Allied Health Care Research Articles

Awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in Central India

To know the awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in central India A web-based survey, cross-sectional study was conducted to obtain responses from health care workers (HCWs) in central India from the month of May – July 2020 to access the awareness and knowledge of ocular manifestation in COVID 19 patients among HCWs in central India. This survey was divided into three parts: (i) Participant characteristics (ii) awareness / knowledge of COVID-19 disease (iii) awareness / knowledge regarding ocular manifestation of COVID 19 patients and their source of information. Knowledge regarding ocular manifestation of the disease was assessed by questions focusing on COVID-19 signs / symptoms and risk in eyes, its transmission, and prevention. Ethical clearance was taken and electronic informed consent was taken and confidentiality of each person was maintained throughout the study. A total of 408 healthcare workers participated in the study, in which approximately 59.06% (n = 241) of males and 40.94% (n= 167) females, majority of them belong to urban area 74% (n= 302). Most of the HCWs 39.9% were between 35-44 years of age, in which 51.71% (n = 211) were Doctors, 35.04% (n =143) were nursing staff and 6.61%, 1.47% were hospital attendant and sanitary workers respectively Almost all participants (n=408) had heard about COVID-19, out of which 92.15% agreed that corona patients can recover completely. The study reviled that most of HCWs had good knowledge about the disease and its transmission. However, 336 (82.35%) HCWs were aware that the disease can also affect the eye and 278 (68.13%) accepted that it can cause conjunctivitis. The study revealed that 193 doctors (91.46%), 120 (83.91%) nursing staff and only 23 allied health workers (42.59%) thought that COVID-19 can affect eyes. In which (n=119) 56.39% doctors, (n=61) 42.65% nursing staff, and only (n=19) 35.18% allied health care workers believed that corona can spread through tears. Most doctors (n=165, 78.19%) agreed that COVID 19 can cause conjunctivitis, Which was not same in the case of nursing staffs and other allied Health care workers. Hence, there was a knowledge gap between doctors and other HCWs regarding ocular manifestation of COVID-19 disease. The study concluded that most of the HCWs were aware about the disease (COVID-19) and had good knowledge about the general condition of the disease but participant’s knowledge regarding ocular manifestation of the disease was comparatively less, though most of the HCWs agreed that COVID-19 could also affect the eyes.

A Delphi consensus study introducing a Problem And attRibutes‐bAsed DIabetes self‐manaGeMent (PARADIGM) intervention for patients with type 2 diabetes

AimEncouraging patients to improve their self-management behavior based on a strict definition of the intervention is important for a standardized delivery but, until recently, there was no consensus on the core attributes that define such an intervention. The purpose of this study is to generate a core-attribute based and stakeholder-informed problem-based curriculum for promotion of type 2 diabetes self-management structured around five core attributes derived from a previous concept analysis that defined the intervention. MethodsUsing a Delphi process for consensus achievement, physicians, clinical epidemiologists and allied health care professionals completed eleven rounds of online meetings over 6 months. ResultsCore self-management skills were identified by consensus for each of the five attributes and then used to design a model case and interactions of a problem-based self-management education intervention for delivery in a health care setting. Five model cases and associated interactions were developed by consensus for delivery in group-based and problem-based learning sessions. ConclusionsThe final structured curriculum will be useful to inform and standardize diabetes self-management based on a clear conceptual definition of the intervention and can thus help make the latter more effective tools for encouraging persons with type 2 diabetes to self manage their condition.

Real-Time Telehealth Versus Face-to-Face Management for Patients With PTSD in Primary Care: A Systematic Review and Meta-Analysis.

Objective: We conducted a systematic review and meta-analysis of randomized controlled trials comparing real-time telehealth (video, phone) with face-to-face therapy delivery to individuals with posttraumatic stress disorder (PTSD), by primary or allied health care practitioners.Data Sources: We searched MEDLINE, Embase, CINAHL, and Cochrane Central (inception to November 18, 2020); conducted a citation analysis on included studies (January 7, 2021) in Web of Science; and searched ClinicalTrials.gov and WHO ICTRP (March 25, 2021). No language or publication date restrictions were used.Study Selection: From 4,651 individual records screened, 13 trials (27 references) met the inclusion criteria.Data Extraction: Data on PTSD severity, depression severity, quality of life, therapeutic alliance, and treatment satisfaction outcomes were extracted.Results: There were no differences between telehealth and face-to-face for PTSD severity (at 6 months: standardized mean difference [SMD] = -0.11; 95% CI, -0.28 to 0.06), depression severity (at 6 months: SMD = -0.02; 95% CI, -0.26 to 0.22; P = .87), therapeutic alliance (at 3 months: SMD = 0.04; 95% CI, -0.51 to 0.59; P = .90), or treatment satisfaction (at 3 months: mean difference = 3.09; 95% CI, -7.76 to 13.94; P = .58). One trial reported similar changes in quality of life in telehealth and face-to-face.Conclusions: Telehealth appears to be a viable alternative for care provision to patients with PTSD. Trials evaluating therapy provision by telephone, and in populations other than veterans, are warranted.

