Consultation Practice Research Articles

Co-morbidities: Prevalence and evaluation of risk with COVID-19 (SARS CoV2) infection: A retrospective study

: Cases of COVID 19 is a challenge for clinicians to evaluate the effect of SARS CoV2 on patients has preexisting medical illness.To assess the potential effect and incidence of COVID 19 with comorbidity.680 COVID-19 positive cases were included. This research was limited to the admitted patients from October 2020 to February 2021. Applicable data were collected from patient’s files, reviewed and included based on the applicability to the topic.As of October, 2020, our institute had 954 suspected cases of COVID-19 infection. Out of these 680 patients were positive and rests were negative. We obtained data from the hospital records which provided information regarding the age, gender, chief complaints, co-morbidity and its type, positive /negative status and outcomes (Recovered/death). We divided the patients into three groups; (1) had no co-morbidity; (2) had one co-morbidity (3) had two or more co-morbidity and compared their outcomes (Recovery/Death/admitted). We also compared the outcomes of patients those had more than two co-morbidities.clinical data and co-morbidities were examined with SPSS Statistics, Version 23.Most patients were male (76.21%) with commonest complain of difficulty in breathing (46.03%). Among total cases, no co-morbidity was noted in 402 (59.11%) patients, one co-morbidity in 205(30.15%) and more than one co-morbidity in 73 (10.74%) patients. Higher death rate was noted in positive patients with two or more co-morbidities (35.62%). Diabetes and hypertension were the common observed illness with higher death rate in COPD and HTN with CAD (75.00%) patients.Result of this study suggests a strong clinical relationship between COVID-19 and co-morbidities. Patients with pre-existing medical sickness with COVID 19 is a challenge to the physicians as it yielded poorer clinical outcomes. So, the physicians need to be prepared to reorganize their consultative practices during this pandemic period.

Radiographer advanced and consultant practice and community diagnostic hubs – a vision for the future

ObjectivesThis article combines a brief narrative review of the Richards Report with an overview of current radiographer advanced and consultant clinical practice (ACCP) to provide suggestions for future ACCP within radiography. Key findingsThe ‘Diagnostics: Recovery and Renewal’ report by Professor Sir Mike Richards, published in 2020, has identified a need for improvements to be made to diagnostic services. His recommendations include the introduction of Community Diagnostic Hubs (CDHs) that would provide quicker and easier access to diagnostic tests for patients(1) A narrative review around the concept of Advanced and Consultant Clinical Practice (ACCP) for radiographers demonstrates the capability of the radiographers to expand their role. The article concludes with a vision of how CDHs could potentially provide multiple career pathways for radiographers working at this level of practice. Conclusion and implications for practiceIt is acknowledged that some of these concepts are a combination of visionary and aspirational in outlook rather than being entirely based on current practice. The intention of this article, and the implications for practice, are to support on-going discussions to enable radiography, as a profession, to seek ways and opportunities to do things differently whilst ensuring that the patient remains at the centre of the services delivered.

Implementing Industrial Symbiosis Incentives: an Applied Assessment Framework for Risk Mitigation

Industrial symbiosis (IS) is a business model that proposes symbiotic exchanges, allowing the flow of resources, wastes, and utilities between companies. In recent years, IS initiatives have been exponentially growing around the world. This can be attributed to the increasing awareness on the possibility of obtaining economic, environmental, and social benefits through the implementation of this model. Despite the exponential growth of IS initiatives, the companies are still facing problems in the achievement of reliable and permanent synergies. Over the years the literature has identified several factors in the IS emerging process. Incentives are among these factors, being defined as unlocking tools or mechanisms related to diverse dimensions such as economic, political, social, intermediaries, process, and technology. Authors believe that the large-scale implementation of IS incentives has not been properly addressed. In order to promote facilitated IS implementation and achieve a replicator effect, incentives should be fully addressed. In many case studies, it has been observed that the incentives for IS can be threatened by risks, compromising the implementation, and hindering the emerging process. This study developed a dedicated framework that is composed of incentive identification from best practices of IS and expert consultation; a risk assessment model based on risk factors identification and clustering; and finally, the mitigation actions based on the assessment outputs. The main result of this study is one set of mitigations actions that correlate the implementation levels (clusters) and the potential stakeholders involved.

