Practitioner Characteristics Research Articles

The characteristics of general practitioners and geriatricians who take overall responsibility for the care of older patients with multimorbidity.

Older patients with multimorbidity often seek care from multiple health care providers and visit several medical institutions. Having a primary care provider who takes overall responsibility for their care may be beneficial. We conducted a survey to identify the characteristics of general practitioners and geriatricians who frequently assume such responsibility for older patients with multimorbidity. In June 2022, we distributed by mail an anonymous questionnaire to 3300 family medicine specialists, primary care-certified physicians, and geriatric specialists in Japan. We used a four-point Likert-type scale to score items related to conditions and patient backgrounds that pose challenges in treatment, key clinical factors, and important clinical strategies. Modified Poisson regression was used to identify factors associated with frequently assuming overall responsibility for medical care. Data from 746 physicians were included in the analysis. Factors associated with frequently assuming overall responsibility for medical care of older patients with multimorbidity included providing inpatient ward care (prevalence ratio [PR] 1.237, 95% CI 1.124-1.362), providing home medical care (PR 1.357, 95% CI 1.225-1.504), frequently treating patients over 90 years old (PR 2.043, 95% CI 1.258-3.318), and the overall score for clinical strategies (PR 1.021, 95% CI 1.010-1.033). General practitioners and geriatricians who frequently assume overall responsibility for the care of older patients with multimorbidity tend to engage significantly in ward and home medical care, often treat patients above 90 years, and employ numerous clinical strategies.

Insufficient safety capability among general aviation practitioners: Evidence from Chinese accident data

The rapid development of China’s general aviation (GA) industry has brought about an increase in safety risks and accidents. Despite extensive investigations into these accidents, the factors related to the safety capability (SC) of practitioners have been largely overlooked, resulting in a lack of targeted safety education and training policies. Hence, this study aims to investigate the characteristics of practitioners’ SC deficiencies in the GA industry. Data for this study were sourced from GA accident reports in China from 2018 to 2022. First, the reports were identified and encoded to extract relevant concepts and categories based on grounded theory. Second, the 24Model was used to classify these categories. After that, the relationship between the core category and the main category was delineated according to the accident scenarios. This comprehensive study has resulted in the development of a SC conceptual framework comprising five core categories and fifteen main categories. In addition, the correspondence between flight tasks, practitioners, and SC factors and the relationship between cases and SC factors are revealed. The findings underscore that insufficient theoretical knowledge and a lack of risk awareness, particularly among pilots, emerge as pivotal SC factors contributing to GA accidents, especially during flight training. In summary, this study introduces a framework that advances our comprehension of SC deficiencies among GA practitioners and offers valuable insights for the enhancement of GA safety through safety education and training. Additionally, it offers guidance to stakeholders in formulating the most effective strategies for cultivating SC.

Study of factors influencing psychosocial and professional characteristics of general practitioners (family doctors): validation of the international questionnaire COPSOQ III (Long version)

Introduction. Professional activity of physicians is associated with high psychological tension, which leads to the development of emotional and physical burnout. The management of factors of potential impact on psychosocial and indirectly on professional characteristics of medical workers in health policy is an important part of providing quality of the medical care to the population. The purpose of the study. Identification of psychosocial predictors forming burnout syndrome in the professional activity of general practitioners (GPs), family doctors (FDs) with using the psychosocial questionnaire COPSOQ III (Long version). Materials and methods. The methods of questionnaire survey, statistical analysis, and generalization of three hundred forty respondents’ answers were applied. The survey was conducted from May to November 2022 using the electronic Russian version of the international questionnaire COPSOQ III (Long version), available on the website of the N.A. Semashko National Research Institute of Public Health. General practitioners (family doctors) of the outpatient and polyclinic level of Moscow health care institutions participated in the survey. Results. Factor analysis of new predictors of psychosocial tension in the work of GPS (FDs), was carried out on a considerable volume of statistical material, which formed a high level of professional burnout — 233.01 ± 82.39 (224.23; 241.80, p = 0.05) points. Research limitations. The study was limited to a representative sample of GPS (FDs) working in healthcare facilities in Moscow within the framework of testing the reliability and construct validity of the full Russian-language version of COPSOQ III (Long version). The results of the study as a whole are not interpolated to the problem area of working conditions of GPs (FDs) in the health care system of the Russian Federation, further research is required. Conclusion. The research has revealed new factors of the development of professional burnout of GPS (FDs) on the basis of their interview with the help of adapted psychosocial international questionnaire COPSOQ III (Long version).