Multidisciplinary integrated care pathway for von Hippel-Lindau disease.

BACKGROUNDClinical pathways are care plans established to describe essential steps in the care of patients with a specific clinical problem. They translate (inter)national guidelines into local applicable protocols and clinical practice. The purpose of this article is to establish a multidisciplinary integrated care pathway for specialists and allied health care professionals in caring for individuals with von Hippel–Lindau (VHL) disease.METHODSUsing a modified Delphi consensus‐making process, a multidisciplinary panel from 5 Dutch University Medical Centers produced an integrated care pathway relating to the provision of care for patients with VHL by medical specialists, specialized nurses, and associated health care professionals. Patient representatives cocreated the pathway and contributed quality criteria from the patients' perspective.RESULTSThe panel agreed on recommendations for the optimal quality of care for individuals with a VHL gene mutation. These items were the starting point for the development of a patient care pathway. With international medical guidelines addressing the different VHL‐related disorders, this article presents a patient care pathway as a flowchart that can be incorporated into VHL expertise clinics or nonacademic treatment clinics.CONCLUSIONSMedical specialists (internists, urologists, neurosurgeons, ophthalmologists, geneticists, medical oncologists, neurologists, gastroenterologists, pediatricians, and ear‐nose‐throat specialists) together with specialized nurses play a vital role alongside health care professionals in providing care to people affected by VHL and their families. This article presents a set of consensus recommendations, supported by organ‐specific guidelines, for the roles of these practitioners in order to provide optimal VHL care. This care pathway can form the basis for the development of comprehensive, integrated pathways for multiple neoplasia syndromes.

The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review.

BackgroundImproving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding–related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic.ObjectiveThe aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels.MethodsA search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures.ResultsElectronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022.ConclusionsThe findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability.International Registered Report Identifier (IRRID)DERR1-10.2196/36448

Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study.

BackgroundThe integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries.ObjectiveThe aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics.MethodsA cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic.ResultsIn total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97).ConclusionsOur findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.

The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India.

The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.

A survey on functional disabilities and perceived need for allied health and complementary therapies for Thai individuals with Parkinson’s disease

Background: Evidence regarding functional disability and the need for alternative health care services to improve abilities among Thai individuals with Parkinson’s disease (PD) is limited. Objectives: The study aims to survey PD patients on their functional difficulties and determined the correlation between personal- and disease-related factors on the difficulties they experience. Additionally, we asked about the need for, utilization of, and satisfaction with allied health care (AHC) and alternative complementary therapy (ACT) to minimize these difficulties in PD. Materials and methods: Researchers conducted one-on-one interviews in a movement disorder clinic in a Thai university hospital. The survey consisted of interviews for personal and disease data at first, followed by the self-rating of functional disabilities and the need for and experience of AHC and ACT. Results: Patients with severe disease had regressive disability in some activities. There were 4 factors related to the level of functional disability: stage of severity, duration of disease, cognitive performance, and depression score. Half of the participants needed treatment via AHC and ACT. Of the patients, 37%, 50% and 38.9% had experience with physical therapy, massage, and acupuncture, respectively. Almost all of them were satisfied with massage and physical therapy, while a small number of patients were satisfied with acupuncture. Conclusion: These results indicate that functional disability worsens as the disease progresses. A small number of patients have experience with AHC and ACT; however, they need alternative treatment. Further research regarding related factors for utilizing AHC and ACT in Thai PD patients’ needs to be conducted.

