Practitioner Characteristics Research Articles

Contemporary trends in professional development of teachers: importance of recognising the context

PurposeWhereas the achievement of students has closely been linked with the quality of teachers and there is a bulk of literature supporting the need of teachers' preparation in enhancing their quality, professional development (PD) of teachers has been a central focus of reform initiatives in education across the globe. This paper aims at analysing the existing literature on PD of teachers to reflect on the models and characteristics of effective PD, and to highlight the importance of context in PD of teachers.Design/methodology/approachTo respond to the aim of the paper, a search in the field of pedagogy in Education Resource Information Centre (ERIC) was undertaken. The search strings used were “models of teachers' professional development”, “characteristics of teachers professional development” and “context in professional development” restricted to time period from 2000 to 2020.FindingsThe major argument this paper presents is that the models and characteristics of PD are relative and there is no uniform model to be implemented across contexts. Instead of debating the models and characteristics of effective PD, academics and practitioners have to be watchful to the context and the real needs of teachers in a particular context.Originality/valueThe paper critiques the generalisation of Western generated PD models to the developing world especially Pakistan which the existing research and literature is silent about.

Lymphedema rehabilitation: Provision and practice patterns among service providers: National survey.

Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve the current health care system. Therefore, this study aimed to describe the characteristics of lymphedema practitioners, and lymphedema patients' profiles, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. A cross‐sectional study design used an online survey to gather data. The survey included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profiles, questions on the services provided, and perceived barriers in providing services. Eighteen lymphedema practitioners (38%) responded to the survey. Most of the respondents were physical therapists (94%), who had completed 135 hours of basic training course, and were certified as lymphedema therapists (89%). Most of these practitioners were in Riyadh (58%), Jeddah (25%), and Dammam (17%). About 75% of patients seen by practitioners had secondary lymphedema, predominately breast cancer‐related lymphedema (47%). The average number of lymphedema practitioners per service is three. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each; 72%), and limited space for lymphedema practice/management (89%). The results suggest lymphedema practitioners provide reasonable services for lymphedema patients; however, services are still limited and needs are unmet. Therefore, more staffing is required to promote awareness of the condition and related services, to develop and implement appropriate educational strategies, and improve geographical and multidisciplinary coordination of the services in Saudi Arabia.

Oral medicine practice in Europe and Australia: Identifying practitioner characteristics and their clinical activity.

Oral Medicine is a young dental specialty born almost a century ago and deals with orofacial conditions not directly attributable to the most prevalent tooth pathologies such as dental caries or periodontal diseases. Presentations may reflect local disease or orofacial manifestations of more widespread pathology affecting other parts of the body. Due to its recency as a distinct discipline and to heterogeneous global settings, Oral Medicine has not yet achieved a shared scope and definition, as well as a recognized status across the globe. The current report presents survey data gathered from Oral Medicine practitioners in Europe and Australia and aimed to identify practitioner characteristics including demographics, training, clinical and research activity. As expected, Oral Medicine clinical practice commonly deals with conditions such as immune-mediated disorders, potentially malignant disorders, oral mucosal infections and chronic pain disorders, but geographical heterogeneities are observed. The present data, representative of current clinical practice, are valuable in order to understand the evolution of Oral Medicine as a distinct discipline and should be taken into consideration in order to create or update postgraduate training curricula able to meet the needs of future practitioners and the communities they serve.

Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings.

ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe-reperfusion as quickly as possible-the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

Association between telehealth use and general practitioner characteristics during COVID-19: findings from a nationally representative survey of Australian doctors

ObjectiveTo investigate factors associated with the use of telehealth by general practitioners (GPs) during COVID-19.DesignA nationally representative longitudinal survey study of Australian doctors analysed using regression analysis.SettingGeneral practice in Australia...

