Problem Clinical supervision has been shown to support midwives, but it is unclear whether online delivery would provide equivalent benefits or would require additional facilitation skills. Background Midwives have reported high levels of stress, burnout and moral distress, within a strained workforce. Clinical supervision can support reflection, professional development and wellbeing yet evidence on online delivery remains limited despite increased use of virtual platforms during the COVID-19 pandemic. Aim To explore midwives’ perceptions of the acceptability and efficacy of clinical supervision delivered via videoconferencing. Methods A mixed methods study was conducted with midwives from two regional New South Wales Local Health Districts. Three groups participated in monthly online group clinical supervision for six months. Post-intervention survey and interview data were collected informed by the Theoretical Framework of Acceptability. Findings Eleven of fifteen participants completed the survey and six were interviewed. Online clinical supervision was viewed positively across purpose, process and impact domains. Five themes were developed from the qualitative data: finding time and space, flexibility, valuing clinical supervision, feeling safe and the online experience. Participants described online sessions as accessible, supportive and safe, with flexibility particularly beneficial for regional and early-career midwives. Discussion Online delivery supported psychological safety and reflective practice, indicating that effective supervision can occur virtually. However, participation relied on protected time, private space and reliable technology - factors that limited engagement for some midwives. Conclusion Online clinical supervision was acceptable and perceived as effective, providing a safe, flexible reflective space and improving access where in-person options were limited. Successful implementation requires organisational support, reliable technology, protected time and skilled facilitation.

PROBLEM STATEMENT:There is limited understanding of midwifery students' education, their personal use, and their views on complementary therapies. BACKGROUND:The use of complementary therapies has grown worldwide, with women in the perinatal period among the highest users. Midwifery students, as future practitioners, have a pivotal responsibility to support women with evidence-based information to promote informed choices regarding these therapies. This study explored midwifery students' education, personal use of, and personal views on complementary therapies across four Asia-Pacific countries: Australia, New Zealand, Indonesia, and Japan. METHOD:A cross-sectional online survey was conducted with midwifery students from the four countries enrolled in an undergraduate or postgraduate program leading to registration as a midwife, who were recruited via purposive sampling. The survey included items on educational exposure, personal use, personal views toward complementary therapies, and demographics. Descriptive and statistical analyses were undertaken. RESULTS:Of 291 respondents, 158 completed at least one section of the survey and were included in the analysis. Indonesian students were more likely to have completed external qualifications (p < .001) and workshops in complementary therapies, in addition to therapies embedded in their curriculum (p = .017). In contrast, Australian/New Zealand and Japanese respondents significantly exceeded Indonesian respondents in their interest in learning more about specific complementary therapies. Most students rated their personal experiences and views of complementary therapies as positive to very positive, with no significant cross-country difference. CONCLUSION:This is the first study to explore midwifery students' education, personal use, and views on complementary therapies in Australia, New Zealand, Indonesia, and Japan. We found strong support for integrating complementary therapies into midwifery education. Incorporating education on complementary therapies into the undergraduate midwifery program provides students with evidence-based information, enabling them to discuss the safe use of these therapies with women in the perinatal period.

The ubiquity of negative childbirth experiences, and their repercussions, are gaining increased global attention. 'Humanizing birth' principles, developed by social science and midwifery scholars, promote relationship-based care tailored to women/birthing people's needs. Midwives play a vital role in birth experiences, but little is known about how they form their perspectives on and capacities to facilitate humanized birth. To address this gap, this study analyses Australian midwives' and students' views of a good birth, a good midwife, and the factors assisting or preventing them facilitating humanized birth experiences. Focus groups and semi-structured interviews elicited participants' (n = 23) perspectives. Participants consistently articulate a specialized midwifery approach and knowledge base aligning strongly with humanizing birth principles. However, they describe having their expertise dismissed within the hospital-based birth system, thus prevented from practicing according to these principles and the evidence base. We argue this constitutes epistemic injustice, with testimonial injustice occurring when midwives'/students' knowledge is wrongly overridden by others with higher status in the professional hierarchy, and hermeneutical injustice perpetuated by epistemic assumptions built into the healthcare system itself. Unable to deploy their expertise, midwives experience epistemic stress and are driven to leave the mainstream birth system, further diminishing the possibilities of humanizing birth.