Understanding The Motives Of Body Donors

In the United Kingdom (UK) and Ireland approximately 1,400 body donors for Anatomical Examination are needed per year for the education and training of medical and allied health care professionals. The current study aimed to explore prospective donors’ motives, beliefs and desires about body donation to medical schools in England, Ireland, Scotland and Wales, with the hypothesis that their attitudes had not changed since the last such study in the UK in 1995 and that their motivation remained largely altruistic. A prospective, questionnaire‐based study of 821 potential donors over a 12 month period revealed a high level of agreement in answers to a number of questions exploring their motivation. Ninety six % of donors agreed they wished to improve the education of health care professionals, 92% agreed it was to help improve health care for patients, 78% considered that it provided a ‘good ending’ to their life. However, answers to two questions demonstrated a split viewpoint. When asked if saving relatives money was a motive 43% disagreed and 32% agreed, which was a marked increase compared to the 1995 study. A similar trend was seen when it came to sparing relatives inconvenience, with 46% of potential donors answering that this was not a motivating factor, but an increased 29% agreeing that it was. Inconvenience may mean different things to different people; practical, financial and emotional. Donors also reported differing views on avoiding traditional burial rituals with 46% agreeing that body donation helped them avoid such rituals, reflecting that some donor attitudes have changed since the last survey. Understanding donors’ altruistic motives is important, but so is recognizing some of the practical considerations important to them and how these may change with time. Therefore, the results of the current study help further our understanding of how we can support socially acceptable and ethical donation practices, including improved resources for donors, as well as also match future needs of the sector.

Challenges experienced in the dental care of persons with special needs: a qualitative study among health professionals and caregivers

BackgroundThis study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country.MethodsThis qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed.ResultsBarriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies.ConclusionsCaregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.

Temporal patterns of chronic disease incidence after breast cancer: a nationwide population-based cohort study

We conducted a retrospective cohort study to evaluate the temporal pattern of incidence of chronic conditions after developing breast cancer using a population-based national registry. We selected 84,969 women with newly diagnosed breast cancer between 2002 and 2016 and a 1:10 sample of age-matched non-breast cancer controls (N = 1,057,674). The main study exposure was incident breast cancer, considered as a time-varying exposure. The outcomes were incident cases of leukemia, endometrial cancer, myeloma, cardiomyopathy, osteoporosis, end stage renal disease (ESRD), pulmonary fibrosis, hypothyroidism, type 2 diabetes, hypertension and hyperlipidemia. The development of breast cancer was associated with a significantly increased risk of all outcomes analyzed except for ESRD and hypertension. The fully-adjusted risks of leukemia (HR 3.09; 95% CI 2.11–4.51), cardiomyopathy (HR 2.65; 95% CI 1.90–3.68), endometrial cancer (HR 3.53; 95% CI 2.76–4.53), hypothyroidism (HR 1.29; 95% CI 1.19–1.40), pulmonary fibrosis (HR 1.84; 95% CI 1.12–3.02), and hyperlipidemia (HR 1.24; 95% CI 1.20–1.28) remained significantly elevated after more than 5 years since diagnosis. Optimal care for breast cancer survivors requires close collaboration between oncologists and allied health care professionals to identify and manage the long-term morbidity and mortality associated with these chronic conditions.

The 2021 European Alliance of Associations for Rheumatology/American College of Rheumatology Points to Consider for Diagnosis and Management of Autoinflammatory Type I Interferonopathies: CANDLE/PRAAS, SAVI, and AGS.

Autoinflammatory type I interferonopathies, chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature/proteasome-associated autoinflammatory syndrome (CANDLE/PRAAS), stimulator of interferon genes (STING)-associated vasculopathy with onset in infancy (SAVI), and Aicardi-Goutières syndrome (AGS) are rare and clinically complex immunodysregulatory diseases. With emerging knowledge of genetic causes and targeted treatments, a Task Force was charged with the development of "points to consider" to improve diagnosis, treatment, and long-term monitoring of patients with these rare diseases. Members of a Task Force consisting of rheumatologists, neurologists, an immunologist, geneticists, patient advocates, and an allied health care professional formulated research questions for a systematic literature review. Then, based on literature, Delphi questionnaires, and consensus methodology, "points to consider" to guide patient management were developed. The Task Force devised consensus and evidence-based guidance of 4 overarching principles and 17 points to consider regarding the diagnosis, treatment, and long-term monitoring of patients with the autoinflammatory interferonopathies, CANDLE/PRAAS, SAVI, and AGS. These points to consider represent state-of-the-art knowledge to guide diagnostic evaluation, treatment, and management of patients with CANDLE/PRAAS, SAVI, and AGS and aim to standardize and improve care, quality of life, and disease outcomes.