Ferritin Cutoffs and Diagnosis of Iron Deficiency in Primary Care

Ferritin is often measured by general practitioners, but the association of different cutoffs with the rates of iron deficiency diagnoses, particularly nonanemic iron deficiency, is unknown. To investigate the association of the ferritin cutoff choice with the incidence of nonanemic and anemic iron deficiency diagnoses in primary care. In this retrospective cohort study, patients 18 years or older with at least 1 consultation with a general practitioner participating in the Family Medicine Research Using Electronic Medical Records (FIRE) project, an electronic medical records database of Swiss primary care, from January 1, 2021, to November 30, 2023, were evaluated. Sex, age, clinical patient characteristics, and professional general practitioner characteristics. Incidence of iron deficiency diagnoses (nonanemic and anemic) at ferritin cutoffs of 15, 30, and 45 ng/mL and ferritin testing itself. Time-dependent Cox proportional hazards regression was used to examine associations of patient and general practitioner characteristics with ferritin testing as adjusted hazard ratios (AHRs). The study included 255 351 patients (median [IQR] age, 52 [36-66] years; 52.1% female). Per 1000 patient-years and at ferritin cutoffs of 15, 30, and 45 ng/mL, iron deficiency diagnoses had incidences of 10.9 (95% CI, 10.6-11.2), 29.9 (95% CI, 29.4-30.4), and 48.3 (95% CI, 47.7-48.9) cases, respectively; nonanemic iron deficiency diagnoses had incidences of 4.1 (95% CI, 3.9-4.2), 14.6 (95% CI, 14.3-15.0), and 25.8 (95% CI, 25.3-26.2) cases, respectively; and anemic iron deficiency diagnoses had incidences of 3.5 (95% CI, 3.3-3.7), 6.0 (95% CI, 5.8-6.2), and 7.5 (95% CI, 7.3-7.7) cases, respectively. Ferritin testing showed notable associations with fatigue (AHR, 2.03; 95% CI, 1.95-2.12), anemia (AHR, 1.75; 95% CI, 1.70-1.79), and iron therapy (AHR, 1.50; 95% CI, 1.46-1.54). Ferritin testing was associated with female sex in all age groups, including postmenopausal. Of the patients who received ferritin testing, 72.1% received concomitant hemoglobin testing, and 49.6% received concomitant C-reactive protein testing. In this retrospective cohort study of primary care patients, ferritin cutoffs of 30 and 45 ng/mL were associated with a substantially higher incidence of iron deficiency compared with 15 ng/mL. These results provide a basis for health system-level evaluation and benchmarking of ferritin testing in high-resource settings and call for a harmonization of diagnostic criteria for iron deficiency in primary care.

Cerebral Edema Monitoring and Management Strategies: Results from an International Practice Survey.