From the “Paris Agreement” to the “London Pact”: Political Aspects of the Democratisation of Poland’s April Constitution of 1935

In the history of Poland’s April Constitution of 1935, there were two attempts to democratise it, the first one in November 1939 referred to as the “Paris agreement” and the other one in September 1950 included in the formula of the “London pact”, both of which concerned the ways of implementing Article 13 defining the scope of the President’s personal powers. The “Paris agreement” introduced into political life the practice of consultation between the President and the Prime Minister; the “London pact” provided for a thorough change in the nature of the President’s relations with the Government and the planned Parliament-in-exile called the Council of National Unity, as well as strengthened the role of the political parties in political decision-making. Motivated by the notion of the modernisation of the Constitution and its adjustment to the democratic standards of Western states, the postulate to democratise it was put forward by established political actors, the Polish Socialist Party (PPS) and the National Party (SN), supported by the Independence and Democracy (NiD) party founded in exile. Appearing together as the Political Council, they took part in negotiations on the formation of a government of national unity after the death of Prime Minister T. Tomaszewski. Representatives of the Polish People’s Party did not take part in the talks; its leader, Stanisław Mikołajczyk, rejected the April Constitution “in its entirety”. The “pact” did not gain the approval of the “Castle”: the President defended the Constitution and did not accept concessions as regards Article 13. Nevertheless, the postulates of the “pact” were not nullified as they were used to build a new political construction – the National Unity – from 1954 functioning in parallel to the presidential centre. Due to the importance of the issue, the negotiations can be regarded as a breakthrough event in the political life of the émigré community. It is no exaggeration to say that the roots of the most important political events in the life of the émigré milieu go back to the “London pact”.
 The research goal of this article is to bring to light the political aspects of the initiative motivated by the idea of democratising the April Constitution, expressed in the formula of the “London pact”, against the background of the hypothesis that the leaders of the Political Council, behind the screen of their demand for the modernisation of the political system, aimed at weakening the position of the President as an obstacle on the way to building a new political centre – the Unity camp. They used the stage of negotiations based on the demands of the “pact” to orchestrate an anti-presidential propaganda campaign and to portray Zaleski as an opponent of the notion of unity. At the same time, they promoted the false premise that the democratisation of political life would help unblock the channels of émigré diplomacy and change the position of the Polish cause in the international arena. In this way, taking advantage of the atmosphere of distrust towards the President, they were able to launch their own political project: the National Unity, planned for as early as in 1949. For them, their participation in the Unity’s bodies opened the possibility of realising their own political ambitions reserved for politicians from President Zaleski’s closest milieu referred to as the ‘Castle entourage’.

Radiation oncologist consultations prior to prostatectomy in Ontario, Canada: Disparities and opportunities.

e17052 Background: Men with localized prostate cancer have many options for initial definitive treatment. In 2015, Cancer Care Ontario Quality Based Procedures (QBP) recommended that men undergoing radical prostatectomy (RP) in Ontario be seen by a radiation oncologist (RO) or discussed at a multidisciplinary case conference (MCC) prior to surgery. An a-priori target rate of 76% was set by QBP, but to our knowledge, has not been reported upon to date. Our objective was to use population-based data to explore factors associated with not receiving RO consult/MCC prior to RP. Methods: Men with localized prostate cancer diagnosed and treated in Ontario, Canada with RP between 2007 and 2017 were identified using administrative data from the Institute for Clinical Evaluative Sciences. Physician billing data was utilized to identify patients who received RO consult/MCC prior to RP. Trends were evaluated using the Cochran-Armitage test. Multivariable logistic regression was used to identify patient and provider factors predictive of RO/MCC prior to RP. Results: 31,467 men with localized prostate cancer underwent RP between 2007 and 2017. Prior to RP, 29.3% of men were seen by RO, 1.0% underwent MCC, and 1.6% had both. RO consult/MCC prior to RP increased from 18.0% in 2007 to 47.8% in 2017 ( p<0.001). On multivariable analysis, the Odds Ratio (OR) of RO consult/MCC prior to RP between the lowest and highest geographic regions (LHINs) was 8.79 (95% CI 6.83–11.32, p<0.001). RO consult/MCC was less likely to occur for patients living further from the nearest cancer center (OR 0.74 per 50km, 95% CI 0.70–0.77, p<0.001) and more likely to occur for men residing in the highest versus lowest income quintile regions (OR 1.42, 95% CI 1.30–1.55, p<0.001). Men with NCCN Low (OR 1.31, 95% CI 1.16–1.47, p<0.001), High (OR 1.20, 95% CI 1.09–1.31, p<0.001) or Very High (OR 1.24, 95% CI 1.11–1.30, p<0.001) risk disease were more likely to receive RO consult/MCC compared to those with favourable-intermediate risk disease. Of the 128 urologists who performed at least 10 RP between 2016 and 2017, RO referral/MCC rate ranged from 0% to 100%, with 31 urologists (24.2%) having ≥76% of their patients seen prior to RP. To meet QBP targets in 2017, an additional 701 men would have needed RO consult/MCC. If all were seen by RO, approximately 2.4 additional full time equivalent RO positions would be needed. Conclusions: Despite increasing rates of utilization, a large proportion of men are not seen by RO or MCC prior to RP in Ontario, Canada. While the largest factors predicting RO consult/MCC discussion appear to be geographic and which urologist performs the RP, these factors are closely intertwined. In addition, these factors may be related to RO availability and radiation system capacity, which would need to be addressed to meet patient demand should QBP consultation rates be mandated to reduce disparities in pre-RP consultation practices.

