Allied Health Team Research Articles

Developing a codesigned text message-based digital oral health education resource (TOOTH).

Digital health technologies offer a more equitable way of providing access to health education. This study engaged consumers and clinicians from two Australian regions with a high burden of oral disease to develop a digital oral health resource called "TOOTH" tailored for adults. A total of three focus groups (one clinician and two consumers) were conducted to identify themes that were used to draft text message content. The study team reviewed, refined, and mapped these messages to behaviour change techniques and developed videos to support key concepts. Eight multidisciplinary clinicians (dentist, oral health therapist, dietician, cardiac nurse, and dental nurse), 75% female with a mean age of 48 ± 10 years, and seven consumers from a metropolitan and a regional area in New South Wales, 43% female with a mean age 62 ± 11.6 years participated in the focus groups. Key themes identified by clinicians included (1) limited support from medical and allied health teams for integrating oral health care into the healthcare system, (2) government-supported measures enable prevention, and (3) poor oral health of Australians. Consumers highlighted (1) barriers to accessing oral health care, (2) negative attitudes towards oral health, and (3) limited oral health-related knowledge. The final resource developed includes 81 text messages sequenced to ensure a gradual increase in knowledge and skill and five supporting videos. The TOOTH resource has the potential to improve awareness and knowledge regarding oral disease prevention, enabling more equitable access to oral health education and better self-management of oral health.

Fidelity, acceptability, and feasibility of the revised functional autonomy measurement system for hospitalised people: An implementation study.

The revised functional autonomy measurement system (SMAF-R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF-R as a routine outcome measure in acute and subacute inpatients. This was a mixed-methods implementation study. Occupational therapists were asked to complete the SMAF-R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12-month period (n= 13,348). A baseline audit of SMAF-R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF-R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated. Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions. Peak completion of the SMAF-R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF-R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF-R influenced acceptability; (2) using the SMAF-R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF-R scores during their hospital stay (median difference 16.5 [6.5-27.0], p< 0.001, n= 764). Although most occupational therapists reported the SMAF-R was acceptable, there were mixed opinions regarding the relevance of the SMAF-R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF-R relevance to practice) may assist with improving SMAF-R completion. Further research is required to assess the psychometric properties of the SMAF-R in the hospital environment. The revised functional autonomy measurement system (SMAF-R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve. This study aimed to measure (1) how often occupational therapists use the SMAF-R with patients in hospital, (2) how acceptable occupational therapists find the SMAF-R, and (3) whether the SMAF-R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF-R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF-R completion over 12 months. After this, completion of the SMAF-R improved to between 9% and 38% in different hospital settings. Changes in SMAF-R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF-R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF-R was not fit for purpose in this setting or that more support is needed to increase completion.

Spine Surgery and Home Again: The Nurse's Role in the Patient Journey

Abstract Enhanced recovery after surgery (ERAS) programs – also referred to as fast-track programs - are multidisciplinary, evidence-based perioperative pathways, designed to achieve early recovery for patients undergoing major surgery (Ali et al., 2018). ERAS utilises strategies to optimise the patient's condition for surgery and recovery. In particular, the aim is to achieve an earlier discharge from hospital for the patient and a more rapid resumption of normal activities after surgery, without an increase in complications or readmissions (Dietz et al., 2019). An essential element of ERAS programs is multidisciplinary collaboration between surgical, anaesthetic, nursing and allied health teams. While elements of ERAS may vary between surgical units and hospitals, there are many common features in the preoperative, intraoperative and postoperative phases. Minimally invasive spine surgery techniques and instrumentation have evolved rapidly over the past decade, and there is now a worldwide interest in ERAS programs for spine surgeries, including lumbar and cervical decompression and fusion procedures (Li et al., 2021). Nurses have a pivotal role in the successful implementation and sustainability of ERAS protocols because of their specialised knowledge and skill, and their constant presence throughout the patient care pathway (Wainwright et al., 2022). This publication presents learnings from the implementation of an ERAS program for minimally invasive spine surgery at Westmead Hospital, NSW.

