhibition of antibody binding at 17 +/- 2 micrograms of MMD and at 24.5 +/- 2 micrograms of nicergoline, and the BNA-specific hybridoma exhibited similar inhibition at 147 +/- 6 micrograms of BNA and 500 +/- 30 micrograms of nicergoline. A main requirement for analytical purposes is that two different types of monoclonal antibodies recognize two different epitopes on nicergoline and its main metabolite, as shown by hapten-inhibition ELISA.

Alkaloids↗

Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema.

OBJECTIVES: The aim of this study was to compare quality of life and symptoms between breast cancer survivors who have developed and undergone treatment for chronic lymphedema with those who have not developed lymphedema. PATIENTS AND METHODS: The cross-sectional, mixed-methods design included 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema. Variables assessed quantitatively included sociodemographic information, medical data, body mass index (BMI), arm extracellular fluid volume, quality of life (QOL), and physical and emotional symptoms. For the qualitative component, individuals with lymphedema responded in writing to the question: During the past week what other difficulties have you experienced because of your lymphedema? RESULTS: Compared with those without lymphedema, breast cancer survivors with lymphedema reported poorer QOL. A symptom cluster that included alteration in limb sensation, loss of confidence in body, decreased physical activity, fatigue, and psychological distress was identified. Perception of limb size influenced the cumulative symptom experience more than objective arm volume. Qualitative data revealed multiple QOL, physical health, and psychological concerns. BMI correlated with multiple outcomes. CONCLUSIONS: Findings suggest that current lymphedema treatments, although beneficial, may not provide complete relief of symptoms associated with lymphedema and complementary interventions are needed. The poorer QOL in breast cancer survivors with lymphedema may relate to the presence of an untreated symptom cluster.

Breast Neoplasms↗

Coronary artery bypass graft operation: Patients' experience of health and well-being over time.

BACKGROUND: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms and improve functional ability, quality of life and survival. However, having the surgery does not always have the desired outcomes. Although numerous studies have investigated the outcomes of coronary artery bypass graft operation, little attention has been given to patients' perceptions of the outcomes or effects of the operation on health and well-being over time. AIM: To explore patients' perspectives on the effects of coronary artery bypass surgery on health and well-being over time. METHODS: As part of a larger mixed methods study, 62 in-depth audio-taped interviews with men and women who had undergone coronary artery bypass approximately 7 years earlier were conducted. Interviews were audio-taped and transcribed. Data were analysed thematically. This paper reports the findings from the qualitative component of the larger study. FINDINGS: The four main themes: 'Recovery and Rehabilitation', 'Seven Years On', 'Maintaining a Positive Approach', and 'Health Behaviour Change' reflect the main areas of focus emerging across the interviews and provide credible overarching descriptors of the sub-themes they encompass. The 11 sub-themes identified were recognised as central to the patients' experiences of their health and well-being over the longer-term. CONCLUSIONS: Although most patients report improved health and well-being after coronary artery bypass operation, many have described their recovery and rehabilitation as a complex process with both short and long term effects. The insights provided by participants help improve our understanding of the impact of the operation on patients' health and well-being over time. We believe these insights will help us to anticipate the possible needs of future patients and enable us develop appropriate interventions that may facilitate self-management for optimal recovery and health maintenance.

Activities of Daily Living↗

Evaluating the clinical effectiveness of neonatal nurse practitioners: an exploratory study.

AIM AND OBJECTIVES: The aim of the investigation was to establish if there was any preliminary evidence to indicate if the quality of care and clinical outcomes for premature birth babies are affected by the type of practitioner (i.e. nurse practitioner vs. medical practitioner) responsible for the initial assessment, treatment and management of neonates during the first 6-12 hours following admission to a neonatal intensive care unit. BACKGROUND: The United Kingdom (UK) has seen a proliferation in the number of nurse practitioners in the past decade. While there is a growing body of evidence to suggest that nurse practitioners in primary care settings are able to provide a high quality and effective level of clinical service comparable with many of their medical counterparts, there has been relatively little evaluation of the nurse practitioner role in acute or high dependency hospital settings. DESIGN AND METHODS: The study design used a mixed method approach combining a retrospective examination and quality assessment of nursing and medical records. A random sample of 61 sets of medical records, relating specifically to the initial management and treatment of neonates were criterion assessed by an experienced consultant neonatologist and a variety of patient outcome data collated and analysed. RESULTS: The analysis of the patient outcome data and quality assessment of nursing and medical records revealed that there was no statistical difference in the standard and quality of care provided between nurse practitioners and medical staff in the vast majority of areas evaluated. However, trends in the data suggest that Advanced Neonatal Nurse Practitioners (ANNPs) did not perform as well as their medical counterparts in terms of the overall completeness or comprehensiveness of the standard care provided in a number of areas. CONCLUSION: Neonatal nurse practitioners provide an alternative model of service delivery in the initial admission and management of premature birth babies. While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard. Nonetheless, some deficits in the standard of care provided by both groups of practitioners were identified which in turn have implications for ongoing training and skills development. Relevance to clinical practice. The findings suggest that ANNPs are capable of taking on an advanced role in the assessment and management of neonates.