Cerebral edema is a common, potentially life-threatening complication in critically ill patients with acute brain injury. However, uncertainty remains regarding best monitoring and treatment strategies, which may result in wide practice variations. A 20-question digital survey on monitoring and management practices was disseminated between July 2022 and May 2023 to clinicians who manage cerebral edema. The survey was promoted through email, social media, medical conferences, and the Neurocritical Care Society Web site. We used the χ2 test, Fisher's exact test, analysis of variance, and logistic regression to report factors associated with practice variation, diagnostic monitoring methods, and therapeutic triggers based on practitioner and institutional characteristics. Of 321 participants from 160 institutions in 30 countries, 65% were from university-affiliated centers, 74% were attending physicians, 38% were woman, 38% had neurology training, and 55% were US-based. Eighty-four percent observed practice variations at their institutions, with "provider preference" being cited most (87%). Factors linked to variation included gender, experience, university affiliation, and practicing outside the United States. University affiliates tended to use more tests (median 3.87 vs. 3.43, p = 0.01) to monitor cerebral edema. Regarding management practices, 20% of respondents' preferred timing for decompressive hemicraniectomy was after 48h, and 37% stated that radiographic findings only would be sufficient to trigger surgery. Fifty percent of respondents reported initiating osmotic therapy based on radiographic indications or prophylactically. There were no significant associations between management strategies and respondent or center characteristics. Twenty-seven percent of respondents indicated that they acquired neuroimaging at intervals of 24h or less. Within this group, attending physicians were more likely to follow this practice (65.5% vs. 34.5%, p = 0.04). Cerebral edema monitoring and management strategies vary. Features associated with practice variations include both practitioner and institutional characteristics. We provide a foundation for understanding practice patterns that is crucial for informing educational initiatives, standardizing guidelines, and conducting future trials.

P-135 Impact of TE-biopsy practitioners on PGT-A results and live-birth outcomes after single euploid blastocyst transfer: comparison of 19 TE-biopsy practitioners in a single center

Abstract Study question Can TE-biopsy practitioners impact pre-implantation genetic test for aneuploidy (PGT-A) results, pregnancy, and live-birth outcomes in a single center that has nineteen biopsy practitioners? Summary answer Yes. Trophectoderm (TE)-biopsy practitioners, especially micromanipulation experience, can impact PGT-A results but do not impact pregnancy or live-birth outcomes after single euploid blastocyst transfer (SeBT). What is known already Recently, PGT-A has become important in in vitro fertilization treatment. However, several factors can impact the accuracy and interpretation of PGT-A results. Several studies have suggested that TE-biopsy practitioners can impact PGT-A results. However, these findings are controversial because these previous studies used data from a low number of TE-biopsy practitioners and from multiple centers. There is, therefore, still limited knowledge of the impact of TE-biopsy practitioners on PGT-A results and their clinical outcomes. Study design, size, duration A total of 3,589 PGT-A cycles (average maternal age, 40.9±3.2; 1,168 patients; February 2020 to November 2022) were retrospectively analyzed. Furthermore, 779 single frozen euploid blastocyst transfer (SeBT) cycles were analyzed. First, we investigated the association between TE-biopsy practitioners and transferable blastocysts that included euploid and low-level mosaic blastocysts (LLM, 20 to 40% abnormal cells). Second, we analyzed the impact of TE-biopsy practitioners on pregnancy and live-birth outcomes after SeBT. Participants/materials, setting, methods The nineteen practitioners (Years of intracytoplasmic sperm injection (ICSI) experience: 2 to 20 years) who received the same training performed a total of 5,613 TE-biopsies for PGT-A. The same practitioner performed both the biopsy and the tubing procedures for each blastocyst they biopsied. The Wald test for multivariable logistic regression analysis (mLR) was used to determine the impact of TE-biopsy practitioners. The confounding factors were selected by univariable logistic regression analysis before mLR. Main results and the role of chance TE-biopsy was carried out by the flicking method with laser assistance and it was taken five to seven TE cells. Overall, 22.9% of blastocysts were transferable blastocysts (euploid: 21.1%, LLM: 1.8%). The results were inconclusive for 0.1% of the blastocysts. Maternal/paternal age, number of previous egg retrieval/embryo transfers, anti-Müllerian hormone, sperm characteristics, indication for PGT-A, number of previous deliveries/chemical abortions, blastocyst quality (the day of vitrification, inner diameters of blastocysts, and Gardner grading) were used as confounding factors on the mLR. TE-biopsy practitioners were significantly associated with both ensuring transferable blastocysts and LLM in transferable blastocysts (p < 0.05). Additionally, the practitioner characteristics that impact ensuring transferable blastocysts or LLM in transferable blastocysts were assessed in a sub-analysis. Years of ICSI experience (p < 0.05), number of ICSI performed during the last years (p < 0.05), and number of TE-biopsies at that point (p < 0.05) were associated with ensuring transferable blastocysts and LLM in transferable blastocysts. On the other hand, TE-biopsy practitioners did not have a significant impact on biological pregnancy, chemical abortion, pregnancy, or live-birth rates after SeBT. Limitations, reasons for caution This study did not determine the influence of TE biopsy itself and the laser assistance on PGT-A and clinical results. And this study was based on a minimal stimulation cycle. Moreover, the patient cohort in this study only included cases involving recurrent implantation failure or repeated pregnancy loss. Wider implications of the findings This study showed that TE-biopsy practitioners could impact decreasing transferable blastocysts, and this depends on their micromanipulation experience. This result suggests TE-biopsy training should be started when embryologists have gained several years of experience with ICSI procedures. This could prevent the decline in the efficacy of PGT-A for clinical results. Trial registration number not applicable