Older women's view on frailty and an Emergency Department evidence-based Frailty Intervention Team (FIT) program: An evaluation using the Reach, Effectiveness, Adoption, Implementation, Maintenance RE-AIM framework

BackgroundOlder women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a ‘Frailty Intervention Team’ (FIT) program. MethodsA prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention. ResultsOver three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified. ConclusionsThe FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.

From doctors to ancillary staff: Regional and metropolitan cancer workforce perceptions and distress resulting from COVID-19 pandemic adaptations

The declaration of the COVID-19 pandemic has resulted in necessary and rapid changes to health service delivery. In the Australian context, it has been broadly identified that these impacts have been felt by health care workers (HCW) providing care. We aimed to capture oncology HCW perceptions of support, stress, personal ability to meet needs and institutional preparedness across longitudinal periods of COVID-19 response in the early stages of the pandemic. An electronic survey was developed to measure the weekly impacts and distress experienced by HCW during the early phases of the pandemic. Hospital email communications relating to pandemic directives were noted. HCW included nursing, medical, ancillary staff and allied health team members at 2 study sites, 1 metropolitan and 1 regional center in Queensland, Australia. Descriptive statistics were applied to quantitative data, and a framework analysis for qualitative data. Key themes were synthesized using mixed methods approaches. A total of 176 HCW consented to participate. Four key themes were identified. Key theme 1 was strategies for protection, and included the subthemes of self-isolation, using personal protective equipment (PPE), protecting patients and families and each other. Key theme 2 was navigating rules and keeping up, and included the subthemes of compliance, exceptions, conflict and complex decision fatigue. Key theme 3 was tempered optimism, with subthemes including this is grief, pride in one's place and strategies for coping. Key theme 4 was framing the new normal, with subthemes including using technology, second wave and uncertainty. Staff groups reported the emotional impacts of rapid change across clinical areas and centers. Distress corresponded to rapid change amid uncertainty, rather than reported infection rates. These findings give insight into the experiences of patient facing oncology HCW during periods of uncertainty, potentially informing policy in the future.

Adherence With Early Allied Health Assessments in Specialist Burn Services.

Appropriate multidisciplinary allied health assessment during the early stages of admission following burn injury positively influences recovery and quality of life. Variation in allied health care may affect patient outcomes. We aimed to explore adherence in providing early allied health assessments in accordance with local parameters. Associations between the number of assessments and hospital length of stay (LOS) were also explored. The Burns Registry of Australia and New Zealand was queried for adult (≥ 16 years) burn injured patients admitted to a specialist burn service for > 48 hours between July 2016 and June 2020. Quality indicator data relating to allied health assessment processes were examined; patients were grouped according to the number of assessments they received within 48 hours of admission. Of the 5789 patients included in the study, 5598 (97%) received at least one allied health assessment within 48 hours of admission and 3976 (69%) received all three assessments. A greater proportion of patients who received no assessments were admitted on a Saturday. Patients receiving three assessments had more severe injuries compared to their counterparts who received fewer assessments. Hospital LOS was not associated with the number of allied health assessments during an acute admission following burn injury after accounting for confounding factors, particularly TBSA. Multidisciplinary allied health teams provide routine burn care to Australian and New Zealand burns patients at a consistent level. Further, this study provides evidence that allied health input is prioritized towards patients with increasing severity of burn injury, playing an integral role in early rehabilitation.

Development and delivery of an allied health team intervention for older adults in the emergency department: A process evaluation.