Clinical Nursing Research↗

Evaluation of a national quality use of medicines service in Australia: an evolving model.

RATIONALE: To describe the first phase of a global evaluation framework for the National Prescribing Service (NPS), with a focus on services for health professionals, and in particular highlight the lessons learnt from evaluation around the establishment and implementation of this national program. METHODS: The agreed evaluation framework used mixed methods focused around a series of evaluation questions, aimed at measuring the overall effect of this new organization as well as the individual programs within it. The evaluation questions were determined a priori and were based on the objectives established by the organization in its first year of operation. A detailed analyses has been completed of: the process, scope and reach of program delivery using both quantitative and qualitative measures; changes in attitudes and knowledge measured through key informant interviews and surveys of professional groups and consumers; and changes in prescribing behaviour and savings to the Pharmaceutical Benefits Scheme (PBS) through analysis of prescription data. The evaluation period for this report was mid-1998 to mid-2004. RESULTS: The NPS has successfully implemented a complex, multi-faceted program across Australia. From 1998 to 2004, in addition to print material provided to all general practitioners (GPs) and pharmacists, 90% of all GPs have been actively involved in one or more educational activity; 116 of 120 divisions of general practice have coordinated local NPS programs; and 9% of pharmacists have actively participated in at least one educational activity. Sixty per cent of GPs and pharmacists rated the printed educational materials as good or very good. In the last three years, the NPS activities have generated savings in the range of $121-163 million to the PBS, owing to changes in prescribing practices. CONCLUSION: The national evaluation framework has informed program delivery and ongoing design and development. Continued refinement of existing evaluation methods and further exploration of new techniques will remain a priority for the organization.

Australia↗

Increasing nurses' knowledge and skills for enhanced response to intimate partner violence.

BACKGROUND: A theoretically based intimate partner violence in-service program was developed, implemented, and evaluated among public health nurses. METHODS: A two-phase, mixed-methods design was used. Phase 1 used qualitative methods for content development of the in-service program. Phase 2 used a one-group pretest-posttest design to evaluate the effectiveness of the program. RESULTS: In Phase 1, nurses perceived a need for knowledge about community intimate partner violence prevention resources and enhancement of interviewing skills. In Phase 2, no significant difference was noted in level of intimate partner violence knowledge between pretest and posttest (p < .107). However, a significant difference in skill level was noted between pretest and posttest (p < .003). CONCLUSIONS: Results support the use of an in-service program as an effective method of enhancing the intimate partner violence clinical skills of nurses.

Attitude of Health Personnel↗

Exploring stress and coping among urban African American adolescents: the Shifting the Lens study.

INTRODUCTION: Stress can have a significant effect on an adolescent's long-term physical and mental well-being. An understanding of the role of unmanaged stress during early adolescence is critical for the prevention of chronic diseases such as depression. The purpose of the Shifting the Lens study was to explore perceptions of stress, sources of social support, and use of coping strategies among urban African American ninth graders. METHODS: A youth-driven, mixed-method approach was used to assess teens' perceptions of stress. During the 2001-2002 school year, teen participants (N = 26) from East Baltimore, Md, completed questionnaires, audio journals, pile-sort activities, and personal social support network maps. RESULTS: In contrast with existing literature that emphasizes the influence of violence and neighborhood factors on stress among teens, teens prioritized other sources of stress, particularly from school, friends, and family. For support, they relied on different individuals, depending on the source of the stress--friends for romantic relationship stress and family for job, school, and family stress. Sex differences in the coping styles of the participating teens were found. Girls reported more frequent use of support-seeking and active coping strategies than boys. CONCLUSION: The use of multiple data collection strategies to explore stress uniquely contributes to our understanding of how one group of teens perceives and copes with stress. Future research should explore stress from the youth perspective in communities that are similar to East Baltimore, Md. In addition, programmatic recommendations include the need for sex-specific stress management activities and education about youth stress for adults. Community participatory translation interventions based on study findings, such as a youth-produced video and a resource guide for youth service providers, were implemented.

