Clinic Directors Research Articles

Hypnosis support in anaesthesia is rarely used in German anaesthesia departments - a nationwide survey among leading physicians of anaesthesia departments

BackgroundThe aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas.MethodsA descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed.Results476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses).ConclusionsHypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures.

Factors Associated With Increased Substance Use Disorder Care in VA PTSD Specialty Outpatient Treatment

Objective Substance use disorders (SUDs) commonly co-occur with posttraumatic stress disorder (PTSD). Understanding PTSD clinics that serve higher percentages of patients with PTSD/SUD is crucial for improving SUD care in clinics with lower percentages of such patients. This study examined the differences between Veterans Affairs (VA) PTSD treatment sites with higher percentages ("High%") and lower percentages ("Low%") of patients with PTSD/SUD as well as exploring the roles of the PTSD/SUD specialists. Methods The study collected quantitative and qualitative data from 18 clinic directors and 21 specialists from 33 VA PTSD specialty outpatient clinics from 2014 to 2016. The clinics were chosen from the top and bottom quartiles based on two criteria: (1) the percentage of patients with PTSD/SUD and (2) the percentage of patients with PTSD/SUD who completed at least three SUD visits within the first month of their SUD treatment. The interviews sought to identify distinguishing characteristics between the High% and Low% clinics in terms of treatment access and practices for patients with PTSD/SUD. Results More of the High% clinics reported providing evidence-based, patient-centered, and integrated/concurrent PTSD/SUD treatment and had staff members with more up-to-date knowledge and skills than the Low% clinics. We also found the roles of the PTSD/SUD specialists were demanding and confusing, leading to high turnover rates. Conclusions The two groups of PTSD clinics differed in three key factors: Resources, knowledge and skills of staff members, and local policies. Future research should focus on addressing resource limitations, knowledge gaps, and local policy disparities in Low% clinics. By emulating the practices of High% clinics, VA PTSD clinics can improve SUD care for patients with PTSD/SUD.

Follow-up outpatient clinics for patients with post COVID: a survey to assess and characterize aspects of care

After acute infection with the SARS-CoV-2 virus, up to 10 % of affected individuals suffer from long-term health impairments, also referred to as "Post-COVID". In Germany, specialized outpatient clinics have been established to care for patients with Post-COVID. A structured survey of the care situation is not yet available, but essential for a demand-oriented care. The present study aimed to systematically assess and describe structural and process-related aspects of care, and to perform an inventory and needs analysis of Post-COVID outpatient clinics in Germany.An online survey was developed assessing the structure and organization of the outpatient clinics, service offerings and networking of care from the perspective of the outpatient clinic directors. A total of 95 outpatient clinics were identified, and an invitation to participate in the online survey was sent via e-mail to the directors of the outpatient clinics. Data were collected between February and May 2022. Descriptive data analysis was performed.A total of 28 outpatient clinic managers (29 %) took part in the survey. Participants were between 32 and 66 years old, and 61 % (n = 17) were male. The outpatient clinics were most frequently affiliated with the specialties of pneumology (n = 10; 36 %), internal medicine, psychiatric and psychosomatic medicine, and neurology (n = 8; 29 %, respectively). Among the outpatient clinic directors, 64 % (n = 18) stated that the time spent waiting for an appointment was more than one month. Utilization (n = 25; 89 %), appointment demand (n = 26; 93 %), and the need for more Post-COVID outpatient clinics (n = 20; 71 %) were rated as high by the outpatient clinic directors. Nearly all directors reported networking with in-clinic facilities (n = 27; 96 %), with primary care physicians and with specialists in private practice (n = 21; 75 %, respectively).The main focus of care is pneumology. Internal medicine, psychiatry/psychosomatics and neurology are also equally represented. Our data further suggest a high demand for Post-COVID outpatient clinics and the need to expand this care offer.