There is encouraging evidence that interdisciplinary teams of Health and Social Care Professionals (HSCPs) can enhance patient care in the Emergency Department (ED), especially for older adults with complex needs. However, no formal process evaluations of implementations of ED-based HSCP interventions are available. The study aimed to evaluate the development and delivery of a HSCP team intervention for older adults in the ED of a large Irish teaching hospital. Using the Medical Research Council (MRC) Framework for process evaluations, we investigated implementation and delivery, mechanisms of impact, and contextual influences on implementation by analysing the HSCP team's activity notes and participant recruitment logs, and by carrying out six interviews and four focus groups with 26 participants (HSCP team members, ED doctors and nurses, hospital staff). Qualitative insights were analysed thematically. The implementation process had three phases (pre-implementation, piloting, and delivery), with the first two described as pivotal to optimise care procedures and build positive stakeholders' involvement. The team's motivation and proactive communication were key to promote acceptability and integration in the ED (Theme 1); also, their specialised skills and interdisciplinary approach enhanced patient and staff's ED experience (Theme 2). The investment and collaboration of multiple stakeholders were described as essential contextual enablers of implementation (Theme 4). Delivering the intervention within a randomised controlled trial fostered credibility but caused frustration among patients and staff (Theme 3). This process evaluation is the first to provide in-depth and practical insights on the complexities of developing and delivering an ED-based HSCP team intervention for older adults. Our findings highlight the importance of establishing a team of HSCPs with a strong interdisciplinary ethos to ensure buy-in and integration in the ED processes. Also, actively involving relevant stakeholders is key to facilitate implementation. ClinicalTrials.gov, NCT03739515; registered on 12th November 2018.

COVID-19 and hospice community palliative care in New Zealand: A qualitative study.

Within the context of an ageing population and the added challenges posed by COVID‐19, the need to optimise palliative care management in the community – the setting where a significant proportion of people prefer to die – cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID‐19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February–18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID‐19‐positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged ‘challenges’ and 'adaptations’. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in‐home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID‐19 pandemic and ensure that these services are incorporated into the healthcare system response.

Evaluation of a Multidisciplinary Integrated Treatment Approach Versus Standard Model of Care for Functional Gastrointestinal Disorders (FGIDS): A Matched Cohort Study

BackgroundFunctional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions.AimsTo assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden.MethodsA matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS).ResultsMixed models estimated the within ICC change in SAGIS total as −9.7 (95% CI −13.6, −5.8; p < 0.0001), compared with −1.7 (95% CI −4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, −7.6 (95% CI −11.4, −3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001).ConclusionThis matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study.

PurposeAustralia’s rural and remote populations experience inequality of access to healthcare, with demand exceeding capacity for delivery of health services, often due to a maldistribution of the health workforce. A strategy which may overcome barriers to accessing adequate healthcare includes implementation of interdisciplinary collaborative teams, identified as a successful method of healthcare delivery. This study thus aimed to explore interdisciplinary allied health collaborative practice in a rural community.MethodsRole theory, as a philosophical perspective, was used to explore role perceptions and the potential for interdisciplinary collaboration between pharmacists and allied health professionals including dieticians/public health nutritionists, speech pathologists, occupational therapists, and physiotherapists, by conducting 29 interviews in a rural community. All interviews were transcribed verbatim, coded, and categorised into emerging themes.ResultsFive constructs of role theory were used to describe the data: role identity, role overload, role sufficiency, role conflict, and role ambiguity. Participants identified as rural generalists and health promoters, who work within innovative and adaptive healthcare settings. Role overload was reported as considerable due to high demand for services and a lack of resources in rural and remote regions, resulting in poor role sufficiency. Overall, there was a low level of role conflict, and participants were highly in favor of interprofessional collaboration; however, uncertainty of the pharmacist’s role (role ambiguity) was a major barrier identified. Health professionals with more years in practice provided few examples of how they would utilise a pharmacist in their practice, although these gave valuable insight into the potential integration of a pharmacist into an interdisciplinary health team, with allied health professionals.ConclusionThis study has applied role theory providing a greater understanding of the enablers and barriers of pharmacists working within interdisciplinary allied health teams and highlighting opportunities to bridge interprofessional roles to improve patient outcomes, especially in rural and remote communities.