Why Clinicians Choose Their Language Intervention Approach: An International Perspective on Intervention for Children with Developmental Language Disorder

Purpose: Considerable progress has been made in recent years in generating external evidence underpinning interventions for children with developmental language disorder (DLD), but less is known about the practitioner decision-making process underpinning such interventions and whether such decisions are context specific or are internationally generalizable. Methods: An online survey about clinical practice was developed by members of COST Action IS1406, an EU-funded research network, which included representation from 39 countries. The participants were 2,408 practitioners who answered questions in relation to their decision making for a specific child of their choosing with DLD. Analysis of open-ended questions was undertaken, and data were converted into codes for the purpose of quantitative analysis. Results: Although a wide range of intervention approaches and rationales were reported, the majority of responses referenced a client-centred approach. Level of functioning was used as a rationale only if a child had severe DLD. Practitioners with university level education or above were less likely to report basing intervention on client-centred factors. A number of differently named interventions with variable theoretical and empirical underpinnings were used in different countries. Conclusions: Specific client and practitioner characteristics have an impact on the intervention approaches and rationales adopted across countries. A limited number of practitioners reported use of external scientific evidence, which suggests that there should be more initiatives in basic training of practitioners and continuing professional development to encourage the uptake of scientific evidence-based practice.

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA1c in type 2 diabetes in norwegian general practice.

AimsTo identify individual and general practitioner (GP) characteristics associated with potential over‐ and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured.MethodsA cross‐sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations.ResultsOverall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non‐western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed.ConclusionPotential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de‐intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine.

Background:The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.Methods:In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.Results:The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.Conclusions:This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, and 3,238,498 Patient-Years.

Variation in medical practice is associated with poorer health outcomes, increased costs, disparities in care, and increased burden on the public health system. In the present study, we sought to describe and assess inter- and intra-primary care physician variation, adjusted for patient and clinic characteristics, over a decade of practice and across a broad range of health services. We assessed practice patterns of 251 primary care physicians in southern Israel. For each of 14 health services (imaging tests, cardiac tests, laboratory tests, and specialist visits) we described interphysician and intraphysician variation, adjusted for patient case mix and clinic characteristics, using the coefficient of variation. The adjusted rates were assessed by generalized linear negative-binomial mixed models. The variation between physicians was on average 3-fold greater than the variation of individual physician practice over the years. Services with low utilization were associated with greater inter- and intraphysician variation: rs = (-0.58), P = .03 and rs = (-0.39), P = .17, respectively. In addition, physician utilization ranks averaged over all health services were consistent across the 14 health services (intraclass correlation coefficient, 0.94; 95% CI, 0.93-0.95). Our results show greater variation in practice patterns between physicians than for individual physicians over the years. It appears that the variation remains high even after adjustment for patient and clinic characteristics and that the individual physician utilization patterns are stable across health services. We propose that personal behavioral characteristics of medical practitioners might explain this variation.

Family-centred early intervention: Comparing practitioners' actual and desired practices.

In Spain, as in other countries, there has been a deep and intense process of change towards the adoption and use of family-centred practices (FCPs) on early intervention (EI). Despite that several international organizations have recommended FCPs be embedded in EI services, researchers on this field have highlighted a recommendation-implementation gap, as well as the need to point investigation on practitioners and intervention variables involved. Consequently, our goals were to describe and compare the practitioners' appraisals on actual and desired practices in Spain and to explore the relationships between practitioners and intervention characteristics and the use of recommended practices. A survey including practitioner and intervention characteristics measures was used to obtain data needed. The actual and desired practices were explored through the Family Orientation of Community and Agency Services Scale. The participants were 119 EI Spanish practitioners whose programmes were in the first stages of different FCP implementation projects. Practitioners reported actual practices to be less family centred than they would like, moderately in line with FCP. They reported desired practices as quite close to recommended practices. Intervention characteristics were related to actual practices, whereas practitioner characteristics were not. The results suggest that the recommendation-implementation gap still exists in our context, as well as in other countries. Intervention characteristics seem to be one of the key elements significantly influencing actual practices, though additional research is needed. A comprehensive framework for implementation is needed to bridge the gap between recommendation practices and the use of these practices.