How to make arts-based interventions appropriate for young refugees?: towards a decolonial framework

ABSTRACT There is now a well-established tradition of using participatory research methods, of which arts-based interventions constitute an important kind, for working with young people from disadvantaged backgrounds. At the same time, literature on decolonisation, and how decolonial research frameworks can be applied to specific research contexts (such as migration and refuge in varied settings) is still emerging. Therefore, this article discusses the methods employed, and feedback obtained in a 2018–2019 project in south west Sydney involving university students partnering with young ex refugees to produce short films on belonging. While the methods themselves are not novel, they were carefully chosen to help facilitate cultural safety, agency of participants, and move towards a decolonial research paradigm. The feedback from collaborating organisations and participants is also unpacked to arrive at the criteria which could be applied to similar projects interested in a decolonising agenda. Ultimately, I argue that this is not an end in itself, but helps build local capacity for change and momentum for decision-making organisations to also institute more consultative practices.

From management consultancy to management therapy: Diagnostic of managerial disorders and anatomy of management therapy.

In this paper I develop an idea which can provide the ground in order to start the transition from an amatorial/common sense management consultancy practice towards a scientific validated management consultancy practice. Rooted in medicine, psychiatry and psychology, the innovative tool is aiming at moving the management consultancy practice towards a direction already present in the classical fields of science mentioned above. The new more formal, rigorous, systematic and science-based management consultancy practice is called management therapy (MT). The MT is different from management consultancy because it is substantiated in the emerging field of research called Evidence Based Management (EBM). The paper introduces the first two steps in order to favor opening the discussions and the practice of management therapy: (1) developing the analogous/equivalent of Diagnostic and Statistical Manual of Mental Disorders (DSM) in the management field and (2) developing the action/process of MT (the anatomy of the MT).

Impact of adding abdominal circumference to the definition of fetal growth restriction

Fetal growth restriction has traditionally been defined as fetuses with an estimated fetal weight <10th percentile for gestational age. In 2020, the Society for Maternal-Fetal Medicine recommended that the definition be expanded to include either an estimated fetal weight<10th percentile or a fetal abdominal circumference<10th percentile. We sought to determine the impact of adding the criterion abdominal circumference<10th percentile on the rate of diagnosis of fetal growth restriction vs using the criterion estimated fetal weight<10th percentile alone. In addition, we evaluated the definition proposed by Copel and Bahtiyar, estimated fetal weight<10th percentile or abdominal circumference<5th percentile. This was a retrospective, descriptive study from 3 consultative maternal-fetal medicine practices. Biometry was compiled from ultrasound examinations from January 2019 to July 2020. The inclusion criteria were singleton pregnancy, gestational age of ≥24 weeks, presence of fetal cardiac activity, and presence of 4 standard fetal biometry parameters (biparietal diameter, head circumference, abdominal circumference, and femur length). We tabulated the indications for the examinations and the number of examinations meeting several criteria for the diagnosis of fetal growth restriction: Traditional criterion (estimated fetal weight<10th percentile), Copel-Bahtiyar criteria (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), and Society for Maternal-Fetal Medicine criteria (estimated fetal weight<10th percentile or abdominal circumference<10th percentile). During the study period, 20,633 ultrasound examinations met the inclusion criteria. In 62% of examinations, there was ≥1 factor for fetal growth restriction, and in 51% of examinations, there was ≥1 factor for large for gestational age. The rate of estimated fetal weight<10th percentile was 9.7%. The rate of abdominal circumference<5th percentile was 5.7%, and the rate of abdominal circumference<10th percentile was 9.2%. The rate of fetal growth restriction was 9.7% using the traditional definition (estimated fetal weight<10th percentile only). The rate of fetal growth restriction was 10.2% using the Copel-Bahtiyar definition (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), significantly higher than using the traditional definition (P<.001). The rate of fetal growth restriction was 11.6% using the Society for Maternal-Fetal Medicine definition (estimated fetal weight<10th percentile or abdominal circumference<10th percentile), significantly higher than using either the traditional or Copel-Bahtiyar definition (P<.001 for both). Among examinations with an abdominal circumference<10th percentile, 79% also had an estimated fetal weight<10th percentile and was considered fetal growth restriction even without considering abdominal circumference. Adding the criterion abdominal circumference<5th percentile or abdominal circumference<10th percentile to the definition of fetal growth restriction resulted in a statistically significant increase in the rate of diagnosis of fetal growth restriction. However, the absolute increase in the rate was small and was not expected to place a large burden on practice resources.