Case managers within general practices in 11 Western countries: repeat cross-sectional studies.

In the context of an ageing population and increasing health needs, primary care reform is needed and several new models have emerged, including the introduction of case managers in general practitioner practices. To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency. A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question "Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?", with possible answers "Yes, within the practice", "Yes, outside the practice", "Yes, both within and outside the practice" or "No". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed. The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners. The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.

Job characteristics model-based study of the intrinsic motivations for primary care practitioners

BackgroundIncentives for primary care workforce are close related to the “strengthening basic healthcare” strategy of the new health reform of China and help achieve the goals of establishing a tiered system for rational diagnosis and treatment. Previous studies primarily focused on extrinsic incentives and their influence on performance, with limitation of exploring intrinsic motivations directly from the job. ObjectiveThis study aimed to analyze the job characteristics of primary care practitioners within the framework of Job Characteristics Model, evaluate their effect of intrinsic motivations on various job performance, compare the impact of five job characteristic dimensions with extrinsic motivators such as salary on these performance, and offer policy suggestions to enhance the motivations for bettering performance of primary care practitioners. MethodsA questionnaire survey was conducted between February and June 2021. The questionnaire was developed by the authors and delivered to primary care practitioners of 18 community health centers and 20 township health centers of three cities in Shandong Province China. The health centers were selected through a multi-stage sampling method. Within participants who completed the questionnaires, 167 participants were selected through a convenience sampling process, for semi-structured interviews. These interviews explored their opinions on job characteristics in their roles. Pearson correlation analysis was used to examine the association between the five job characteristics and extrinsic motivators, with self-motivation, performance, professional burnout, and intent to leave. Multiple linear regression was employed to assess the impact of these factors on job performance. The interview data were analyzed through thematic analysis. ResultsA total of 870 questionnaires were included in the study. Participants gave the highest rating to skill variety (4.09 ± 0.71) and the lowest to task integrity (3.18 ± 1.04) in the job characteristics. Scores for task significance, feedback, and autonomy were 3.91 ± 0.76, 3.46 ± 0.83, and 3.43 ± 0.79, respectively. Pearson correlation indicated positive associations of each job characteristic dimension with self-motivation and performance (P<0.05), and negative associations with burnout and intent to leave (P<0.05). Multiple linear regression results revealed that job characteristics dimensions significantly affected job performance, with notable impacts on self-motivation (R²=18.8 %), performance (R²=11.3 %), professional burnout (R²=16.5 %), and intent to leave (R²=21.9 %). These characteristics showed greater explanatory power compared to extrinsic motivators (1.7 %, 3.4 %, 5.8 %, and 11.8 % contributions to the four performances, respectively). Interviews highlighted challenges such as fragmented task assignment, limited autonomy, and inadequate feedback. ConclusionThe influence of intrinsic motivations stemming from of job characteristics is more significant in explaining job performance among primary care practitioners than extrinsic motivational factors. A noticeable discrepancy exists between theoretical job characteristics and their practical application. Focus should be shifted towards the intrinsic motivations of job. Recommended measures include enhancing training opportunities and their quality of service, reducing work-related stress, empowering medical professionals, increasing resource investments, relaxing policy constraints, and improving the performance management system. These measures aim to impact job perceptions, thereby enhancing the motivations and performance of primary care practitioners.