People with physical disability experience systemic and societal barriers to accessing cervical screening. Service providers play an important role in supporting access to cervical screening for this population. In 2017 Australia’s National Cervical Screening Program introduced the choice to self-collect using a vaginal swab, with universal access available from July 2022. This study aimed to understand service providers’ perspectives on the opportunities self-collection provides to improve access to cervical screening for people with physical disability. Semi-structured interviews were conducted online between June and August 2023 with 22 clinical and non-clinical service providers from all States and Territories except the Northern Territory. The Updated Consolidated Framework for Implementation Research informed the analysis. All participants believed that self-collection was a highly acceptable option, both for people with physical disability and service providers, due to its potential to reduce anxiety and discomfort for screening participants, and the opportunities it provides to increase access to screening in non-clinical settings, including at home and in supported accommodation. To date, few services providing disability support had integrated self-collection into their practice. Key barriers to offering self-collection included confusion regarding whether cervical screening was within all provider’s scope of practice, a lack of communication between the health system and the disability sector and an absence of education and resources for providers and people with disability. Attitudes toward people with disability held by healthcare providers, such as general practitioners and other health and wellbeing services, and the quality of relationships between services were seen as either barriers or enablers depending on whether these were positive or not. Several providers expressed concern that the swab may be difficult for some people with physical and sensory disability to use, with adaptations recommended. Self-collection offers opportunities to improve access to cervical screening for people with physical disability, if supported by providers who have the required knowledge and skills. Implementation strategies to support uptake of self-collection for people with physical disability are required at the individual, device, service, and system level.

Background Midwifery professional practice experience (MPE) is critical to student learning. Midwifery education standards in Australia prescribe that students must complete midwifery continuity of care experiences across pregnancy, birth and postnatally for ten women. Midwifery Professional Experience (MPE) can occur in partnering health facilities and in midwifery continuity of care models. Aim To compare the MPE experiences of midwifery students in public hospital maternity and continuity of midwifery care models using the validated Midwifery Students' Experience of Practice (MidSTEP) Tool. Methods Recruitment was via university learning management systems. Data were collected via REDCap using the validated MidSTEP tool. Demographics, program information and 26 Likert-style responses were included. Categorical data were analysed using descriptive statistics, Likert responses were dichotomised and compared between public hospital maternity care and midwifery continuity of care using McNemar’s test (significance 0.05). Open text questions were thematically analysed. Findings 92 responses were received, 96.7 % MPE was in public maternity models of care and 3.3 % in a midwifery continuity of care model. Midwifery student responses to the MidSTEP scale favoured learning experiences through midwifery continuity of care. Open text responses were coded into four themes, culture, implicit values of the maternity service, support for students and experiences with midwifery continuity of care models. Conclusion This study demonstrates learning in MPE is optimised when students are embedded within continuity of midwifery care models. Prioritising student feedback using the MidSTEP tool aligns with midwifery philosophy and should be prioritised.

Background Midwifery continuity of care improves perinatal outcomes, yet implementing these models can be challenging, particularly in regional and rural settings. Midwives express a preference for working within these models of care however historically opportunities are often restricted to full‑time employment. Most women have limited knowledge of how to access midwifery continuity. Evaluating the prevalence and accessibility of midwifery continuity of care models, and how midwives provide this care remains a complex task. Aim The aim of this study was to nationally map Australian midwifery continuity of care models, identifying which women could gain access and how midwives provide the care. Methods A cross-sectional study design with an online survey was undertaken. Quantitative analyses included descriptive statistics. Findings Midwifery group practice (MGP) was offered by 73.1% (n = 79/108) of respondents (responding services), 45.6% (n = 36/79) of respondents offering MGP made it available to women with risk factors. Pre-existing diabetes 48.1% (n = 38/79), vaginal birth after caesarean section 87.3% (n = 69/79) and psychosocial risk factors 89.9% (n = 71/77). Access was also reported for women under 18 years 88.5% (n = 69/78), migrant/refugee women 93.6% (n = 73/78) and Aboriginal and Torres Strait Islander women 94.9% (n = 75/79). Over a third 35.2% (n = 38/108) of respondents were from regional, rural or remote areas. Homebirth was available in 23.4% (n = 18/77) of respondents. Almost all respondents supported midwives to work part-time 90.9% (n = 70/77) and 64.1% (n = 50/78) did not require midwives to have a minimum number of years’ experience. Conclusion Australian midwifery continuity is provided through various models. Survey responses identified women with pregnancy risk factors can access midwifery continuity. Midwives were offered flexible work options with opportunities for early career midwives to provide continuity.

