Bioethics’ Lack in Relation to Person-Centred User-Driven Health Systems Planning: A Call for Change

La tribune de l'éditeur / Editor's Soapbox

Phase 1 Delivering care "A framework for nursing and Midwifery Workforce planning to support person centred care in Northern Ireland"

Delivering Care - Nurse staffing in Northern Ireland is the outcome of a commission undertaken by the PHA Director of Nursing from the DHSSPS Chief Nursing Officer and approved by the Minister of Health in 2014.� The aim of the Delivering Care project is to support the provision of quality care which is safe and effective in hospital and community settings.

Person-centred information to parents in paediatric oncology (the PIFBO study) : A study protocol of an ongoing RCT

Background: Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method. Methods/Design: This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses. Discussion: Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective. Trial registration: Clinical trials NCT02332226 (December 11, 2014).

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

Entropy feature extraction of EEG signals for automatic person identification

The use of human brain electroencephalography (EEG) signals for automatic person identi cation has been investigated for a decade. It has been found that the performance of an EEG-based person identication system highly depends on what feature to be extracted from multi-channel EEG signals. Linear methods such as Power Spectral Density and Autoregressive Model have been used to extract EEG features. However these methods assumed that EEG signals are stationary. In fact, EEG signals are complex, non-linear, non-stationary, and random in nature. In addition, other factors such as brain condition or human characteristics may have impacts on the performance, however these factors have not been investigated and evaluated in previous studies. It has been found in the literature that entropy is used to measure the randomness of non-linear time series data. Entropy is also used to measure the level of chaos of braincomputer interface systems. Therefore, this thesis proposes to study the role of entropy in non-linear analysis of EEG signals to discover new features for EEG-based person identi- cation. Five dierent entropy methods including Shannon Entropy, Approximate Entropy, Sample Entropy, Spectral Entropy, and Conditional Entropy have been proposed to extract entropy features that are used to evaluate the performance of EEG-based person identication systems and the impacts of epilepsy, alcohol, age and gender characteristics on these systems. Experiments were performed on the Australian EEG and Alcoholism datasets. Experimental results have shown that, in most cases, the proposed entropy features yield very fast person identication, yet with compatible accuracy because the feature dimension is low. In real life security operation, timely response is critical. The experimental results have also shown that epilepsy, alcohol, age and gender characteristics have impacts on the EEG-based person identication systems.

Doctors' thinking about the system as a threat to patient safety

‘Systems thinking’ is an important feature of the emerging ‘patient safety’ agenda. As a key component of a ‘safety culture’, it encourages clinicians to look past individual error to recognise the latent factors that threaten safety. This paper investigates whether current medical thinking is commensurate with the idea of ‘systems thinking’ together with its implications for policy. The findings are based on qualitative semistructured interviews with specialist physicians working within one NHS District General Hospital in the English Midlands. It is shown that, rather then favouring a 'person-centred’ perspective, doctors readily identify ‘the system’ as a threat to patient safety. This is not necessarily a reflection of the prevailing safety discourse or knowledge of policy, but reflects a tacit understanding of how services are (dis)organised. This line of thinking serves to mitigate individual wrong-doing and protect professional credibility by encouraging doctors to accept and accommodate the shortcomings of the system, rather than participate in new forms of organisational learning.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. Selection criteria: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Main results: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the service. Authors' conclusions: There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.

North Down & Ards AMH

AMH, founded in 1963, one of the largest regional voluntary sector organization in NI, has provided a range of services for people with mental health difficulties and learning disabilities. AMH Ards offers a range of person centred activities eg training in IT, administration, catering, literacy and numeracy, crafts etc. They have completed 2 Level 2 applications. This Level 3 application will endeavor to build on the success of the second project, encouraging and building capacity for people to identify their own health needs, enable them to benefit from a range of support services, including pharmacy available to them. In addition, it will continue to educate and involve pharmacists in the road to mental health recovery. 4 programmes (7 weeks long ï¿_ 3 with the pharmacist) will be delivered each year (2 at each of the centers in Ards and Bangor). This more formal programme will be supplemented by ongoing support, staff training (2 sessions) and 4 informal drop in sessions and more general health events. At all of these sessions, the pharmacists will either lead on or attend.