Dental practitioners’ use of health risk assessments for a variety of health conditions: Results from the South Atlantic region of The National Dental Practice-Based Research Network

BackgroundAn important step in integrating dental and medical care is improving understanding of the frequency and characteristics of dental practitioners who conduct health risk assessments (HRAs). MethodsFrom September 2017 through July 2018, active dentist and hygienist members of the South Atlantic region of The National Dental Practice-Based Research Network (N = 870) were invited to participate in a survey evaluating their HRA practices (screening, measuring, discussing, referring patients) for 6 health conditions (obesity, hypertension, sexual activities, diabetes, alcohol use, tobacco use). For each health condition, the authors used ordinal logistic regression to measure the associations among the practitioner’s HRA practices and the practitioner’s characteristics, barriers, and practice characteristics. ResultsMost of the 475 responding practitioners (≥ 72%) reported they at least occasionally complete 1 or more HRA steps for the health conditions except sexual activities. Most practitioners screened (that is, asked about) and gave referral information to affected patients for diabetes (56%) and hypertension (63%). Factors associated with each increased HRA practice for 2 or more outcomes were non-Hispanic white compared with Hispanic practitioner (cumulative odds ratio [COR] obesity, 0.4; 95% confidence interval [CI], 0.2 to 0.8; and COR diabetes, 0.3; 95% CI 0.2 to 0.8), male compared with female practitioner (COR tobacco, 0.3; 95% CI, 0.2 to 0.7; and COR hypertension, 0.4; 95% CI 0.2 to 0.8), and practitioner discomfort (COR, obesity and alcohol use, 0.7; 95% CI, 0.6 to 0.9; and COR, sexual activities 0.6; 95% CI 0.5 to 0.8). Conclusions and Practical ImplicationsDental practitioners are conducting HRA practices for multiple conditions. Interventions should focus on reducing practitioner discomfort and target non-Hispanic white, male practitioners.

Nature and outcomes of sanctioned medical misconduct in six international jurisdictions: a case series.

Objective The aim of this study was to determine the types of medical misconduct, the practitioner, specialities and jurisdictions at risk, patient outcomes and the sanctions imposed. Methods This study was a retrospective case series of 822 adverse medical tribunal determinations in Australia, New Zealand, Canada (Ontario, Alberta), Pennsylvania (USA), Singapore and Hong Kong in 2013-17. Results Inappropriate medical care and illegal or unethical prescribing were the most common types of misconduct. Misconduct varied with practitioner sex, international medical graduate status, speciality and jurisdiction (P<0.05). Cases of inappropriate medical care were more common in Singapore (46.7% of all Singapore cases; 95% confidence interval (CI) 31.9-62.0) and among surgeons (47.6% of all surgeon cases; 95% CI 36.5-58.8). Illegal or unethical prescribing was more common in Australia (31.1%; 95% CI 24.8-38.2) and among general or family practitioners (26.9%; 95% CI 20.0-35.0). Misconduct not related to patients was more common in Pennsylvania (30.3%; 95% CI 25.2-36.0) and among local graduates (20.5%; 95% CI 17.1-24.5). Sexual misconduct was more common in Australia (29.6%; 95% CI 23.4-36.6) and among males (19.6%, 95% CI 16.7-22.8). Healthcare dishonesty was more common in Hong Kong (21.8%; 95% CI 14.0-32.2) and among surgeons (13.4%; 95% CI 7.2-23.2). The most common patient outcomes were patient risk (40.6%; 95% CI 36.1-45.4) and death and actual physical harm combined (31.2%; 95% CI 26.9-35.7). Sanctions were most commonly suspension or deregistration. Deregistration was most common in cases of sexual misconduct. Conclusion Medical misconduct varies widely. Risk factors for particular misconduct types are apparent among jurisdictions and practitioner characteristics. The nature of patient harm varied by type of misconduct, with illegal unethical prescribing commonly leading to drug dependency and sexual misconduct leading to psychiatric injury. What is known about the topic? Medical misconduct is a continuing problem. Tribunals and medical boards sanction misconduct to protect patient safety and public trust. What does this paper add? Tribunals and boards differ in misconduct reporting and permitting public access to determinations. Types of misconduct vary between international jurisdictions, practitioner sex, international graduate status and speciality. Risk and physical injury (including death) are the most common patient outcomes. The nature of patient harm varied by type of misconduct, with illegal unethical prescribing commonly leading to drug dependency and sexual misconduct leading to psychiatric injury. What are the implications for practitioners? Medical colleges should tailor trainee programs to address the common types of misconduct within their specialities. Standardisation of misconduct reporting, and report access, across jurisdictions would facilitate ongoing surveillance and intervention evaluation.