The social, demographic and professional characteristics of general practitioners and district therapists of state and private sectors of health care

The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

Helping Practitioners Stop, Drop, and Roll: Suggestions to Help Improve Responses to Intense Clinical Events.

Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners' emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This "hot-cold state empathy gap" is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners' ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.

Characteristics of bowen therapy practitioners and practice in Australia: An exploratorysecondary analysis of the practitioner research and collaboration initiative (PRACI) practice-based research network

IntroductionBowen Therapy (BT) is a non-invasive manual therapy used to treat muscle pain and discomfort, poor flexibility and imbalances in the body's tissues. Globally, the BT profession comprises a small, but widely dispersed, network of practitioners. While a small pool of preliminary clinical research has begun to investigate the effectiveness of BT for a range of conditions, the investigation of the practice of BT remains extremely limited. MethodsThis study employs secondary analysis of a national cross-sectional workforce survey of complementary medicine practitioners, to describe the characteristics of BT professionals and their practices in Australia. The study sampled data collected from individuals with qualifications in Bowen Therapy involved in the Practitioner Research and Collaboration Initiative (PRACI). Data were analysed using descriptive statistics. ResultsStudy participants (n = 80), primarily female (71.3%) and with a mean age of 52.9 years, reported commonly using a range of assessment tools, discussing a range of health topics with their clients, and using diverse manual therapy techniques in their practice. Participants most commonly reported consulting with clients reporting stress (84.9%), neck pain (75.0%) and sciatica (66.0%). Participants reported treating middle aged (93.4%) and older people (63.3%) most frequently. Discussion and conclusionBTs provide care to a range of clients experiencing a number of conditions and symptoms. Further research should explore the rich details and establish the outcomes of BTs’ care with a view to helping inform safe, effective, coordinated patient care across the wider primary care team.

The development of new occupation practitioners in China's first-tier cities: A comparative analysis.

Owing to the increasingly complex economic environment and difficult employment situation, a large number of new occupations have emerged in China, leading to job diversification. Currently, the overall development status of new occupations in China and the structural characteristics of new occupation practitioners in different cities are still unclear. This study first constructed a development index system for new occupation practitioners from five dimensions (group size, cultural appreciation, salary level, occupation perception, and environmental perception). Relevant data to compare and analyze the development status of new occupation practitioners were derived from the big data mining of China's mainstream recruitment platforms and the questionnaire survey of new professional practitioners which from four first-tier cities and 15 new first-tier cities in China. The results show that the development level of new occupation practitioners in the four first-tier cities is the highest, and the two new first-tier cities, Chengdu and Hangzhou, have outstanding performance. The cities with the best development level of new occupation practitioners in Eastern, Central, and Western China are Shanghai, Wuhan, and Chengdu, respectively. Most new occupation practitioners in China are confident about the future of their careers. However, more than half of the 19 cities are uncoordinated in the five dimensions of the development of new occupation practitioners, especially those cities with middle development levels. A good policy environment and social environment have not yet been formulated to ensure the sustainable development of new occupation practitioners. Finally, we proposed the following countermeasures and suggestions: (1) Establish a classified database of new occupation talents. (2) Implement a talent industry agglomeration strategy. (3) Pay attention to the coordinated development of new occupation practitioners in cities.

Recruitment strategies and retention rates for five National Dental PBRN studies.