Neurological conditions: involvement to improve service delivery

A major, ongoing Public Health Agency led consultation exercise has identified 12 recommendations to improve the lives of the 48,000 people, and their carers, who experience neurological conditions across Northern Ireland. These recommendations will form the basis of an action plan to improve service delivery and support for those experiencing a range of conditions, such as epilepsy, Huntington's Disease, Parkinson's Disease, progressive supranuclear palsy (PSP) and multiple sclerosis (MS).The recommendations cover four areas:accurate information and diagnosis;control and choice, particularly self-management and person-centred services;day-to-day living and independence, including finance, employment, social life and ability to get out and about;emotional and psychological impact on individuals and families, eg the support available to deal with stress, fear, frustration, isolation, loss and vulnerability associated with living with a neurological condition.The report was launched at a regional workshop, held in Cookstown (today) and co-ordinated through the Neurological Conditions Network, which was established to develop this work.Speaking before the workshop, Health Minister Edwin Poots said: "Neurological conditions give rise to complex needs, which require support from a wide range of professionals. They also change lives, both for those directly affected and for their families and carers, and it is so important not to lose sight of this if we are to successfully address the challenges in tackling neurological conditions."Last week, I visited the home of Beth McCune, who suffers from motor neurone disease. I was invited to see for myself the daily challenges faced by Beth and her husband and carer, Arthur, and to hear of their experiences. While I was struck by their courage and patience, this visit underlined again for me the severe life-changing impact of the disease."At present, there are some 48,000 people in Northern Ireland living with neurological conditions. It was in recognition of the needs of men and women like Beth that my department requested the establishment of the Neurological Conditions Network and provided the necessary funding to support it."Michelle Tennyson, PHA Assistant Director and Chair of the Neurological Conditions Network, said: "This detailed engagement exercise was undertaken to get the views and quality of life experiences of those affected by these conditions. We tried to ensure everyone who wanted to contribute could, by providing support through helplines, the internet and face-to-face events. I am honoured that so many people have trusted us with their experiences to help us make a difference and was privileged to be invited into the home of Beth and Arthur McCune for the same reason."The recommendations cover a range of conditions and their implementation will need cooperation and action from professionals, service users, voluntary organizations and others, across many sectors and agencies. The network is looking forward to delivering on these challenging new ways of working to improve the lives of all those affected by neurological conditions."The workshop attracted service users and carers along with delegates from across Northern Ireland's community, voluntary and statutory sectors.If you have a neurological condition, or care for someone who does, and want to share your experiences, please go to: www.publichealth.hscni.net/ncnsurveyYou can also contact Julie Mawhinney, Tel: 028 9032 1313.

The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes ILC-UK

The International Longevity Centre - UK��launched a new paper (Wednesday, 6th July 2011). The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes, provides care home workers and managers with information and practical advice on this complex, controversial and sensitive issue.The need for affection, intimacy and relationships for people with dementia in care homes has too often been ignored and side-lined in policy and practice. The onset of old age or a cognitive impairment does not erase the need for affection, intimacy and/or relationships. While the issues involved can be complex, controversial and sensitive and may challenge our own beliefs and value system, it is essential that we understand more about them to foster a more person-centred approach to dementia care. Care home residents with dementia often have complex care needs and trying to understand and respond to the more intimate and sexual aspects of a resident’s personality can be challenging.Aimed at care home workers and managers, the guide not only provides essential information on this aspect of dementia care but offers practical advice to support current work-based practices. Set out in an accessible and easy-to-read format, this guide includes case studies, questions, suggestions and a self assessment quiz to promote easy learning. It also provides a possible pathway for care home managers to develop a guiding policy on sexual expression in dementia.The guide for care staff is summarised in 10 key points:1. Some residents with dementia will have sexual or sensual needs.2. Affection and intimacy contribute to overall health and wellbeing for residents.3. Some residents with dementia will have the capacity to make decisions about their needs.4. If an individual in care is not competent to decide, the home has a duty of care towards the individual to ensure they are protected from harm.5. There are no hard and fast rules. Assess each situation on an individual basis6. Remember not everyone with dementia is heterosexual.7. Inappropriate sexual behaviour is not particularly common in dementia.8. Confront your own attitudes and behaviour towards older people and sex generally.9. Communicate – look at how you can improve communication with your colleagues, managers, residents and carers on this subject10. Look after yourself and remember your own needs as a care professional��The full paper is available: The Last Taboo

Regional Health and Social Care Personal and Public Involvement Forum: Annual Update Report 2012/13

Personal and Public Involvement (PPI) is an essential component in the delivery of truly person centred services.�It is also a statutory duty.�The PHA has leadership responsibilities in respect of the implementation of PPI across HSC.�One of the ways in which the PHA discharges that leadership function, is through the Regional HSC PPI Forum.�This body brings together all HSC organisations, working alongside service users and carers, to bring a focus on involvement.�It promotes the sharing of best practice, identifies and tackles issues of common concern and providers a platform for the active participation of service users and carers.� Each year in response to a Priorities for Action (PFA) target, the PHA, working with HSC partners, service users and carers in the Forum, develop an Annual Report on PPI work taken forward through the Forum.The report for 2012/13 details progress in a number of important areas such as training, development of standards etc.