Comparison of general practitioner consultations among Chinese patients with different reasons for visits: a multimethod investigation

BackgroundThe reasons for visits (RFVs) of patients reflect their needs and health problems when they enter the health system. It is important for general practitioners to identify and target appropriate health care for patients with different RFVs. How general practitioners interact with different patients during consultations remained unknown in China. Our study aimed to compare the content of general practitioner consultations among Chinese patients with different RFVs. MethodsWe did a multimethod investigation of general practitioner consultations in eight community health centres in Guangdong, China. We collected data on visits to general practitioners by direct observation and audiotape, and coded the data with a modified Davis Observation Code. We adopted a nested sampling method and recruited a total of 17 eligible general practitioners and 445 patients. Inclusion criteria for general practitioners were rich clinical experience, large volume of outpatient visits per day, and signed informed consent to participate in the study. Eligible patients had to be older than 18 years and verbally agree to participate in this study. We collected general practitioner and patient characteristics including RFV with a post-visit survey. We compared general practitioner consultation using a general linear model adjusted for patient characteristics and health-care use factors. We obtained written informed consent from all general practitioners and informed verbal consent from all patients. Ethical approval was obtained from the Institutional Review Board of the School of Public Health, Sun Yat-Sen University, China. The protocol for this study conforms to the guidelines of the 1975 Declaration of Helsinki. FindingsBetween Jul 2, 2018 and Jan 16, 2019, we collected data on 445 visits to general practitioners. Chronic illness (212 [48%]), acute illness (188 [42%]), and health counselling (30 [7%]) were the three major reasons for visits, while the remaining reasons included health examination and rehabilitation (15 [3%]). The mean duration of visits were 5·6 min (SD 3·8) for chronic illness visits, 4·8 min (SD 2·7) for acute illness visits, and 6·5 min (SD 4·1) for health counselling visits. Treatment planning was the leading content of general practitioner consultation among all three groups. However, for the chronic illness group, general practitioners spent more time in negotiation for drug costs (29·2%, SD 25·8 for chronic illness vs 15·8%, SD 15·1 for acute illness vs 11·1%, SD 14·7 for health counselling; p<0·0001), but less time on taking patient history (28·1%, SD 27·6 for chronic illness vs 40·7%, SD 19·6 for acute illness vs 37·9%, SD 18·1 for health counselling; p=0·028) and physical examination (12·4%, SD 13·4 for chronic illness vs 21·1%, SD 15·5 for acute illness vs 18·3%, SD 14·6 for health counselling; p<0·0001). InterpretationThe mean duration of general practitioner consultations in China was shorter than that shown by studies in other countries. Treatment planning remained the most important content of general practitioner consultation regardless of patient RFV, although drug prescription was more of a concern among patient visits for chronic illness. This finding might provide evidence for health service planning and general practitioner training. FundingThe National Natural Science Foundation of China (grant 71673311).

A survey identifying leadership and research activities among Nurse Practitioners

Background: Nurse Practitioners are identified as the ideal conduit to transform healthcare delivery internationally. Healthcare transformation requires the application of leadership and research skills. Current literature has limited information on NPs as leaders or researchers in the nursing profession. Objectives: Determine if Nurse Practitioners identify themselves as leaders in nursing. Identify the leadership and research activities and influencing characteristics of Nurse Practitioners in Ireland and Australia. Establish similarities in leadership and research activities between Nurse Practitioners in Ireland and Australia. To identify if there is a relationship between leadership and research activities. Design: A quantitative electronic survey. Methods: A survey instrument was developed by combining two previously validated instruments. Nurse Practitioners in Ireland or Australia that had practiced within the last five years, and members of the respective professional association were included. Descriptive statistics were used to describe the findings and explore relationships in the data. Results: 14% (n = 96) of Nurse Practitioners responded to the survey. Nurse Practitioners in Ireland and Australia identified themselves as leaders of the nursing profession. Nurse Practitioners work practices, leadership and research activities are similar in Ireland and Australia. The majority (n = 55, 57%), of participants reported being research active. There was an association between perceived leadership and research activities among participants. Conclusion: Nurse Practitioners in both Ireland and Australia identify themselves as leaders of the nursing profession. There is no difference in reported work practices, leadership or research activities of Nurse Practitioners in both Ireland and Australia. There is an association between perceived leadership and research activity. Impact Statement: Nurse Practitioners in Ireland and Australia percieved themselves as leaders in nursing and this perception increases with research activity.