Nursing consultation practice for psychosocial problems on heart failure patiens in hospital-based outpatient clinic

Abstract Funding Acknowledgements Type of funding sources: None. Background The client"s condition for heart failure requires environmental support to be able to be confident and able to carry out activities according to the directions given while the patient is undergoing treatment in the hospital, but sometimes in the client"s time period at home there will be situations where patients may experience complaints or changes in conditions that can affect his cardiovascular status. Purpose this study is conducted to identify psychological and social problems and needs of heart failure clients with a qualitative approach of observation, invite individuals or families to participate, motivate individuals to develop the potential to maintain optimal health. In addition, this study was conducted to assess the need and effectiveness of the practice of consulting for heart failure nursing in hospital outpatients Method qualitative observation approach in nursing consulting practice using steps of the nursing process consisting of an assessment of physical, psychological and social conditions and client needs, formulating problems, making plans and taking care of actions in accordance with the problems that exist by nurses in the outpatient clinic at home sick. Results Clients who came to the outpatient clinic had various psychological and social problems. From the observations and interviews it was found that psychological and social problems were the most common causes. Psychosocial problems arise due to the client himself, life companion (husband or wife) and family members who live together. So that the family system to support clients with heart failure is not awakened. Health education and promotion to clients, life companions, and family members of heart failure clients who live at home are needed when the client controls health to maintain the client"s health support system while at home. All clients and families in this study stated that the practice of nursing consultations in hospital outpatients is very helpful for clients and families to improve the situation they face. Conclusion the practice of nursing consultations can identify the problems and needs of clients and families. Strengthening the client support system for heart failure at home is needed so that psychological and social problems can be reduced when the client is in the family environment. Nursing consultation practices at outpatient hospitals are needed to help motivate clients and families in maintaining and increasing care and support for clients who suffer from heart failure while at home. Psychosocial problems The client felt anxious, lack of attention, complained sleeping difficulty, often forgot taking medicine, and forgot managing fluid intakeThe client,while at home, was fastidious and wanted to many, was difficult to be told or managed, was always suspicious with their spouse"s activity easily got angry or temperamental, the client"s child felt annoyed because the client acted annoying, the client"s spouse felt annoyed because the client was impatient and temperamentalPsychological, and social problems in heart failure patients

Questionnements éthiques en ORL pendant la pandémie COVID-19 : étude qualitative de témoignages

IntroductionLa pandémie au coronavirus SARS-CoV-2 a profondément impacté la pratique des soignants. L’objectif est d’analyser les questionnements éthiques soulevés par la communauté ORL française pendant la première vague d’infections au COVID-19.MéthodesUn appel à témoignage a été lancé à propos des questionnements éthiques en ORL au mois d’avril 2020, avec quatre questions ouvertes standardisées : (i) les difficultés de prise en charge pour les patients COVID-19 positifs ; (ii) le retentissement de la crise sanitaire sur les patients COVID-19 négatifs ; (iii) la communication avec les équipes soignantes et/ou le personnel de consultation et de bloc ; et (iv) le traitement des informations par la presse et les instances nationales de l’ORL. Une analyse thématique de contenu a été effectuée en croisant avec les données épidémiologiques de chaque répondant.RésultatsTrente et un réponses provenant de 13 départements français différents, dont 21 hospitaliers et 10 libéraux, âge médian de 45 ans et 17 hommes pour 14 femmes, ont été analysées. Les questionnements éthiques concernaient la prise en charge par les ORL des patients COVID-19 positifs, la modification des pratiques en consultation et au bloc opératoire, la crainte de perte de chance pour les patients COVID-19 négatifs, l’usage approprié des téléconsultations et du télétravail et les conséquences délétères des fausses informations pour le grand public.ConclusionEn préparation de possibles futures pandémies, les aspects éthiques clés sont d’adapter la prise en charge des patients aux ressources et à la prévalence locale, et de diffuser des recommandations institutionnelles claires.

What influences the information exchange during self-medication consultations in community pharmacies? A non-participant observation study.