Adaptation, Psychological↗

Matrix description of general motion correction applied to multishot images.

Motion of an object degrades MR images, as the acquisition is time-dependent, and thus k-space is inconsistently sampled. This causes ghosts. Current motion correction methods make restrictive assumptions on the type of motions, for example, that it is a translation or rotation, and use special properties of k-space for these transformations. Such methods, however, cannot be generalized easily to nonrigid types of motions, and even rotations in multiple shots can be a problem. Here, a method is presented that can handle general nonrigid motion models. A general matrix equation gives the corrupted image from the ideal object. Thus, inversion of this system allows us to get the ideal image from the corrupted one. This inversion is possible by efficient methods mixing Fourier transforms with the conjugate gradient method. A faster but empirical inversion is discussed as well as methods to determine the motion. Simulated three-dimensional affine data and two-dimensional pulsation data and in vivo nonrigid data are used for demonstration. All examples are multishot images where the object moves between shots. The results indicate that it is now possible to correct for nonrigid types of motion that are representative of many types of patient motion, although computation times remain an issue.

Algorithms↗

How AI-supported intelligent systems support infection prevention and control training in healthcare: A systematic review of educational functions and outcomes.

AIMS: Artificial intelligence (AI)-supported intelligent systems have been increasingly incorporated into infection prevention and control (IPC) education and training, primarily to support the monitoring of observable behaviors and the provision of feedback. However, existing evidence has focused largely on short-term compliance outcomes, with limited synthesis of the educational role of AI-supported intelligent systems in supporting sustained IPC competence. This systematic review examined how AI-supported intelligent systems have been designed and used to support IPC education and training, with a focus on system characteristics, educational functions, and reported outcomes. DESIGN: A systematic literature search was conducted across the PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases. DATA SOURCES: A total of 18 studies met the inclusion criteria. Findings were qualitatively synthesized according to system design characteristics, educational functions, and outcome domains. REVIEW METHODS: Methodological quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: Most AI-supported intelligent systems focused on hand hygiene and relied on fully automated monitoring systems to capture behaviors and provide performance feedback. Educational functions were predominantly limited to performance assessment, automated feedback, and reminders. Outcomes were mainly measured using compliance or performance metrics, whereas sustained behavioral change and decision quality were rarely assessed. CONCLUSIONS: AI-supported intelligent systems have been used primarily to reinforce short-term IPC performance and compliance. However, their current applications for supporting sustained competence over time remain limited. The findings of this review suggest that AI-supported intelligent systems may serve as maintenance-oriented educational support by extending learning beyond initial instruction through repeated practice and feedback. Future research should prioritize outcome measures that capture the durability of performance and decision-making processes to better align AI-supported intelligent systems used in IPC education and training with the educational demands of clinical practice.

Humans↗

Generating revenues: fiscal changes in public mental health care and the emergence of moral conflicts among care-givers.

OBJECTIVE: The author examined how the focus on financial accountability in the public mental health sector has affected direct service providers' experience of their work. METHODS: This was a two-year mixed method study conducted throughout one small, state-run system. Data that were collected include field notes taken in the course of participant-observation research, tape-recorded semi-structured ethnographic interviews, as well as responses to an ethnographically-informed survey instrument that was administered to providers throughout the system. RESULTS: Interview materials suggest that care-givers view their jobs as a "calling," work that they perform in the service of something greater than themselves. As the public mental health sector increases its emphasis on fiscal issues, however, these employees are experiencing heightened moral tensions around their work. Jobs that were once conceptualized as being done "for love" now are being done "for money" - a change that represents a moral contamination of the workplace for many individuals. CONCLUSIONS: The goal of enhanced fiscal accountability in the public mental health system is to increase service effectiveness and cost-efficiency, that is, to do better work and to do it for less money. These study results suggest that this strategy could backfire, as some service providers must focus less on the qualities of the services they deliver, and more on the quantities. The study encourages mental health services researchers to incorporate ethnographic methods into study designs so that participants' experiences can be taken into account when evaluating the impact of system changes.