Clinical characteristics of osteopaths treating work-related injuries in Australia: A cross-sectional study

ObjectiveWork-related injuries constitute a significant proportion of osteopaths' practice. This study was designed to determine the practitioner and practice characteristics of osteopaths who treat people with work-related injuries and to identify the impact of workers’ compensation scheme status on the use of osteopathic medicine. MethodsA cross-sectional survey was distributed to a nationally-representative sample of 992 Australian osteopaths. Multivariate logistic regression modelling was performed to identify the practitioner and practice characteristics of osteopaths that were statistically significantly associated with the treatment of work-related injuries. ResultsA total of 847 osteopaths (86%) at least sometimes treated people with work-related injuries within the previous 12-months. One hundred and three participating osteopaths indicated they often treated people with work-related injuries who were covered by a workers' compensation scheme and 341 participating osteopaths indicated they often treated people with work-related injuries who were not covered by a workers’ compensation scheme. Osteopaths who often treated work-related injuries were also more likely to often treat people with sports-related injuries, often treat people with traffic-related injuries, and/or often discuss medications with patients. ConclusionsA large proportion of Australian osteopaths treat people with work-related injuries. Further examination of osteopathic medicine use for work-related injuries is warranted.

Characterizing the Patients, Hospitals, and Data Quality of the eICU Collaborative Research Database.

The eICU Collaborative Research Database is a publicly available repository of granular data from more than 200,000 ICU admissions. The quantity and variety of its entries hold promise for observational critical care research. We sought to understand better the data available within this resource to guide its future use. We conducted a descriptive analysis of the eICU Collaborative Research Database, including patient, practitioner, and hospital characteristics. We investigated the completeness of demographic and hospital data, as well as those values required to calculate an Acute Physiology and Chronic Health Evaluation score. We also assessed the rates of ventilation, intubation, and dialysis, and looked for potential errors in the vital sign data. American ICUs that participated in the Philips Healthcare eICU program between 2014 and 2015. A total of 139,367 individuals who were admitted to one of the 335 participating ICUs between 2014 and 2015. None. Most encounters were from small- and medium-sized hospitals, and managed by nonintensivists. The median ICU length of stay was 1.57 days (interquartile range, 0.82-2.97 d). The median Acute Physiology and Chronic Health Evaluation IV-predicted ICU mortality was 2.2%, with an observed mortality of 5.4%. Rates of ventilation (20-33%), intubation (15-24%), and dialysis (3-5%) varied according to the query method used. Most vital sign readings fell into realistic ranges, with manually curated data less likely to contain implausible results than automatically entered data. Data in the eICU Collaborative Research Database are for the most part complete and plausible. Some ambiguity exists in determining which encounters are associated with various interventions, most notably mechanical ventilation. Caution is warranted in extrapolating findings from the eICU Collaborative Research Database to larger ICUs with higher acuity.