Exploring the perspectives of prosthetic and orthotic users: past and present experiences and insights for the future

Purpose The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and understand their insights for the future. Materials and methods A narrative exploration study design, employing a phenomenological approach was used. Semi-structured interviews were conducted with three female and two male prosthetic and orthotic users from Australia and the United Kingdom. Interviews were analysed, coded and key themes and sub-themes identified. Results Three themes were identified. The Maximising Opportunity theme linked sub-themes of recreation and pushing boundaries. The Health Care Network theme included sub-themes of communication, peer support and building a team. The final theme, Changes over time, included sub-themes of disability perception, advice and advancements over time. Conclusion Prosthetic and orthotic users identified that there had been vast changes in disability perception, disability rights, and their role in the health care system, along with the variety of technology and materials available. Key findings were that prosthetic and orthotic users want to be listened to, considered central to the health care team, and had a deep understanding of their own health care needs. Implications for rehabilitation Prosthesis and orthosis users want to be listened to and considered central within the health care team. Attending medical and allied health teams must recognise that prosthesis and orthosis users have a fundamental understanding of their own health care needs. Themes, whilst potentially generalisable, are derived from specific individuals and may particularly relate to these individuals.

The effect of preoperative immunonutrition on surgical outcomes in patients undergoing resection for pancreatic malignancy

Introduction: The impact of perioperative immunonutrition in pancreatic cancer surgery remains controversial. While some studies have demonstrated a positive impact on outcomes in well-nourished patients, others showed no difference in outcomes. In a recent study examining the effects after pancreatic and gastric cancer surgery, benefits were only identified in malnourished patients. Our goal was to assess the effect of perioperative immunonutrition on the surgical outcomes of patients undergoing pancreatic cancer resections in our institution. Methods: A retrospective review of a prospectively collected database of 101 consecutive patients undergoing surgery for suspected pancreatic malignancy in our centre over an eight-year period was conducted. The demographics, nutritional status, and other relevant endpoints such as grade of surgical complications and length of stay were obtained. Results: 8 patients with benign final histology were excluded. Patients with incomplete data on immunonutrition were also excluded from the final analysis. 36 patients received perioperative immunonutrition while 43 patients did not. There was no statistically significant difference in the infective complications between the two groups and the severity of complications including the median lengths of stay were also similar in both groups. Conclusion: The efficacy of immunonutrition in improving the outcomes of pancreatic cancer resections remains to be proven. Our project is an example of early collaboration with allied health team to improve the outcomes of pancreatic cancer. Given the small sample size of our study and other limitations, further investigations are required to answer this pertinent question.

NURS-08. A CASE REPORT OF RARE AND PROFOUND ANTEROGRADE AMNESIA IN A PAEDIATRIC SURVIVOR OF A BIFOCAL NON GERMINOMATOUS GERM CELL TUMOUR AND DIABETES INSIPIDUS

We present the case of a 12yo female who presented to the emergency department with increasing agitation, confusion, fluctuating GCS, hydrocephalus, and deranged electrolytes. MRI revealed tumour in pineal region and filling the third ventricle. Biopsy and tumour markers confirmed the diagnosis of bifocal Non Germinomatous Germ Cell Tumour (NGGCT). The diagnosis was complicated with the secondary diagnoses of diabetes insipidus and profound permanent anterograde amnesia. Whilst DI is common in NGGT in pineal region, anterograde amnesia is a very rare condition in paediatrics. Thus there is paucity of literature available to the clinicians to know how much improvement to expect or how to target rehabilitation whilst undergoing curative therapy, chemotherapy and craniospinal irradiation; however the importance of a consistent and coordinated nursing and allied health team approach with structure and errorless learning must be initiated from the beginning if independence is to be achieved.

Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure.