Assisting primary care teams and patients in a culturally diverse periphery: impact on medical students’ future career choices

BackgroundMedical students can assist in reducing healthcare disparities and promote health equity by engaging with rural communities and gaining insights into their unique healthcare needs. A two-arm student-delivered program was designed and implemented during COVID-19 in a social-geographic peripheral area to assist clinics with complex chronic and/or socially disadvantaged patients and improve preventive behavior in townships through home visits delivering community kits.MethodsWe conducted a pre-post design study which included weekly structured medical student reports and monthly structured telephone interviews with clinic directors and municipal partners. Students completed pre-post program survey on their knowledge, skills, and capabilities to address chronic patients from diverse cultural backgrounds (n = 73). The Wilcoxon-Signed-Rank test for related samples was used to determine differences.ResultsFollowing the program, the knowledge and awareness levels of students about working in the community (P < 0.001) and their knowledge of common chronic diseases were significantly improved (Mean Difference (MD) = 0.31; p < 0.001). The program significantly increased students’ interest to integrate into community care alongside a hospital (P = 0.012). Thematic analysis of student reports revealed improved insight into the role of primary care. Clinic directors (90%) were highly satisfied and reported that students became an integral part of the clinics’ teams.ConclusionsIntegrating medical students into the community through primary-care clinics and home visits in diverse communities, exposed students to the interwoven effect of clinical and social determinants on health and improve their knowledge of common chronic diseases. Participation in the program encouraged students to consider a career in community care.

A preliminary view of the use of telehealth in a child welfare agency during the pandemic

ABSTRACT Introduction The child welfare system’s method of service delivery shifted abruptly during the pandemic to a telehealth modality. The perceived impact of this change upon service delivery is largely unknown, however. The purpose of this study was to describe how a large child welfare agency shifted to telehealth delivery, including investigating barriers and innovative strategies that were undertaken to resolve obstacles and enhance engagement and the provision of services. Method In September, 2020, direct service providers, supervisors and clinic directors at a large, Southeastern child welfare agency completed a survey that tapped into the perceived impact of telehealth on service delivery, and barriers and benefits of telehealth delivery. Twenty-six (n = 26) individuals completed the survey. Results Over half of participants reported an improvement in service delivery through the use of telehealth, and most saw it as being beneficial to both families and staff. Few participants believed that services were negatively impeded by telehealth.The main barrier to telehealth delivery was technology access and navigation (both on the part of families and staff). Discussion Telehealth was largely perceived as a facilitator to child welfare service delivery; implications and use of remote platforms are discussed.

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation

BackgroundHealth systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA—Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil.MethodsThe study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN).ResultsHERA was feasible and acceptable to women and PHC providers, increased providers’ readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women’s disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus—NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW.ConclusionTraining should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.

Implementing a guideline-based education and exercise program for people with knee and hip osteoarthritis-Practical experiences of providers and clinic leaders: Aqualitative study.

The Good Life with osteoArthritis: Denmark (GLA:DTM ) program is an evidence-based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLADTM implementation in Canada (Alberta) by applying the RE-AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program. Semi-structured telephone interviews were conducted with GLA:DTM -trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process. Eighteen GLA:DTM -trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi-level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long-term sustainability. The GLA:DTM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability.

Reimagining Family Engagement in Online Literacy Clinics During the Pandemic

During the dual pandemics of COVID-19 and continuing racial injustices, many literacy clinics pivoted to online instruction. Educators were now in students’ homes for virtual literacy lessons. To understand how literacy clinics responded, teacher educators analyzed a national survey of clinic directors’ perspectives. Analysis regarding family communication and participation led to six categories: parent involvement, communication, family presence, learning with families v. teaching families, diminished/enhanced experiences, and access/digital divide. Contrasting examples from these categories were chosen to create a research-based verbatim audio play. Teacher educators then used fieldnotes, artifacts, and transcripts from their clinical experiences to create vignettes of clinic instruction, which they then put into dialogue with survey findings to reconceptualize, animate, and (re)present these as navigating digital divides/access, challenging school-centric definitions of family literacy, and building community with families in online settings. Findings from this study highlight that as the technological landscape of literacy clinics changes, so must our understanding of engaging with families’ literacy practices.

Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing.

Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. Qualitative study of semi-structured telephone interviews. We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints.