تقییم دور ممارسی الخدمة الاجتماعیة المباشرة فی صنع سیاسات الرعایة الاجتماعیة

الملخص: هدفت هذه الدراسة إلى تحديد مستوى أداء ممارسي الخدمة الاجتماعية المباشرة لدورهم في صنع سياسات الرعاية الاجتماعية، وذلک من خلال تحديد مستوى أدائهم للمهام المهنية في مراحل صنع سياسات الرعاية الاجتماعية، وفحص العلاقة بين بعض الخصائص الشخصية والمهنية للممارسين المباشرين ومستوى أدائهم لهذا الدور. هذه الدراسة وصفية واعتمدت على منهج المسح الاجتماعي، وتم استخدام الاستبيان في جمع البيانات. أوضحت النتائج أن مستوى أداء ممارسي الخدمة الاجتماعية المباشرة لدورهم في صنع سياسات الرعاية الاجتماعية متوسط. واختلف مستوى أدائهم لهذا الدور وفقا لمراحل صنع السياسة، حيث کان المستوى مرتفع في أدائهم للمهام المهنية المتعلقة بمرحلة تنفيذ السياسة، ومتوسط في أداء المهام المهنية المتعلقة بمرحلتي التقويم ووضع السياسة على الترتيب. کما أوضحت النتائج أن هناک علاقة معنوية بين بعض الخصائص الشخصية (المشارکة السياسية - العضوية بمنظمات المجتمع المدني) والمهنية (المؤهل العلمي- مجال العمل) لممارسي الخدمة الاجتماعية المباشرة ومستوى أدائهم لدورهم في صنع سياسات الرعاية الاجتماعية. وتم معالجة قضايا مرتبطة بالخدمة الاجتماعية المباشرة ودورها في صنع سياسات الرعاية الاجتماعية. کلمات مفتاحية: تقييم- دور- الخدمة الاجتماعية المباشرة – صنع سياسات الرعاية الاجتماعية - مراحل صنع السياسة. Assessing the Role of Direct Social Work Practitioners in Social Welfare Policies Making Abstract: This study aimed to determine the level of performance of direct social work practitioners of their role in social welfare policies making, by determining the level of their performance of professional tasks in the stages of social welfare policies making, and examining the relationship between some personal and professional characteristics of direct practitioners and their level of performance in this role. This study is descriptive and it depended on the social survey method, and a questionnaire was used to collect data. The results showed that the level of performance of direct social work practitioners for their role in making social welfare policies is medium. The level of their performance for this role differed according to the stages of policy making, where the level was high in their performance of professional tasks related to the policy implementation stage, and medium in the performance of professional tasks related to the evaluation and policy setting stages, respectively. The results also showed ther is a significance relationship between some personal characteristics (political participation - membership in civil society organizations) and professional (academic qualification - work field) of direct social work practitioners and their level of performance of their role in making social welfare policies. Issues related to direct social work and its role in making social welfare policies were addressed. Keywords: Assessing - Role - Direct Social Work - Social Welfare Policy Making – Policy Making Stages

Individual level predictors of implementation climate in child welfare services

Abstract Background Child welfare services (CWS) are characterized by having demanding work environments, large diversity in client needs, and limited use of evidence-based practices (EBPs). Thus, CWSs can benefit from quality improvement strategies. Accumulating evidence suggests that an organization’s strategic climate towards implementation of change and EBPs (i.e., Implementation Climate [IC]) is a critical determinant for quality improvement, such as implementation of EBPs. It is also important to understand how practitioner characteristics are implicated in successful implementation. Knowledge about how practitioner characteristics predict IC can inform priorities, improvements, and processes at several levels of CWSs to promote successful EBP implementation and sustainment. Methods We collected data on IC, job satisfaction, job stress, participation in implementation, and practitioner demographics from a total of 233 participants employed in three Norwegian CWSs during a hybrid trial investigating the implementation and effectiveness of an academic intervention (Enhanced Academic Support) for children and families receiving support from CWSs. Data were collected at two time points; before initial implementation and 20–24 months after initial implementation. We ran confirmatory factor analyses to test the factor structures and intercorrelations of translated measures. We compared Implementation Climate Scale scores with a study using the same scale in United States-based CWSs. Hierarchical multiple regression analysis was used to test whether job stress, job satisfaction, practitioner tenure, postgraduate education, and whether respondents were active or inactive participants in an ongoing implementation process predicted IC. Results Measures of IC exhibited acceptable psychometric properties. Significant differences between IC in Norwegian and United States-based CWSs were found for three subscales (educational support-, recognition-, and rewards for EBPs). Composite scores did not differ significantly. Job satisfaction was the strongest and only unique predictor of IC at both time points. Length of tenure was a unique predictor at T2. Discussion To improve the climate for implementation in CWSs, strategies should address the job characteristics and demands that can increase job satisfaction and reduce high levels of job stress. Job satisfaction and tenure may inform strategic priorities and role selection in implementation processes. Differences in the work-culture between Norwegian and United States-based CWSs may produce different interpretations of certain items in the Implementation Climate Scale.

Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care.

Background: Adherence to guidelines by physicians of an emergency department (ED) depends on many factors: guideline and environmental factors; patient and practitioner characteristics; the social-political context. We focused on the impact of the environmental influence and of the patients’ characteristics on adherence to the guidelines. It is our intention to demonstrate how environmental factors such as ED organization more affect adherence to guidelines than the patient’s clinical presentation, even in a clinically insidious disease such as pulmonary embolism (PE). Methods: A single-center observational study was carried out on all patients who were seen at our Department of Emergency and Acceptance from 1 January to 31 December 2017 for PE. For the assessment of adherence to guidelines, we used the European guidelines 2014 and analyzed adherence to the correct use of clinical decision rule (CDR as Wells, Geneva, and YEARS); the correct initiation of heparin therapy; and the management of patients at high risk for short-term mortality. The primary endpoint of our study was to determine whether adherence to the guidelines as a whole depends on patients’ management in a holding area. The secondary objective was to determine whether adherence to the guidelines depended on patient characteristics such as the presence of typical symptoms or severe clinical features (massive pulmonary embolism; organ damage). Results: There were significant differences between patients who passed through OBI and those who did not, in terms of both administration of heparin therapy alone (p = 0.007) and the composite endpoints of heparin therapy initiation and observation/monitoring (p = 0.004), as indicated by the guidelines. For the subgroups of patients with massive PE, organ damage, and typical symptoms, there was no greater adherence to the decision making, administration of heparin therapy alone, and the endpoints of heparin therapy initiation and guideline-based observation/monitoring. Conclusions: Patients managed in an ED holding area were managed more in accordance with the guidelines than those who were managed only in the visiting ED rooms and directly hospitalized from there.

Hausärztliche Delegationskonzepte in Nordrhein-Westfalen Ergebnisse der hausärztlichen Befragung zum Einsatz von EVA, VERAH, VERAH Plus zur Delegation definierter Tätigkeiten

BackgroundThe delegation of traditional GP tasks to qualified medical assistants (MFA) includes several modalities based on extended qualification curricula known as „Nicht-ärztliche Praxisassistentin” (NäPa) [non-physician practice assistant], also known as the “Entlastende Versorgungsassistentin” (EVA) and the “Versorgungsassistentin in der Hausarztpraxis” (VERAH and VERAH Plus) [professional healthcare assistants in the family practice]. Delegation to MFA has gained importance in recent years due to an increasing workload of general practitioners in Germany. ObjectivesThis article examines the characteristics of general practitioners (GPs) currently delegating activities to MFAs with and without extended qualification based on the three mentioned modalities (EVA, VERAH and VERAH Plus). In addition, we explore whether the delegated activities are delivered in the office, at the patient's home or in the nursing home and how GPs perceived the potential of future delegation. Materials and methodsBetween April and August 2016, we conducted an anonymous postal survey of a representative randomized sample of general practitioners in North Rhine-Westphalia (n = 2,404). The questionnaire contained questions about practice staff, setting for delivery of the delegated activity as well as the perceived added values of and barriers to delegation. We compare characteristics of GPs delegating to MFA with extended qualification to those delegating to standard qualified MFA. ResultsThe response rate was 32 % (n = 762). Almost one third of the respondents (n = 239) delegated tasks to MFAs with extended qualification. These GPs are more likely to be younger and male and less likely to be working alone in individual practice. They delegate more activities to be delivered in all settings than GPs employing MFAs without extended qualification. Discussion and conclusionsGPs benefit from delegating to MFA with extended qualification as shown by the associated added values and setting of deployment for delivery of tasks. Delegation to non-medical staff should be considered by more GPs as a means of supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.