Objective:This review aims to identify the facilitators and barriers to recruiting pregnant people with anxiety/depression into group-based intervention studies designed to support their mental health.Introduction:Recruiting pregnant people, particularly those with anxiety/depression, for research studies is crucial for developing effective mental health interventions; however, this remains a significant challenge. There is a lack of focused evidence on the specific facilitators and barriers to recruiting participants for perinatal mental health studies.Eligibility criteria:This review will include studies on pregnant people with anxiety/depression focusing on the facilitators and barriers to recruiting participants for group-based programs designed to support their mental health.Methods:The review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will systematically search PubMed, Embase, CINAHL (EBSCOhost), Scopus, PsycINFO (Ovid), and ScienceDirect. ProQuest Dissertations and Theses (ProQuest) and Google Scholar will be searched for grayliterature. The references of the relevant articles will be manually searched to identify additional studies. Identified studies will be independently assessed for inclusion by 2 reviewers. Independent double extraction of study characteristics and critical appraisal items will be conducted using standardized tools. Quantitative and qualitative data will be summarized in narrative and tabular format, and synthesized using a convergent integrated approach, in which quantitative data will be transformed to support the synthesis of narrative findings. Consistency will be verified by 2 reviewers, with any discrepancies resolved through discussion.Review registration:PROSPERO CRD42025635015

INTRODUCTION:Pregnancy is a critical period of heightened vulnerability to mental health challenges. Peer support and mindfulness have individually shown promise as non-pharmacological perinatal mental health strategies, yet their combined potential remains underexplored. This study evaluated the feasibility of a novel intervention integrating peer support with a mindfulness application. METHODS:A quasi-experimental pre-post feasibility design was conducted between April 2024 and January 2025 at an antenatal clinic in a public hospital in New South Wales, Australia, using convenience sampling across two sequential recruitment phases. The 4-week intervention combined mutual peer support sessions with guided mindfulness practice via the Headspace app, enrolling pregnant women at elevated risk of anxiety and depression (priority group) and those from the general pregnant population. Validated self-report measures (DASS-21, FFMQ-15, MSPSS) and salivary cortisol samples were collected pre- and post-intervention. Wilcoxon signed-rank and Mann-Whitney U tests examined within- and between-group changes; open-ended post-intervention survey responses were analyzed using content analysis. RESULTS:Thirteen pregnant women participated, achieving a 100% retention rate despite recruitment challenges. A statistically significant reduction in stress was observed in the general group compared to the priority group (median [IQR]: 22 [14-30] vs 8 [2-20]; p<0.050). No significant pre-to-post changes were found in anxiety, depression, mindfulness, or perceived social support in either group (p>0.05). Qualitative findings highlighted that the intervention fostered emotional support, connectedness, and mindfulness engagement, with participants expressing willingness to recommend the program. CONCLUSIONS:Combining peer support with a mindfulness application appears feasible and acceptable for pregnant women and warrants evaluation in adequately powered randomized controlled trials.

PROBLEM:It is unknown if graduate midwives receive similar support from midwives providing continuity of care and midwives not working in continuity models. BACKGROUND:All new graduate midwives require support as they transition from student to practitioner regardless of model of care in which they work. New graduate midwives are keen to work in continuity of care models but require good mentorship. AIM:To compare the perceptions of support provided by midwives to new graduates between those working in continuity of care models and those not working in those models. METHODS:A cross-sectional study design with an online survey was undertaken. Quantitative analyses included descriptive statistics and independent t-tests. Content analysis was used for the open-ended questions data. FINDINGS:Both groups of midwives reported it was important for new graduates to have knowledge and continue lifelong learning. Both groups of midwives also reported the importance of new graduates being involved in decision-making. Midwives working in continuity of care models were more likely to role model desirable behaviours of self-care, provide supportive environments, and think that new graduates should have more opportunities to work in continuity of care with a reduced workload than midwives not in continuity models. CONCLUSION:Midwives thought that it was important to listen to new graduates' opinions and to value their opinions as an integral part of care. Mentoring and supporting new graduates with ongoing educational support and being inclusive is important for all regardless of model of care.