We describe a retrospective assessment of practitioner and patient recruitment strategies, patient retention strategies, and rates for five clinical studies conducted in the National Dental Practice-Based Research Network between 2012 and 2019, and practitioner and patient characteristics associated with retention. Similar recruitment strategies were adopted in the studies. The characteristics of the practitioners and patients are described. The proportion of patients who either attended a follow-up (FU) assessment or completed an online assessment was calculated. For studies with multiple FU visits or questionnaire assessments, rates for completing each FU were calculated, as were the rates for completing any and for completing all FU assessments. The associations of practitioner and patient characteristics with all clinic FU visits, and with the completion of all assessments for a study were ascertained. Overall, 591 practitioners and 12,159 patients were included. FU rates by patients for any assessment varied from 91% to 96.5%, and rates for participating in all assessments ranged from 68% to 87%. The mean total number of patients each practitioner recruited was 21 (sd = 15); the mean number per study was 13 (sd = 7). For practitioners, practice type and patient enrollment were associated with greater clinic retention, while only race was associated with their patients completing post-visit online assessments. For patients, age was associated with clinic retention, while female gender, age, race, and education were all associated with greater completion of post-visit online assessments. The Network efficiently recruited practitioners and patients and achieved high patient retention rates for the five studies.

Drivers of variation in postpartum opioid prescribing across hospitals participating in a statewide maternity care quality collaborative.

We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics. We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner- and hospital-level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient. Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient-level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8-1066.7) and third-/fourth-degree perineal laceration (aOR 25.7, 95% CI 17.4-37.9). Receiving care from a certified nurse-midwife (aOR 0.63, 95% CI 0.48-0.82) or family medicine physician (aOR 0.60, 95%CI 0.39-0.91) was associated with lower prescribing rates. Hospital-level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61-15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15-0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%). Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner- and hospital-level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms.

Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network.

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.

Environmental Degradation and Changes in Traditional Health Practice (THP) in Bayelsa State, Nigeria

This study on environmental degradation and changes in traditional health practices in Bayelsa state has come at the right time to contribute to the move in repositioning the Nigerian health care system. The study has identified the challenges of the traditional medicine practices majorly from the impact of environmental degradation. It sought to investigate the socio-economic characteristics of traditional health practitioners (THPs) in Bayelsa state; to examine the nature and trend of traditional health practices in Bayelsa state; and to investigate the dynamics in traditional health practices due to environmental changes in Bayelsa state. This was done by using the multi stage sampling method to select 72 THPs age between 21 and 100 years in Bayelsa state. Using a semi structured interview guide, the study sourced primary data from the respondents which was analysed using the thematic method of analysis. The results from the analysis reveals that there is low level of education among the THPs; the traditional health services no longer sustain the practitioners financially, so they result to alternative sources of income; and the reason why the practices no longer sustain the practitioners is found the challenges posed on the practice by environmental degradation. The study therefore concludes that if other factors like level of education of THPs and people’s orientation towards traditional medicine, is ruled out, then environmental degradation is one major challenge to the development of traditional medicine in Bayelsa state and Nigeria generally. Therefore, recommendations were made based on these findings.

What makes for a ‘Top Doc’? An analysis of UK press portrayals of so-called top doctors

ObjectiveTo determine the characteristics of medical practitioners designated ‘top doctor’ or ‘Top Doc’ in the UK press.DesignObservational study of news stories related to the term top doctor (or Top Doc)...

태권도 수련에 따른 초등학교 1학년의 학교생활적응의 차이

The purpose of this study is that first-year elementary school students who enter school for the first time start socially and physically adapting to the environment and psychological adaptation to changes based on admission. The most important thing is to end with a successful adaptation to school life. Children are using Taekwondo to adapt to school life before entering school, but there is no accurate s tudy on the results, so this s tudy will confirm. The subjects of this study were 143 parents of Gwangju and Jeonnam regions who had children in the first grade of elementary school, and a random sample was conducted. A survey was conducted on 73 parents who had registered at a Taekwondo school before entering school, and a survey was conducted on 70 parents who had not registered at a Taekwondo school. Among the surveys collected from parents registered at Taekwondo school, 71 questionnaires were used for the study, excluding 2 inappropriate ones, and 69 parents excluding 1 parent who did not register at Taekwondo school received responses from a total of 140 parents as a result of the study. was derived. SPSS 27.0 program was used, and independent-t test and one-way ANOVA were used for group differences. The criterion for statistical processing was α=.05. Taekwondo training was found to be statistically significant in the factors of adaptation to homeroom teacher, adaptation to school friends, adaptation to learning activities, and adaptation to rule compliance in the first grade of elementary school. Based on this study, the need for various follow-up studies was recognized. The purpose of this study is to study the individual characteristics of Taekwondo practitioners, to develop a questionnaire that first graders of elementary school can directly participate in, to derive various detailed factors of school life adaptation, and to receive surveys from more subjects.