Screening and treating problematic substance use among patients in psychiatry – obstacles and solutions

ObjectiveIn Sweden, national guidelines recommend that all staff in the healthcare system systematically screen patients for alcohol use and illicit substance use. Where hazardous use is identified, it should be addressed as soon as possible, preferably through brief interventions (BI). Results from a previous national survey showed that most clinic directors stated that they had clear guidelines for screening alcohol use and illicit substance use, but that fewer staff than expected used screening in their work. This study aims to identify obstacles and solutions to screening and brief intervention, based on survey respondents’ free-text responses to open-ended questions.ResultsA qualitative content analysis yielded four codes: guidelines, continuing education, cooperation and resources. The codes indicated that staff would need (a) clearer routines in order to optimize compliance with the national guidelines; (b) more knowledge about how to treat patients with problematic substance use; (c) better cooperation between addiction care and psychiatry; and (d) increased resources to improve routines at their own clinic. We conclude that increased resources could contribute to better routines and cooperation, and provide increased opportunities for continuing education. This could increase guideline compliance and increase healthy behavior changes among patients in psychiatry with problematic substance use.

Optimizing Medication Safety with Oral Antitumor Therapy: A Methodological Approach for the Real-World Implementation of the AMBORA Competence and Consultation Center.

Generating evidence for the efficacy of an intervention is not sufficient to guarantee its implementation in real-world settings. The randomized AMBORA trial (Medication Safety with Oral Antitumor Therapy) demonstrated that an intensified clinical pharmacological/pharmaceutical care program has substantial benefits for patients, treatment teams, and the healthcare system. Thus, we are now investigating its implementation into routine care within the AMBORA Competence and Consultation Center (AMBORA Center). We perform a multicenter type III hybrid trial following the RE-AIM framework to assess the clinical effectiveness of this care program under real-world conditions, while evaluating the implementation outcomes. Semi-structured stakeholder interviews based on the Consolidated Framework for Implementation Research (CFIR) have been conducted to identify barriers and facilitators. So far, 332 patients treated with oral antitumor drugs have been referred to the AMBORA Center by 66 physicians from 13 independent clinical units. In 20 stakeholder interviews (e.g., with clinic directors), 30% (6/20) of the interviewees anticipated possible barriers which may partly hinder sustainable implementation (e.g., unavailable consultation rooms). Furthermore, important facilitators (e.g., operational processes) were identified. This methodological description adds knowledge on how to structure a hybrid effectiveness-implementation trial and proposes multilevel implementation strategies to improve the medication safety of oral antitumor therapy.

Focus Group Study of Medical Stakeholders to Inform the Development of Resilient Together for Dementia: Protocol for a Postdiagnosis Live Video Dyadic Resiliency Intervention.

Alzheimer disease and related dementias (ADRD) are increasingly common conditions that disrupt the lives of persons living with dementia and their spousal care partners. At the time of ADRD diagnoses, many couples experience challenges that produce emotional distress and relationship strain. At present, there are no interventions to address these challenges early after diagnoses to promote positive adjustment. The study protocol described here is part of the first phase of a larger program of research that aims to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention to be delivered over live video early after diagnosis, with the goal of preventing chronic emotional distress. This study will elicit and systematically summarize perspectives of ADRD medical stakeholders to inform the procedures (eg, recruitment and screening methods, eligibility, timing of intervention, and intervention delivery) of the first iteration of RT-ADRD prior to pilot-testing. We will recruit interdisciplinary medical stakeholders (eg, neurologists, social workers, neuropsychologists, care coordinators, and speech language pathologists) from academic medical center clinics in the departments treating persons living with dementia such as neurology, psychiatry, and geriatric medicine via flyers and word-of-mouth referrals from clinic directors and members of relevant organizations (eg, dementia care collaboratives and Alzheimer disease research centers). The participants will complete electronic screening and consent procedures. Consenting individuals will then participate in a 30- to 60-minute qualitative virtual focus group, held either via telephone or Zoom, using an interview guide designed to assess provider experiences with postdiagnosis clinical care and to gather feedback on the proposed RT-ADRD protocol. The participants will also have the opportunity to participate in an optional exit interview and web-based survey to gather additional feedback. Qualitative data will be analyzed using a hybrid inductive-deductive approach and the framework method for thematic synthesis. We will conduct approximately 6 focus groups with 4-6 individuals in each group (maximum N=30 individuals; until saturation is reached). Data collection began in November 2022 and will continue through June 2023. We anticipate that the study will be completed by late 2023. The results from this study will inform the procedures of the first live video RT-ADRD dyadic resiliency intervention focused on the prevention of chronic emotional and relational distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from stakeholders on ways to best deliver our early prevention-focused intervention and gain detailed feedback on study procedures prior to further testing. DERR1-10.2196/45533.