BACKGROUND:Perinatal depression and anxiety, experienced by about 20 % of women, are a risk factor for associated morbidities for mothers and babies, including risk of suicide and preterm birth. Traditionally this group of women have not been able to access midwifery continuity of care despite the known benefits. AIM:This study aims to explore the experiences of midwives providing continuity of care to women with perinatal mental health disorders and women's experiences of receiving care in a continuity of care model. METHODS:We used a mixed methods design incorporating a qualitative exploratory study using a qualitative descriptive approach [1] to understand midwives experiences. We also explored the women's experience of receiving continuity of care and observed mothers interacting with their babies. The quantitative data was collected using the Parenting Interactions with Children Checklist of Observations (PICCOLO) [2], described in detail below, to measure these interactions. RESULTS:Two overarching themes were generated: Continuity is protective, with subthemes Safe in their hands, Healing from previous trauma and Sustaining breastfeeding; and Having exceptional care deserves equitable access, with sub-themes Having your choices respected, Having a meaningful birth experience, Providing exceptional care requires support. CONCLUSION:This study adds to current literature that indicates midwifery continuity of care as emotionally protective, which is particularly important for women with perinatal mental health conditions and may have ongoing positive effects that foster wellbeing. Experienced as providing 'exceptional' care, our findings demonstrate an urgent need to increase access to such models, and ensuring midwives have equally 'exceptional' training, support and referral pathways, to ensure their sustainability.

Background: There are high levels of consumer demand for homebirth in Australia, however access is limited due to a wide range of factors, including associated costs of a private midwife and the limited number of publicly funded homebirth models. Homebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy. This paper has two aims. The first is to describe the implementation of a publicly funded homebirth service with an employed mentor. The second is to provide the outcomes from a matched cohort of women who received care from the same Midwifery Group Practice [MGP] who gave birth at home, compared with those who gave birth in hospital. Methods: The retrospective comparative cohort study used routinely collected perinatal data from the hospital's electronic database (eMaternity) from July 2018 - October 2021. The cohort of interest were women who received care through MGP. They were identically matched by parity, age, Body Mass Index (BMI), spontaneous labour and gestation of 37-42 weeks. A description of the employed midwifery mentor to implement this model of care is also provided. Findings: 100 women gave birth at home during the study period. They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001). No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes. Conclusion: This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth. This is consistent with the existing literature that place of birth makes a difference. A description of the role of a mentor in supporting the sustainability of a publicly funded homebirth program is provided. Further research is recommended to evaluate the mentor's role in implementing and sustaining the model.

AIM:To explore what midwifery academics and midwifery clinicians understand as the learning goals of the Continuity of care experiences (CoCE) in the Bachelor of Midwifery program. BACKGROUND:Continuity of care experiences are a component of all midwifery programs in Australia with the aim to facilitate an understanding of how relationship-based care is foundational to learning the art and science of midwifery. However, challenges persist in embedding meaningful CoCE, in part because learning goals have not been consistent. DESIGN:A qualitative descriptive approach was used in this study. The study took place in a regional/rural Australian setting. METHOD:Twenty- six midwifery academics and clinicians supporting undergraduate midwifery students participated in a semi structured interview. Reflexive thematic analysis was used to analyse the data set. RESULTS:The overarching theme 'Learning the craft of midwifery', had five subthemes: Building trusting relationships; Experiencing the science of relationships; Navigating the boundaries; Deep reflections: a missed opportunity and Shaping the future. Continuity of care experiences exposed students to the neurophysiological foundations of relationships. CONCLUSION:This paper identifies the perceived educational intent of CoCE is to provide an opportunity for technical skill development in addition to learning how to establish supportive, authentic relationships with women. Clear identification of the learning expectations of CoCE and clarification around the value placed on midwifery philosophy should be developed.