Design This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

Supporting Mature Aged Students to Develop Group Work Skills: A Review of a 2-Year Study of Students’ Experience of Group Work within their Pre-Nursing Program

The University of Newcastle offers a tertiary preparation program that enables mature aged students to gain access to higher education. One of the largest intakes is into the pre-nursing program. This paper will share the findings of a 2-year study of tertiary preparation students undertaking group work within their pre-nursing program. For many mature-aged students returning to study, it requires the development and transition of their identity from that of an adult role to that of a student role. The aim of this study was to examine how group work can help support mature aged students in their transition to a student identity. The premise was to enable students to develop skills for success in their undergraduatenursing studies, whilst fostering social connection and a sense of belonging in the university. We identified an essential aspect of nursing as being able to work collaboratively with other nurses and within allied health teams. Keeping this in mind, we developed and delivered an approach that introduced group work in Week 3 of the students' program to enable them to effectively integrate curricula and co-curricular learning experiences. Using an online assessment tool called SPARK, students were each asked to self-reflect upon their individual role and their role within the group according to specific criteria that promoted positive group work behaviours and fostered social connection. It was hoped that by providing students with resources and evaluation tools they would develop group work and self-reflection skills to succeed in their studies and future profession.

Supporting Mature Aged Students to Develop Group Work Skills: A Review of a 2-Year Study of Students’ Experience of Group Work Within Their Pre-Nursing Program

The University of Newcastle offers a tertiary preparation program that enables mature aged students to gain access to higher education. One of the largest intakes is into the pre-nursing program. This paper will share the findings of a 2-year study of tertiary preparation students undertaking group work within their pre-nursing program. For many mature-aged students returning to study, it requires the development and transition of their identity from that of an adult role to that of a student role. The aim of this study was to examine how group work can help support mature aged students in their transition to a student identity. The premise was to enable students to develop skills for success in their undergraduate nursing studies, whilst fostering social connection and a sense of belonging in the university. We identified an essential aspect of nursing as being able to work collaboratively with other nurses and within allied health teams. Keeping this in mind, we developed and delivered an approach that introduced group work in Week 3 of the students' program to enable them to effectively integrate curricula and co-curricular learning experiences. Using an online assessment tool called SPARK, students were each asked to self-reflect upon their individual role and their role within the group according to specific criteria that promoted positive group work behaviours and fostered social connection. It was hoped that by providing students with resources and evaluation tools they would develop group work and self reflection skills to succeed in their studies and future profession.

A New Model for Optimizing Firefighter Human Performance

ABSTRACT Firefighting is a profession that has the potential to be extremely demanding, both physically and mentally. More specifically, these tactical personnel must be physically fit to perform their occupational requirements, all while they are exposed to daily stressors. This is likely to include everything from physical strain and shift work to interrupted sleep and witnessing potentially traumatizing events. Failure to prepare and mitigate these occupational demands can have long-lasting implications to overall performance as well as health and wellness. Unfortunately, many of these elements often go unaddressed. As such, considerations for collaborative and overarching cross-disciplinary allied health teams should be made. Human performance optimization (HPO) is a model that has been successfully adopted by the U.S. military to enhance the overarching health, wellness, and performance of soldiers. This article proposes the utilization of a similar HPO model by providing a rationale for how it can be used to reduce premature morbidity and mortality, as well as increasing overall readiness and resilience within the firefighting profession.

Vocational counseling for Australian spinal cord injury inpatients – Defining vocational role expectations and behavior

AbstractA novel inpatient vocational counseling service (named “In-Voc”) was developed and evaluated in three Australian spinal cord injury (SCI) rehabilitation hospitals, aiming to improve vocational outcomes after SCI. The program provided a trained Vocational Counseling Coordinator who worked alongside the allied health team, medical, and nursing staff at each hospital. The Coordinators were interviewed to examine the role expectations and role behaviors associated with the introduction of their novel, vocationally focused, occupational role. The Coordinators’ descriptions of their role behavior were very similar to those defined by rehabilitation counselors in North America. They reported the novel role to be a productive and satisfying one. Encouragingly, the In-Voc program was associated with significantly higher post-injury employment outcomes.

Mode of Delivery: Development and Implementation of an Obstetrical In Situ Simulation Program.