Attitude of Health Personnel↗

Patch test sensitization to Compositae mix, sesquiterpene-lactone mix, Compositae extracts, laurel leaf, Chlorophorin, Mansonone A, and dimethoxydalbergione.

BACKGROUND: Compositae mix and sesquiterpene-lactone (SL) mix are important patch test substances to show allergic contact dermatitis from various Compositae plants. OBJECTIVES: The aims of this study are to calculate the sensitization rates to Compositae mix and SL mix in an occupational dermatology clinic and to describe cases of active sensitization caused by patch testing with Compositae mix and SL mix. METHODS: Conventional patch testing was performed. SL mix (0.1%) and Compositae mix (6% in petrolatum) were tested in a modified European standard series and a plant allergen series. Testing with other appropriate patch test series was also performed. RESULTS: SL mix provoked 8 allergic patch test reactions (0.7%) in 1,076 patients, whereas Compositae mix was positive in 15 of 346 patients (4.2%). Three patients were actively sensitized to Compositae mix and 1 patient to SL mix. One patient was also sensitized to other plant allergens in a series of allergenic plant chemicals, namely to Mansonone A, an ortho-quinone; (R)-3,4-dimethoxydalbergione, a quinone; and Chlorophorin, a hydroxy stilbene. Allergic patch test reactions to laurel leaf were caused by cross-sensitization to SLs. CONCLUSION: Compositae mix seems to be a more important patch test substance than SL mix to detect allergic contact dermatitis to Compositae plants, but patch testing may sensitize. The concentration of the individual components of the Compositae mix should be adjusted so that the mix detects allergic patients but does not sensitize.

Adult↗

Use, misuse and non-use of health care assistants: understanding the work of health care assistants in a hospital setting.

AIM(S): This study is concerned with understanding the work of non-registered nurses (health care assistants) in a UK hospital setting. BACKGROUND: There are increasing numbers of health care assistants employed by the National Health Service in the UK to support registered nurses providing nursing care. However, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This study addresses some of these gaps in the research-based literature. METHODS: A single case study design using mixed methods (survey, interviews, participant observations, focus groups and documents) was used to generate an in-depth account of health care assistants' work in one organization. The study is built upon what health care assistants say they do, compared with what they actually do in practice. It explores how and whether the work of health care assistants is adequately supervised, tensions between the work of health care assistants and registered nurses and the subsequent effects on teamwork and patient care. FINDINGS: There are policy expectations associated with the work of health care assistants. However, this study reveals significant deviations from these goals. The workplace arena and the negotiations between health care assistants and registered nurses that take place within it, actively shape the health care assistants' work. Findings suggest dynamic patterns of use, misuse and non-use of the health care assistants as a resource to patient care. DISCUSSION AND IMPLICATIONS FOR PRACTICE: The changing roles of registered nurses have direct implications for the roles of health care assistants: as registered nurses take on extra duties and responsibilities they are conceding some of their role to health care assistants. This has implications for nurse managers. The competence of health care assistants to carry out nursing work needs to be reassessed and there also needs to be ongoing monitoring and supervision of their work to maximize, and further develop, their contribution to patient care and to ensure quality standards. Managers also need to be aware of the importance of workplace negotiations in the interpretation of formal policies and the subsequent shaping of health care assistants' work at the level of service delivery.

Adult↗

Clinical skills for nurses in medical assessment units.

AIM: To identify the skills possessed by nurses working in medical assessment units (MAUs) and those that are needed to enable them to undertake a detailed, holistic assessment of the patient. METHOD: A qualitative study was undertaken using mixed methods to obtain data. A postal survey using Delphi methodology was sent to a group of advanced nurse practitioners educated at master's degree level. Four focus groups were conducted with 38 qualified nurses working in a MAU. FINDINGS: The first round of the Delphi survey identified 27 skills deemed pertinent to nurses working in this setting. A second round resulted in 11 skills and a further five skills for the most senior nurses were identified by the postal survey participants. Focus groups also identified skills that nurses working in MAUs should possess. There was widespread agreement between participants that the degree of expertise pertaining to each skill would be dependent on their experience in the clinical area and would reflect their seniority. CONCLUSION: There is broad agreement between a body of expert opinion and staff working in a MAU that there are core skills nurses working in MAUs should possess. The author plans to use the results of the study to develop future training in the MAU.

Clinical Competence↗

Creating hetero-11-mers composed of wild-type and mutant subunits to study RNA binding to TRAP.