BACKGROUND:Migrant populations are recognised to be at increased risk of adverse health outcomes including perinatal outcomes. Structural barriers to maternity care and racism are recognised globally as an urgent issue for migrants. Midwife continuity of care (MCoC) has well known improved perinatal benefits. AIM:To investigate if duration since migration was associated with reduced access to MCoC. METHODS:We conducted a retrospective cohort study from June 2020-November 2023 at six Australian hospitals. MCoC was investigated by hospital and self-identified ethnic group for women who migrated < 5 years, ≥ 5 years compared to the Australian born population. Regression models adjusted for significant factors including use of interpreter and co-morbidities. FINDINGS:There were 48,240 participants for analysis. Most in the cohort were Australian born (54.7 %, n = 26,365), migrants of < 5 years comprised 13.2 % (n = 6388) and those who migrated ≥ 5 years 32.1 % (n = 15,487). At all study hospitals, new migrants had the least access to MCoC. Compared to Australian born women, new migrants were 70 % less likely to receive MCoC (aOR 0.30; 95 %CI 0.27-0.34) and migrants of ≥ 5 years were 49 % less likely (aOR 0.51; 95 %CI 0.48-0.56). We identified a difference to access to MCoC between ethnic groups. DISCUSSION:Health literacy needs of women who are migrants should be addressed to improve equity of access to a model of care that is evidenced based to improve perinatal outcomes. CONCLUSION:It is incumbent on health services to measure equity of access and adjust services to ensure equity of access for all populations.

Background In perinatal care, obstetric violence and birth trauma are two distinct yet often conflated concepts. This confusion can obscure the specific harms of obstetric violence, as its impact is frequently subsumed under the broader idea of birth trauma, leading to underreporting of obstetric violence. Simultaneous concept analysis is used to clarify two related concepts by comparing their unique elements and identifying overlaps.Aim To compare the antecedents, attributes, and consequences of both the concepts and to identify their intersections.Methods A comprehensive search across PubMed, Google Scholar, CINAHL, and ProQuest yielded 98 articles on obstetric violence and 62 on birth trauma. Thematic analysis of antecedents, attributes, and outcomes informed a comparative validity matrix.Results Obstetric violence and birth trauma have different causes and characteristics but lead to similar outcomes. Birth trauma arises from experiences like fear or unmet expectations, while obstetric violence involves abuse by providers and systemic failures. Both result in emotional distress, anxiety, and fear of future childbirth.Conclusion Existing literature uses the term "birth trauma" as a euphemism for what is essentially obstetric violence. Considering the conceptual confusion between the subjective trauma arising from childbirth experiences and the trauma specifically resulting from abuse by healthcare providers, we are suggesting a new term, "Obstetric Trauma" This would specifically indicate the structural and institutional consequences of obstetric violence on women. It would also help guide targeted interventions, policy changes, and support systems aimed at preventing obstetric violence and promoting respectful maternity care.

Background: Midwifery continuity of care improves outcomes for mothers and babies. High levels of satisfaction with these models of care have been reported by both women and midwives; however, implementation and scale-up have been slow. In New South Wales, Australia, health services have responded by introducing a modified model of continuity of care called midwifery-led antenatal and postnatal service (MAPS). This study explored the experiences of midwives who work in the model of care, the women who receive the care and the managers who implemented the models.Aim: To explore the implementation of a MAPS model from the perspective of maternity managers in seven sites across New South Wales, Australia.Methods: Data were collected via two online focus groups with managers for this statewide study. The Quality Maternal Newborn Care (QMNC) framework was used to guide the focus groups. Data were analysed by coding and mapping to the framework. This analysis identified strengths of the findings and areas for improvement resulting in the final themes and subthemes.Findings: The findings from the focus groups with managers (n = 8) across five local health districts (seven sites) resulted in the following three themes: implementing and evolving the model, increasing access to continuity and managing a skilled and flexible workforce while sustaining the model.Conclusions/Implications: The MAPS model is a way of attracting midwives and sustaining a workforce; however, resources need to be allocated to support managers with implementation. Managers in their quest for scale-up of continuity of care view MAPS as value-add rather than a replacement for midwifery continuity. MAPS can be viewed as a way to transition midwives to providing continuity of care.