Separate But Not Equal? A Cross-Sectional Study of Segregation by Payor Mix in Academic Primary Care Clinics.

At some US Academic Health Centers (AHCs), patients with predominantly Medicaid insurance are seen in one clinic and patients with other insurance are seen in another. The extent of this practice and implications are unknown. To estimate the proportion of AHCs that have at least two primary care internal medicine clinics that differ substantially in proportion of patients with Medicaid and to compare patient demographic, staffing, and operational features. General internal medicine chiefs and clinic directors at 40 randomly selected US AHCs plus the top 10 AHCs in terms of NIH funding. An AHC was classified as maintaining clinics that differed substantially in the proportion of patients with Medicaid if any two differed by ≥ 40% (absolute). Other criteria were used for pre-specified secondary analyses (e.g., ≥ 30%). Thirty-nine of 50 AHCs (78%) participated. Four of 39 (10%; 95% CI, 3 to 24%) had two clinics differing by ≥ 40% in the proportion of patients with Medicaid, eight (21%; 95% CI, 9 to 36%) had clinics differing by ≥ 30%, and 15 (38%; 95% CI, 23 to 55%) had clinics differing by ≥ 20%. Clinics with more patients with Medicaid by any of the three criteria were more likely to employ resident physicians as providers of longitudinal care (with faculty supervision) and more likely to have patients who were Black or Hispanic. Some US AHCs maintain separate clinics defined by the proportion of patients with Medicaid. Clinics with a higher proportion of patients insured by Medicaid are more likely to employ residents (with faculty oversight), feature residents as providers of longitudinal care, and serve patients who are Black and Hispanic. Further research is needed to understand why some AHCs have primary care clinics distinguishable by insurance mix with the goal of ensuring that racism and discrimination are not root causes.

Lawyers in self-estrangement: resolving the challenges of sustaining university law clinics

ABSTRACT This article examines the challenges encountered by university law clinics in their legal aid projects that are designed to assuage national access to justice deficits. Towards the resolution of these challenges, it proposes a sustainability paradigm that bears significant implications for lawyers, legal educators and other clinic collaborators. The article begins by locating the pragmatic, moral and legal underpinnings of the social justice mission of university law clinics. The subsequent analysis of legal aid provided by universities is supported by data on clinic activity collected through interviews of clinic directors and focus group discussions with student leaders in university law clinics in Kenya. The findings reveal the multiple challenges that clinics confront as being in leadership, lack of representational capacity, inadequate resourcing, under-explored potential, poor institutional synergies and sub-optimal placement in university structures. The article then establishes a link between these setbacks and the sustainability of the clinics, arguing that reframing the problem in Kenya as one of sustainability yields potential avenues for addressing the challenges in ways that are progressive and impactful.

Speech-Language Pathology Graduate Students' Perception of Satisfaction, Confidence, and Interpersonal Skill Development During Simulated Experiences Amid COVID-19

Purpose: This quantitative survey correlational study aimed to examine the satisfaction, confidence, and interpersonal skills of speech-language pathology (SLP) graduate students after participating in simulated learning experiences (SLEs) during the COVID-19 pandemic. The research questions addressed (a) How do SLP graduate students perceive satisfaction, confidence, interpersonal skills, and strengths and challenges of this learning after participating in SLEs? and (b) How do SLP graduate students perceive satisfaction, confidence, and interpersonal skills across the number of hours of the SLE, the number of courses that utilize simulation, and the types of simulation experiences? Method: We invited a total of 72 Midwest clinic directors to distribute the survey to students in their respective programs. The final sample included 327 SLP students. Participants responded to questions on satisfaction, confidence, and interpersonal skills after participating in SLEs. Results: Key findings included a positive correlation among student perceptions, including satisfaction, confidence, and interpersonal skills, but no correlations between student perceptions and the number of courses that integrated SLEs and number of hours of simulation experience. Simulation types were analyzed and showed significant differences in interpersonal skill development such that virtual patient simulation is associated with more positive interpersonal skills among all types. A summary of strengths and challenges from the SLP graduate student perspective was also synthesized. Conclusions: Findings necessitate further exploration as they relate to the SLP graduate clinical experiences. This study revealed moderate to positive feedback on SLEs (instead of overall positive feedback) regarding satisfaction, confidence, and interpersonal skill development; however, previous studies noted positive outcomes. Further research should include comparing face-to-face experiences with SLEs and replicating this survey after the COVID-19 pandemic subsides and graduate programs can return to normal operations.

Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study

BackgroundStigma around human immunodeficiency virus (HIV), injection drug use (IDU), and mental health disorders can be co-occurring and have different impacts on the well-being of people living with HIV (PWH) who use drugs and have mental health disorders. This stigma can come from society, health professionals, and internalized stigma. A person who has more than one health condition can experience overlapping health-related stigma and levels of stigma which can prevent them from receiving necessary support and healthcare, serving to intensify their experience with stigma. This study investigates HIV, drug use, and mental health stigmas in three dimensions (social, internalized, and professional) around PWH on methadone maintenance treatment (MMT) who have common mental disorders (CMDs) including depression, anxiety, and stress-related disorders in Hanoi, Vietnam.Please check and confirm whether corresponding author's email id is correctly identified.The cooresponding author's email is correctMethodsWe conducted semi-structured, in-depth interviews (IDIs) (n = 21) and two focus group discussions (FGDs) (n = 10) with PWH receiving MMT who have CMD symptoms, their family members, clinic health care providers, and clinic directors. We applied thematic analysis using NVIVO software version 12.0, with themes based on IDI and FGD guides and emergent themes from interview transcripts.ResultsThe study found evidence of different stigmas towards HIV, IDU, and CMDs from the community, family, health care providers, and participants themselves. Community and family members were physically and emotionally distant from patients due to societal stigma around illicit drug use and fears of acquiring HIV. Participants often conflated stigmas around drug use and HIV, referring to these stigmas interchangeably. The internalized stigma around having HIV and injecting drugs made PWH on MMT hesitant to seek support for CMDs. These stigmas compounded to negatively impact participants’ health.ConclusionsStrategies to reduce stigma affecting PWH on MMT should concurrently address stigmas around HIV, drug addiction, and mental health. Future studies could explore approaches to address internalized stigma to improve self-esteem, mental health, and capacities to cope with stigma for PWH on MMT.Trial registration: NCT04790201, available at clinicaltrials.gov.

Rehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care

ObjectiveTo explore rehabilitation professionals' experiences and perspectives of barriers and facilitators to implementing the Rehabilitation Treatment Specification System (RTSS) in research, education, and clinical care. DesignA cross-sectional survey with free text and binary responses was completed by rehabilitation professionals. Survey data were analyzed with a deductive approach of directed content analysis using 2 implementation science frameworks: Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC). SettingRehabilitation professionals across research, educational, and clinical settings. ParticipantsOne hundred and eleven rehabilitation professionals—including speech-language pathologists, occupational therapists, physical therapists, physicians, psychologists, researchers, and clinic directors—who explored possible uses or applications of the RTSS for clinical care, education, or research (N=111). InterventionsNot applicable. Main Outcome MeasuresFrequency of reported CFIR barriers and facilitators, as well as keywords related to CFIR and ERIC constructs. ResultsThe barriers and facilitating strategies differed according to the end-users’ intended use, that is, research, education, or clinical. Overall, the 4 most frequently encountered CFIR barriers were the RTSS's complexity, a lack of available RTSS resources, reduced access to knowledge and information about the RTSS, and limited knowledge and beliefs about the RTSS. The ERIC-CFIR matching tool identified 7 ERIC strategies to address these barriers, which include conducting educational meetings, developing and distributing educational materials, accessing new funding, capturing and sharing local knowledge, identifying and preparing champions, and promoting adaptability. ConclusionsWhen attempting to use the RTSS, rehabilitation professionals commonly encountered barriers to understanding and skillfully using the framework. Theory-driven implementation strategies have been identified that have potential for addressing the RTSS's complexity and lack of educational and skill-building resources. Future work can develop the identified implementation strategies and evaluate their effects on RTSS implementation.