Simulation is increasingly valued as a learning tool in obstetrical practice. In situ simulation assesses the hands-on and critical thinking skills of a health care team within their clinical setting. We aimed to create an in situ simulation program to promote skills acquisition, enhance teamwork, and identify system limitations. Key obstetrical emergencies were identified through a needs assessment. In situ simulations were developed to address these clinical presentations. During simulations, organizers and participants identified latent safety threats. Medical management was evaluated through comprehensive emergency-specific checklists. Leadership attitudes were assessed using the modified Perinatal Emergency Team Response Assessment tool. Following each simulation, team members were debriefed, and qualitative and quantitative feedback was solicited and aggregated by specialty and discipline. Simulations were conducted monthly at two academic centers over 14 months. Participation was interdisciplinary, including learners, staff physicians, nursing, and allied health team members from the departments of obstetrics, anesthesia, emergency medicine, and neonatology. Participants reported their involvement was enjoyable. Participants reported improvements in communication skills, content knowledge, and procedural knowledge. Participants favourably rated the spontaneity of simulations, clinically relevant scenarios, safe environment, and use of realistic equipment. Latent safety threats, related to equipment, medication, personnel, resources, and technical skills, were identified. We present the successful implementation of a comprehensive in situ simulation program. In situ simulation allows for deliberate practice of obstetrical emergencies and promotes a culture of patient safety. Lessons learned provide valuable data to identify limitations within our current practices and inform future policy change.

Sarcopenia in male patients with head and neck cancer receiving chemoradiotherapy: a longitudinal pilot study.

IntroductionMuscle wasting conditions such as sarcopenia may be highly prevalent in advanced head and neck cancer (HNC) patients (16–71%), with these prevalence rates substantially greater in those who have received chemo-radiotherapy (CRT). According to the updated European Working Group on Sarcopenia in Older People consensus statement, sarcopenia is defined as the age-related loss of muscle strength, muscle mass and physical performance. The high prevalence of sarcopenia in HNC patients is concerning as it has been associated with substantially increased risk of CRT toxicity, respiratory complications and early mortality. With the high prevalence of HNC and sarcopenia in India and the strong link between sarcopenia and poor HNC patient outcomes, it is important to screen for the presence of sarcopenia in Indian patients receiving CRT for HNC.MethodsThis longitudinal pilot study aimed to routinely monitor 19 men receiving CRT for their HNC for a variety of sarcopenic-related outcomes over three time points during their 7 weeks of CRT. Participants were required to be male, with a minimum age of 30 years, with a Stage III, IVa or IVb diagnosis of HNC and be currently undergoing a 7 weeks course of CRT in an oncology department. Outcomes included probable sarcopenic diagnosis were estimated by the SARC-F, handgrip strength, skeletal muscle mass was estimated by bioelectrical impedance and physical performance was assessed by the Timed Up and Go. Repeated measures ANOVA and Bonferroni post-hoc tests were used to identify significant differences at the three time points with a p < 0.05.ResultsThe 19 participants in this trial at a mean age of 56.5 ± 10.2 years (range = 39–75 years), with most (n = 13, 68.4%) employed in laboring occupations. At baseline, 31.5% (n = 6) of the participants already had probable sarcopenia based on their total SARC-F score, with this increasing to 89.4% (n = 17) at the end of 7 weeks CRT. In addition, significant decreases in strength, skeletal muscle mass and Timed Up and Go performance were observed, with these declines significantly greater at 7 weeks than 3 weeks after commencing CRT.ConclusionsPatients with HNC undergoing 7 weeks of CRT showed clinically significant increases in the incidence of probable sarcopenia based on their total SARC-F score as well as clinically significant declines in handgrip strength, skeletal muscle mass and Timed Up and Go performance. Due to the relationship between sarcopenia and a host of adverse events related to CRT in HNC patients, these results suggest that oncologists and their allied health teams should routinely monitor these patients during CRT and provide the relevant exercise therapy and nutritional support to those patients in need.