Electronic Prescribing System and electronic health record priorities for antimicrobial stewardship

Rationale, aims, and objectives: This study provided a platform for electronic prescribing design features that may facilitate antimicrobial stewardship. This study aimed to identify software features within electronic prescribing systems and to assign priorities to these software features according to the opinions of the infection specialist health care professionals. Also, to identify any differences in priorities according to a professional group and experience in using electronic prescribing and communicate research findings to policy-makers and electronic prescribing manufacturers.
 Methods: The study was conducted in a large (600-bed) governmental tertiary and teaching hospital in Amman, Jordan. The survey was delivered by hand to antimicrobial prescribers (internists, surgeons, paediatricians, infectious diseases specialists, and critical care specialists) and non-prescribers (medical interns, clinical pharmacists, nurses, and other allied health care professionals) who filled out the survey face to face. The delivery of the survey started on March 15, 2020, and was closed on April 7, 2020.
 Results: Responses were received from 210 individuals. Interns represented more than one-third of respondents (n= 79, 37.6%), with 15.7% were internal medicine physicians. Among the healthcare professionals, around 44.7% (n= 94) are considered prescribers to antimicrobials, while others are considered non-prescribers (n= 116, 55.2%). The majority of respondents (n= 205, 97.6%) reported using an electronic prescribing and electronic health record system for part or all in their hospital, with 35.7% (n= 75) of them reported using these systems for more than one year. The prompt prescribing feature having the highest assigned priority was the allergy checker (n= 193, 91.9%) followed by the dose checker (n= 192, 91.4%).
 Conclusion: This study demonstrates the first attempt to describe views of healthcare professionals in Jordan about the potential significance of prescribing prompt and active prescription surveillance software features on clinical, microbiological and process outcomes to support antimicrobial stewardship. Findings from this study reveal considerable demand for additional software features expressed by the healthcare professionals charged with promoting rational use of antimicrobials and a consensus of anticipated positive impact on patient safety and efficiency outcomes.

Clinical Issues—March 2022

Nursing scope of practice Key words: state nurse practice act (NPA), state board of nursing, decision-making framework, standards, guidance. Practice of unlicensed perioperative personnel Key words: job description, task delegation, unlicensed personnel, allied health care provider, scope of practice. Definition of a cavity for counting procedures Key words: anatomical hollow space, counting, cavity, retained surgical item (RSI), retained foreign object (RFO). Identifying retained suture needles on radiographic images Key words: suture needle size, suture needle length, radiographic imaging, counting procedures, count discrepancy.

Virtual medical research mentoring and collaboration: breaking the bounds of nationality during the COVID-19 pandemic

Funding AcknowledgementsType of funding sources: None.OnBehalfCardioovascular Analytics GroupBackgroundMedical research is critical to professional advancement, and mentoring is an important means of early research engagement in medical training. In contrast to international research collaborations, research mentoring programs are often locally limited. With the COVID-19 pandemic causing drifts to virtual classes and conferences, virtual international medical research mentoring may be viable. We hereby describe our experience with a virtual, international mentorship group for cardiovascular research.MethodsOur virtual international research mentorship group has been running since 2015. The group focuses on risk stratification and outcomes research in cardiovascular medicine and epidemiology. Mentees from any country or region in all stages of medical careers are welcomed. Considering the increasing emphasis of contemporary research on multidisciplinary healthcare and translational research, our team also includes allied healthcare professionals or students, and graduates from natural sciences (Figure 1). With our members’ diverse backgrounds, we firmly adhere to the principle that all members must be given equal opportunities and treatment, regardless of their age, gender, race, nationality, sexual orientation, family background, and institution of study or practice. We make use of virtual platforms and multi-level mentoring (both senior and peer mentoring), and emphasize active participation, early leadership, open culture, accessible research support, and a distributed research workflow (i.e. an accessible-distributed model).ResultsSince establishment, our group has expanded to include 63 active members from 14 countries (Figure 2), leading a total of 109 peer-reviewed original studies and reviews published. We observed no significant difficulty in communication between team members, nor conflicts due to differences in nationality or ethnicity. Most studies involve cross-country and ethnicity collaborations, and inter-disciplinary and inter-regional knowledge exchanges are frequent. Multi-level mentoring ensured mentoring quality without compromising bonding and communication.ConclusionAn accessible-distributed model of virtual international medical research collaboration and multi-level mentoring is viable, efficient, and caters to the needs of contemporary healthcare. We hope that others will build similar models and improve medical research mentoring globally. Figure 1 Figure 2

Economic Evaluation of a Geriatric Oncology Clinic.