Estudi sobre la qualitat de vida de les persones amb demència ateses a la Unitat d'avaluació de deteriorament cognitiu de l'Hospital de la Santa Creu

OBJECTIU: determinar la qualitat de vida de les persones amb demència ateses en una unitat avaluadora de deteriorament cognitiu. MÈTODE: estudi descriptiu transversal amb una mostra consecutiva no probabilística, formada per 42 persones amb demència tipus Alzheimer lleu o moderada i els seus cuidadors. La Qualitat de Vida (QV) es va avaluar amb el qüestionari QoL-AD (Quality of Life Alzheimer’s Disease) en les versions per al pacient (QoL-ADp) i per al cuidador (QoL-ADc). RESULTATS: la mitjana de puntuació del QoL-ADp va ser de 35,38 punts (DE = 5,24) i del QoL-Adc, de 30,60 (DE 5,33). La diferència entre aquests resultats és significativa (p&0,001). Els pacients amb simptomatologia depressiva i els seus cuidadors van puntuar significativament més baix el QoL-AD (p&0,001). En les freqüències per ítems del QoL-ADp s’observa que: més del 75% van valorar com a bona/excel·lent les condicions de vida, família, matrimoni/relació estreta, vida social, situació financera i vida en general; el 61% valoraren bona/excel·lent la capacitat per realitzar tasques a casa; prop del 50% pensava que l’estat d’ànim, l’energia, la salut física, la capacitat per fer coses per diversió i la visió de si mateixos era dolenta/regular, i el 85,7% opinava que la seva memòria era dolenta/regular. CONCLUSIONS: els resultats obtinguts en el QoL-AD no difereixen dels obtinguts en altres investigacions. Suggereixen que les intervencions que genera l’avaluació de la QV en la pràctica clínica inclouen aspectes centrats pròpiament en la malaltia i aspectes vinculats amb les relacions socials.

Estudi sobre la qualitat de vida de les persones amb demència ateses a la Unitat d'avaluació de deteriorament cognitiu de l'Hospital de la Santa Creu

OBJECTIU: determinar la qualitat de vida de les persones amb demència ateses en una unitat avaluadora de deteriorament cognitiu. MÈTODE: estudi descriptiu transversal amb una mostra consecutiva no probabilística, formada per 42 persones amb demència tipus Alzheimer lleu o moderada i els seus cuidadors. La Qualitat de Vida (QV) es va avaluar amb el qüestionari QoL-AD (Quality of Life Alzheimer’s Disease) en les versions per al pacient (QoL-ADp) i per al cuidador (QoL-ADc). RESULTATS: la mitjana de puntuació del QoL-ADp va ser de 35,38 punts (DE = 5,24) i del QoL-Adc, de 30,60 (DE 5,33). La diferència entre aquests resultats és significativa (p<0,001). Els pacients amb simptomatologia depressiva i els seus cuidadors van puntuar significativament més baix el QoL-AD (p<0,001). En les freqüències per ítems del QoL-ADp s’observa que: més del 75% van valorar com a bona/excel·lent les condicions de vida, família, matrimoni/relació estreta, vida social, situació financera i vida en general; el 61% valoraren bona/excel·lent la capacitat per realitzar tasques a casa; prop del 50% pensava que l’estat d’ànim, l’energia, la salut física, la capacitat per fer coses per diversió i la visió de si mateixos era dolenta/regular, i el 85,7% opinava que la seva memòria era dolenta/regular. CONCLUSIONS: els resultats obtinguts en el QoL-AD no difereixen dels obtinguts en altres investigacions. Suggereixen que les intervencions que genera l’avaluació de la QV en la pràctica clínica inclouen aspectes centrats pròpiament en la malaltia i aspectes vinculats amb les relacions socials.