Endometrial Scratching in Australia, New Zealand and the UK: A Follow-up Survey

Background: Endometrial scratching is a common IVF add-on. In 2015, a survey in Australia, New Zealand and the UK reported that 83% of fertility specialists recommended endometrial scratching for IVF ( 1 ). Several large trials have since been published reporting no clear evidence for improved live birth rates following endometrial scratching before IVF. Aim: To ascertain the current practices and views on endometrial scratching across Australia, New Zealand and the UK. Method: An anonymous online survey was distributed via professional fertility societies and through emails sent directly to Medical Directors of IVF clinics in Australia, New Zealand and the UK. Responses were received between October and December 2020. Results: 121 eligible responses were received (fertility specialists (n=61), embryologists (n=26) and fertility nurses (n=24)); at least one response was received from 40% of IVF clinics. Among fertility specialists, 34% currently offer endometrial scratching, primarily in the case of recurrent implantation failure. Most respondents (&gt;90%) were neutral or did not believe endometrial scratching improved pregnancy and live birth rates. However, for women with recurrent implantation failure, 29% believed it was beneficial. More than half (55%) of respondents viewed reducing psychological distress as a benefit of endometrial scratching. Among fertility specialists who were not offering endometrial scratching, 51% previously did. Conclusion: This study indicates the use of endometrial scratching has declined over the last five years, which may reflect a response to recent evidence reporting no benefit from the procedure. The major limitations of this study are the low response rate, and the potential for bias; professionals with strong views about endometrial scratching (for or against) may have been more likely to complete the survey.

Infection Prevention Strategies Concordance in Canadian Dental Schools During the COVID-19 Pandemic

ObjectiveThe aim of this research was to identify variation in specific infection prevention and control (IPC) strategies across all dental schools in Canada and to evaluate the concordance concerning COVID-19 pandemic-related IPC strategies reported by clinic directors or IPC officers (CDs/IPCOs) and those reported by students, staff, and faculty in the schools.MethodA cross-sectional analysis within a prospective cohort study. Participants in the cohort study reported IPC strategies used in their schools during April or May 2021. Independently, CDs/IPCOs reported IPC strategies in school protocols in July 2021.ResultsOf the 600 participants recruited, 332 participants who were involved in the provision of in-person dental care were further analysed. Of the 16 IPC strategies investigated, only 3 were reported by CDs/IPCOs to be used at all schools, and another 8 strategies were used by 8 or 9 of 10 or by 1 of 10 schools, indicating that concordance across schools was good for 11 of 16 strategies. Agreement between study participants and the CDs/IPCOs varied considerably by strategy (ranging between 50% and 100%) and by school (ranging between 42.9% and 97.2%). The strategies with the highest mean agreement percentage across schools were “screening or interviewing patients before appointment for COVID-19–related symptoms” (92.7%) and “checking the temperature of the staff members at least once a day using a thermometer” (91.5%).ConclusionsThe level of agreement in the use of strategies between participants working in clinics and CDs/IPCOs varied considerably by strategy and by school. Given the low COVID-19 infection rates in dental schools and the reported differences in IPC protocols, key strategies should be identified. During the pandemic, IPC protocols in Canadian dental schools evolved rapidly. Comparing different strategies might help develop a unified standard IPC protocol.

National Canadian Survey on the Management of Noneuploid Embryos

ObjectiveTo comprehensively describe current preimplantation genetic testing for aneuploidy (PGT-A) practices and management of non-euploid embryos in Canada. MethodsThis was a cross-sectional study utilizing an online survey distributed by email to all medical directors of fertility clinics with independent in vitro fertilization (IVF) embryology laboratories. The survey was designed to determine practice patterns regarding PGT-A usage; PGT-A reference laboratory, platform, and thresholds for classifying embryos; and management of embryos classified as mosaic, inconclusive, or aneuploid. ResultsTwenty-five medical directors (69%) participated in the survey. The majority of clinics (91%) offered PGT-A screening, with 45% of clinics offering PGT-A as routine screening. The majority of clinics (90%) that offered PGT-A received mosaicism data; 61% of these clinics had transferred mosaic embryos, and 94% would transfer mosaic embryos. Clinics that performed ≥1000 IVF cycles annually were more likely to have transferred mosaic embryos (100% vs. 45.5%; P = 0.043). The mean percentage of IVF cycles using PGT-A was lower in clinics that had transferred mosaic embryos (12.3% vs. 30.4%; P = 0.033). Only 1 clinic had transferred an aneuploid embryo, but 2 other clinics would consider this option. The majority of clinics (61%) that receive mosaicism data would recommend noninvasive prenatal testing (NIPT) following mosaic embryo transfer, with 22% of clinics indicating that this would be the only genetic test offered. ConclusionWe report significant practice variation in PGT-A and management of non-euploid embryos across Canada and highlight areas where consensus should be encouraged.