Simple SummaryThere is increasing evidence supporting geriatric assessment (GA) prior to starting cancer treatment in older adults. However, GA is not widely available. One reason may be the lack of persuasive economic data demonstrating its value. We performed an economic evaluation of an academic geriatric oncology clinic and included 152 patients aged 65 years and older who underwent a GA in the pre-treatment setting. We carefully calculated the costs of the proposed treatment (prior to the GA), costs of the GA and associated recommendations, costs of the final treatment, and overall value. We found a GA saved CAD 7387 per patient seen. Extensive sensitivity analyses supported our finding that a GA is economically attractive and should be implemented more widely.Geriatric assessment (GA) is supported by recent trials and guidelines yet rarely implemented due to a lack of resources. We performed an economic evaluation of a geriatric oncology clinic. Pre-GA proposed treatments and post-GA actual treatments were obtained from a detailed chart review of patients seen at a single academic centre. GA-based costs for investigations and referrals were calculated. Unit costs were obtained for surgical, radiation, systemic therapy, laboratory, imaging, physician, nursing, and allied health care (all in 2019 Canadian dollars). A six-month time horizon and government payer perspective were used. Consecutive patients aged 65 years or older (n = 152, mean age 82 y) and referred in the pre-treatment setting between July 2016 and June 2018 were included. Treatment plans were modified for 51% of patients. Costs associated with planned treatment were CAD 3,655,015. Costs associated with GA and related interventions were CAD 95,798. Final treatment costs were CAD 2,436,379. Net savings associated with the clinic were CAD 1,122,837, or CAD 7387 per patient seen. Findings were robust in multiple sensitivity analyses. Combined with mounting trial data demonstrating the clinical benefits of GA, our data can inform a strong business case for geriatric oncology clinics in health care environments similar to ours, but additional studies in diverse health care settings are warranted.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players.

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour

Abstract Objectives Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers. Methods A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains. Results In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination. Conclusions By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.

Perceptions About the Efficacy and Acceptability of Telephone and Video-Delivered Allied Health Care for Adults With Disabilities During the COVID-19 Pandemic: A Cross-sectional National Survey

ObjectiveTo investigate and compare perceptions about the efficacy and acceptability of allied health care delivered via telephone and video call for adults with disabilities during the COVID-19 pandemic. DesignCross-sectional national survey. SettingParticipants who accessed occupational therapy, physiotherapy, psychology, or speech pathology care via telephone or via video call from June to September 2020. ParticipantsFive hundred eighty-one adults with permanent or significant disabilities, or their carers, partners, or family members, who were funded by the Australian National Disability Insurance Scheme. InterventionsNot applicable. Main Outcome MeasuresExperiences (eg, safety, efficacy, ease of use) with telephone and video-delivered care. Data were analyzed by calculating response proportions and chi-square tests to evaluate differences in experiences between allied health professions and between telephone and video modalities. ResultsResponses were obtained for 581 adults with disabilities. There was no evidence of differences between experiences with telephone or video-delivered services or across allied health professions. Overall, 47%-56% of respondents found telehealth technology easy to use (vs 17%-26% who found it difficult), 51%-55% felt comfortable communicating (vs 24%-27% who felt uncomfortable), 51%-67% were happy with the privacy and/or security (vs 6%-9% who were unhappy), 74% were happy with the safety (vs 5%-7% who were unhappy), and 56%-64% believed the care they received was effective (vs 17% who believed it was ineffective). Despite this, 48%-51% were unlikely to choose to use telephone or video consultations in the future (vs 32%-36% who were likely). ConclusionsAdults with disabilities in Australia had generally positive experiences receiving allied health care via telehealth during the COVID-19 pandemic, although some experienced difficulties using and communicating via the technology. Findings indicated no differences between satisfaction with telephone or video modalities, or between physiotherapy, speech pathology, occupational therapy, or psychology services.

Stakeholders Contribution in the Development of Occupational Therapy Profession and Impact of the Profession in Rwanda

Introduction: Africa was noted as a challenging place for allied health care professions including occupational therapy. Those challenges include promotion of occupational therapy and educational program. The University of Rwanda started the occupational therapy training program in 2014 with support of different stakeholders such as Humanity & Inclusion (HI), Rwanda. Aim: This study aimed to explore the contribution of different stakeholders in the development of occupational therapy programs and impact on the profession in Rwanda. Methods: A survey and mixed method of qualitative and quantitative approach was used. Client satisfaction questionnaire, semi-structured self-generated questionnaire were administered to the participants. Results: The majority of occupational therapists were between 20 and 30 years old and only half of the entire population were employed. Majority of the involved Universities excellently achieved their responsibilities. However, few of them reported to have achieved only 50% of their responsibilities. Other contributors like lecturers reported to have excellently achieved their duties while others reported to have achieved only 50%. Non-Governmental Organizations reported to contribute to enough level however there were some organizations contributed to the lowest level below 50%. The client receiving the Occupational Therapy services showed that they are very satisfied at the level of 73.5%, satisfied at 59% and not all satisfied at 20%. Conclusion: This study concluded that there is need for various stakeholders’ contributions, and a need for further study to explore the impact of occupational therapy profession in rehabilitation healthcare system of Rwanda.