A geospatial analysis of factors influencing clinical decision-making of rural and urban dental practitioners in Tiruppur district

Objectives: The core of dental practice is clinical decision-making. Geographic information system was used in our study to evaluate the clinical decision-making of dental practitioners in urban and rural Tiruppur district, Tamil Nadu. Materials and Methods: This cross-sectional study included 50 certified dental practitioners from both urban and rural areas. The research was conducted in June 2022. The tem-item and self-administered questionnaire was designed to collect data on practitioner, patient, and provider characteristics. The questionnaire was distributed to participants through an online Google form forum, and the results, clinical decision-making, were quantified using a series of hypothetical case situations. The association between rural and urban dental practitioners was assessed using the “Chi-square test.” Results: Twenty-six (14 [56%] urban and 12 [48%] rural practitioners) chosen the most conservative treatment approach of coronoplasty for asymptomatic impacted mandibular 3rd molar. Thirty (17 [68%] urban and 13 [52%]) rural practitioners preferred the conservative treatment plan of removal of caries followed by GIC Restoration for class I dental caries in a 7-year-old child. For the case scenario relation to class I malocclusion with spacing, 16 (64%) of urban dental practitioners preferred aligner-based treatment rather than fixed orthodontic appliance. This treatment choice differs statistically between urban and rural practitioners. Conclusion: The current research revealed an association between non-clinical features and dental professionals’ self-reported treatment preferences. It provides a foundation for future research into the elements hypothesized to impact dentists’ treatment decisions.

The Australian reflexology workforce: A descriptive secondary-analysis from the PRACI practice-based research network

ObjectivesThis study provides the first detailed empirical examination of the reflexology profession and reflexology practice in Australia. DesignSecondary analysis of the Practitioner Research And Collaboration Initiative (PRACI) online baseline workforce survey and practice-specific manual therapy follow-up survey. MethodsThe baseline survey collected data about participant sociodemographics, practitioner and professional characteristics, and clinical special interest areas. The Follow up survey provided more information about practice behaviours including participant use of diagnostic and therapeutic tools. Responses from both surveys were linked and the data were analysed for descriptive statistics. Bivariate analyses tested the association between practitioner characteristics across two subgroups: those participants with both a reflexology and massage qualification; and those with a reflexology qualification but no massage qualification. ResultsThe baseline survey was completed by 128 reflexologists and 74 (57.8 %) of the baseline respondents completed the secondary practice-specific manual therapy survey. Substantially more females (86.7 %) completed the survey and the mean age of participants was 53.1 years (SD 10.4). A diverse range of clinical interest topics were disclosed. Most frequent were general health and wellbeing (81.3 %) and musculoskeletal complaints (78.1 %). Digestive disorders (68.0 %), women’s health complaints (66.4 %), endocrine conditions (64.8 %), pain (64.8 %) and allergies (60.2 %) were also commonly identified as clinical interest areas. Participants with a reflexology qualification only reported a lower hourly rate, less new clients per month and less days in clinical practice compared to other participants. They also reported discussing diet and nutrition, exercise prescription, nutritional supplements less often than other participants. ConclusionsReflexology is a manual therapy with a broad range of applications that ay support many health conditions. This study highlights the important priority areas for the Australian reflexology profession to ensure sustainability of their workforce into the future.