University students’ regulation of learning and text processing – examples from medical and teacher education

The general aim of the thesis was to study university students’ learning from the perspective of regulation of learning and text processing. The data were collected from the two academic disciplines of medical and teacher education, which share the features of highly scheduled study, a multidisciplinary character, a complex relationship between theory and practice and a professional nature. Contemporary information society poses new challenges for learning, as it is not possible to learn all the information needed in a profession during a study programme. Therefore, it is increasingly important to learn how to think and learn independently, how to recognise gaps in and update one’s knowledge and how to deal with the huge amount of constantly changing information. In other words, it is critical to regulate one’s learning and to process text effectively. The thesis comprises five sub-studies that employed cross-sectional, longitudinal and experimental designs and multiple methods, from surveys to eye tracking. Study I examined the connections between students’ study orientations and the ways they regulate their learning. In total, 410 second-, fourth- and sixth-year medical students from two Finnish medical schools participated in the study by completing a questionnaire measuring both general study orientations and regulation strategies. The students were generally deeply oriented towards their studies. However, they regulated their studying externally. Several interesting and theoretically reasonable connections between the variables were found. For instance, self-regulation was positively correlated with deep orientation and achievement orientation and was negatively correlated with non-commitment. However, external regulation was likewise positively correlated with deep orientation and achievement orientation but also with surface orientation and systematic orientation. It is argued that external regulation might function as an effective coping strategy in the cognitively loaded medical curriculum. Study II focused on medical students’ regulation of learning and their conceptions of the learning environment in an innovative medical course where traditional lectures were combined wth problem-based learning (PBL) group work. First-year medical and dental students (N = 153) completed a questionnaire assessing their regulation strategies of learning and views about the PBL group work. The results indicated that external regulation and self-regulation of the learning content were the most typical regulation strategies among the participants. In line with previous studies, self-regulation wasconnected with study success. Strictly organised PBL sessions were not considered as useful as lectures, although the students’ views of the teacher/tutor and the group were mainly positive. Therefore, developers of teaching methods are challenged to think of new solutions that facilitate reflection of one’s learning and that improve the development of self-regulation. In Study III, a person-centred approach to studying regulation strategies was employed, in contrast to the traditional variable-centred approach used in Study I and Study II. The aim of Study III was to identify different regulation strategy profiles among medical students (N = 162) across time and to examine to what extent these profiles predict study success in preclinical studies. Four regulation strategy profiles were identified, and connections with study success were found. Students with the lowest self-regulation and with an increasing lack of regulation performed worse than the other groups. As the person-centred approach enables us to individualise students with diverse regulation patterns, it could be used in supporting student learning and in facilitating the early diagnosis of learning difficulties. In Study IV, 91 student teachers participated in a pre-test/post-test design where they answered open-ended questions about a complex science concept both before and after reading either a traditional, expository science text or a refutational text that prompted the reader to change his/her beliefs according to scientific beliefs about the phenomenon. The student teachers completed a questionnaire concerning their regulation and processing strategies. The results showed that the students’ understanding improved after text reading intervention and that refutational text promoted understanding better than the traditional text. Additionally, regulation and processing strategies were found to be connected with understanding the science phenomenon. A weak trend showed that weaker learners would benefit more from the refutational text. It seems that learners with effective learning strategies are able to pick out the relevant content regardless of the text type, whereas weaker learners might benefit from refutational parts that contrast the most typical misconceptions with scientific views. The purpose of Study V was to use eye tracking to determine how third-year medical studets (n = 39) and internal medicine residents (n = 13) read and solve patient case texts. The results revealed differences between medical students and residents in processing patient case texts; compared to the students, the residents were more accurate in their diagnoses and processed the texts significantly faster and with a lower number of fixations. Different reading patterns were also found. The observed differences between medical students and residents in processing patient case texts could be used in medical education to model expert reasoning and to teach how a good medical text should be constructed. The main findings of the thesis indicate that even among very selected student populations, such as high-achieving medical students or student teachers, there seems to be a lot of variation in regulation strategies of learning and text processing. As these learning strategies are related to successful studying, students enter educational programmes with rather different chances of managing and achieving success. Further, the ways of engaging in learning seldom centre on a single strategy or approach; rather, students seem to combine several strategies to a certain degree. Sometimes, it can be a matter of perspective of which way of learning can be considered best; therefore, the reality of studying in higher education is often more complicated than the simplistic view of self-regulation as a good quality and external regulation as a harmful quality. The beginning of university studies may be stressful for many, as the gap between high school and university studies is huge and those strategies that were adequate during high school might not work as well in higher education. Therefore, it is important to map students’ learning strategies and to encourage them to engage in using high-quality learning strategies from the beginning. Instead of separate courses on learning skills, the integration of these skills into course contents should be considered. Furthermore, learning complex scientific phenomena could be facilitated by paying attention to high-quality learning materials and texts and other support from the learning environment also in the university. Eye tracking seems to have great potential in evaluating performance and growing diagnostic expertise in text processing, although more research using texts as stimulus is needed. Both medical and teacher education programmes and the professions themselves are challenging in terms of their multidisciplinary nature and increasing amounts of information and therefore require good lifelong learning skills during the study period and later in work life.