Midwifery continuity of care has demonstrated improved outcomes for mothers and babies including higher rates of spontaneous vaginal birth and more positive birth experiences, with health services cost savings, than non-continuity of care. However, midwives report challenges with continuity of care, such as on-call for labour/birth. Health services have responded with a new model, Midwifery Antenatal and Postnatal Service (MAPS), with care from a known midwife only during pregnancy and the early postnatal period. Women in the MAPS model have intrapartum care by rostered birth suite midwives (potentially unknown to the woman) whereas Midwifery Group Practice have a known midwife. AIM:To determine if MAPS is associated with similar perinatal outcomes for women and babies as the Midwifery Group Practice (MGP) model. METHODS:A retrospective study was undertaken using de-identified routinely collected maternity data. All women who booked in and gave birth with MGP or MAPS at one hospital in New South Wales, Australia between April 2022 - April 2023. Descriptive and inferential statistics were used to describe the data. RESULTS:A total of 1303 births were analysed (MGP=349, MAPS =954). The MGP cohort were more likely to experience spontaneous labour (< 0.001) with local anaesthesia or no analgesia, vaginal births without instruments (<0.001), and exclusive breastfeeding at discharge (0.004) compared to MAPS births. CONCLUSION:Continuity of care with a known midwife (antenatal, labour/birth, and postnatal) was associated with less intervention and improved breastfeeding rates as supported by international literature. Future research is needed comparing MAPS to standard fragmented midwifery care.

PROBLEM:Evidence suggests new midwifery graduates are leaving the profession prematurely during the initial graduate years due to workplace stress. BACKGROUND:Graduate midwives are essential to provide a future midwifery workforce. Support for new graduates in the initial years of practice is essential in retaining them in the midwifery profession. AIM:The aim of this study was to explore midwives' perspectives of the support they provide new graduates within existing midwifery graduate programs, and their experiences and perceptions of the health service processes to support midwifery graduates. METHODS:A cross-sectional study was undertaken with a purposive sample of Australian midwives. Descriptive statistics were used to analyse frequencies and percentages of responses. Spearman's correlational analyses were used to determine associations between the variables. Responses to open-ended questions were analysed by content analysis. FINDINGS:In total, 167 midwives responded to the survey. Just over a third (34.1 %) of midwives felt they had sufficient resources to support a midwifery graduate. Half (50.9 %) of the midwives engaged in reflective practice with midwifery graduates. The majority (97 %) of midwives reported that they felt it was important for midwifery graduates to have a mentor. DISCUSSION:A lack of protected time to provide mentoring opportunities and support new graduates to gain further experience and education was identified. These findings support the need for a formal mentorship program to be introduced. CONCLUSION:This study offers insights into the perspective of midwives dealing with the realities of striving to support midwifery graduates in their initial years of practice.

BACKGROUND AND PURPOSE:Globally, women are the highest users of complementary therapies, often during the perinatal period [pregnancy, childbirth, and postnatal time]. Midwives who provide care to women throughout the perinatal period need to have evidence-based knowledge of complementary therapies. There is a lack of research on why midwives are interested in learning about complementary therapies. The purpose of this research is to explore the experiences of Japanese midwives in undertaking professional development in complementary therapies. The study explored what the midwives learnt, how they used these therapies in their practice, and what strategies can help midwives implement these complementary therapies. MATERIALS AND METHODS:A qualitative study was undertaken using semi-structured interviews with 15 Japanese midwives who had completed a certificate in complementary therapy. Content analysis was used to analyse the data. RESULTS:Two themes were identified as reasons midwives undertook professional development in complementary therapies: supporting women during the perinatal period with complementary therapies, and factors that influence midwives to learn complementary therapies as a new skill. Strategies to address challenges in implementing complementary therapy into practice were identified as follows: Needing a supportive working environment and encouraging midwives to increase their knowledge and skills about complementary therapies. CONCLUSION:Midwives in Japan undertook professional development in complementary therapy training as a new skill to support women in the perinatal period. Further research is warranted to assist midwives in implementing complementary therapies in practice by raising awareness of its evidence-based values among medical colleagues.