TRAP (trp RNA-binding attenuation protein) is an RNA-binding protein that regulates expression of the tryptophan biosynthetic genes in Bacillus subtilis by binding to RNA targets that contain multiple GAG and UAG repeats. TRAP is composed of 11 identical subunits arranged symmetrically in a ring. The secondary structure of the protein consists entirely of antiparallel beta-sheets, beta-turns, and loops. We show here that the TRAP 11-mer can be reversibly denatured into unfolded monomers by guanidine hydrochloride. Removing the denaturant allows the protein to spontaneously renature into fully functional 11-mers. Based on this finding, we developed a subunit mixing method to hybridize wild-type and mutant subunits into heteromeric 11-mers by denaturation followed by subunit mixing renaturation. This method allows the study of subunit cooperativity in protein-ligand interaction such as RNA binding. Our data further support and extend the previously proposed two-step model for RNA binding to TRAP by showing that the initiation of binding requires at least one fully active subunit in the protein combined with one fully functional repeat in the RNA. The initiation complex tethers the RNA on the protein, thus allowing cooperative interaction with the remainder of the repeats.

Bacillus subtilis↗

The effect of lipid molecular packing stress on cationic liposome-induced rabbit erythrocyte fusion.

The effect of curvature stress on the efficiency of cationic liposome-induced fusion between rabbit erythrocytes was studied. Multilamellar cationic liposomes containing 1,2-dioleoyl-3-trimethylammoniumpropane (DOTAP) and different PEs (1,2-dilnoleoyl-sn-glycero-3-phosphoethanolamine (dilin-PE), 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE), 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanolamine (POPE), and lysophosphatidylethanolamine, egg (lyso-PE)) were used to induce cell-cell fusion. It was found that high cell-cell fusion yield (FY) of about 50% could be achieved in sucrose solution by using cationic liposomes containing 50% DOTAP. Cell-cell fusion was assayed by shape criterion and was verified by fluorescence microscopy, using a membrane dye mixing method. The curvature stress, as a result of mixing unsaturated PEs in cationic liposomes, had a significant effect on cell-cell FY which increased with the degree of acyl chain unsaturation, in the order dilin-PE > DOPE > POPE > lyso-PE. Replacement of dilin-PE, DOPE, or POPE by lyso-PE gradually in cationic liposomes lowered the cell-cell FY from 50% to 1%. Furthermore, cationic liposome induced cell lysis, and fusion between cationic liposomes and cells, as assayed by the N-(lissamine rhodamine B sulfonyl)-1,2-dihexadecanoyl-sn-glycero-3-phosphoethanolamine, triethylammonium salt and N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)-1,2- dihexadecanoyl-sn-glycero-3-phosphoethanolamine, triethylammonium salt (Rh-PE/NBD-PE) energy transfer method, followed the same order as that for cell-cell fusion. Fusion between the negatively charged PS liposomes and cationic liposomes also followed the same order. The electric double layer screening by electrolytes in NaCl-containing solution and phosphate buffered saline (PBS) was found to reduce the cell-cell FY and cell lysis. These findings suggest that liposome-induced cell-cell fusion was achieved by cationic liposomes serving as fusion-bridges among cells.

Animals↗

Evaluation of the Master's in Genomic Medicine framework: A national, multiprofessional program to educate health care professionals in NHS England.

PURPOSE: Genomic medicine is revolutionizing health care but requires health care professionals to update their understanding of genomics and its application to clinical practice for successful implementation. To meet this need, Health Education England developed the Master's in Genomic Medicine, a national multiprofessional program to increase genomic literacy in the National Health Service workforce. This study summarizes an evaluation of the program, which will inform its future development. METHODS: Underpinned by Moore's evaluation framework, a mixed methods approach was used to characterize (1) learner demographics, (2) perceptions of the program, (3) knowledge and/or qualifications achieved, and (4) the outcome(s) for practice in the workplace. RESULTS: Learners were a diverse cohort of health care professionals, including doctors, health care scientists, nurses and midwives. Participant satisfaction was high for all elements of the program, including the curriculum, learning environment(s), and multiprofessional cohort(s), despite the challenges of engaging working professionals in part-time learning. Both learners and their managers reported enhanced genomic practice after completion of their studies. CONCLUSION: The Master's in Genomic Medicine program is an effective approach to professional education in genomic medicine. This broad multiprofessional learning complements training aimed at specific groups of health care professionals.

Humans↗