Although pharmaceutical staff consider guideline-compliant information exchange during self-medication consultations as crucial, they have not fully integrated it into practice. It is unclear what prevents pharmaceutical staff from implementing their positive intentions into their actual everyday practice. To improve the information exchange during the current consultation practice, a deeper understanding of its implementation is needed. The aim was to evaluate the factors influencing information exchange during self-medication consultations in German community pharmacies. We performed a non-participant observation of real-life consultations with post-consultation interviews of pharmaceutical staff in 10 pharmacies. The information exchanged during self-medication consultations was evaluated via 7 guideline-recommended information parameters in 2 stages of information exchange: (a) 'information gathering' and (b) 'provision of information'. Directly after each observed consultation, pharmaceutical staff's opinion about the consultation, the customer's interest and their own performance was questioned. Factors associated with the observed extent of information exchange were analysed by Poisson regression analysis. In the 379 self-medication consultations with 46 pharmaceutical staff members, 454 different customer enquiries were addressed, and 483 medications were dispensed. In median, 2 predefined information parameters (First-/Third quartile: 1/4) were fulfilled during an enquiry and 2 parameters (First-/Third quartile: 1/3) were fulfilled for a dispensed medication. Pharmaceutical staff were satisfied with 85% of their consultations and perceived 76% of them as easy to handle. In both information stages, information exchange increased when 'customers were perceived to be interested in counselling' (p<0.001) and decreased when customers had a 'specific medication request' (p<0.001). Information exchange in pharmacies needs to be better integrated into daily practice. Strategies to encourage information exchange should also include pharmaceutical staffs' perception of their own counselling technique. Ongoing patient-centred trainings should facilitate strategies to engage uninterested customers or costumers with specific medication requests in consultations.

Improving Post-Disaster Housing Reconstruction Outcomes in the Global South: A Framework for Achieving Greater Beneficiary Satisfaction through Effective Community Consultation

The purpose of this paper was to examine the community consultation practices carried out by implementing agencies when managing post-disaster housing reconstruction (PDHR) projects, identify the obstacles they face, and evaluate the effect these obstacles have on the quality of information obtained in relation to achieving a high level of beneficiary satisfaction. The aim was to develop a framework for community consultation in PDHR, which ensures that the needs of beneficiaries are more accurately reflected in the housing produced. A qualitative research methodology was adopted with data first being obtained through a literature review of relevant publications and implementing agency reports as a means of establishing common themes among community consultation practices and identifying indicators that influence beneficiary satisfaction. This was followed by a case study analysis to further an understanding of how these indicators were affected by the community consultation practices undertaken in a real-world context. The results of the research indicate that community consultation often forms a central role in the planning and delivery of PDHR projects, however, despite the implementing agencies’ best intentions, there are often obstacles that prevent the process from achieving the desired result. The community consultation framework proposed here has been developed to address the identified obstacles with the aim of ensuring that beneficiary requirements are included in housing design as a means of improving the level of beneficiary satisfaction in the housing provided.

Pediatric Interprofessional ICU Ethics Rounds: A Single-Center Study.

We sought to examine whether sociodemographic differences, such as race and socioeconomic status, existed between patients in the PICU, pediatric cardiothoracic ICU (PCTU), and NICU who were identified as having ethical issues during interprofessional ethics rounds and all other patients admitted to these units and to characterize the primary ethical issues identified in this context. We compared sociodemographic factors among patients admitted to a quaternary academic children's hospital between January 2017 and December 2018 who were identified as having ethical issues during PICU, PCTU, and NICU interprofessional ethics rounds (n = 122) with those of all other patients admitted to these units (n = 4971). χ2 tests or Fisher's exact tests, Mann-Whitney U tests, and a multivariable logistic regression analysis were performed. With bivariate analyses, we detected significant differences by race, insurance type, and ventilator dependence, but no significant differences between the 2 groups existed on the basis of sex, ethnicity, religion, primary language, age, or a socioeconomic status metric. After we adjusted for confounders using a multivariable logistic regression analysis, only patients who were ventilator dependent were at significantly higher odds (odds ratio = 5.78; confidence interval = 3.69-9.04; P < .001) of being identified as having ethical issues. Goals of care was the most frequent ethical issue (44%). Except for ventilator dependence, patients with ethical issues during PICU, PCTU, and NICU interprofessional ethics rounds are demographically similar to overall patients admitted in these units. Future research should be used to assess whether proactive rounds impact the timing of ethics consultation requests as well as to determine if interprofessional ethics rounds influence volume and acuity in formal ethics consultation practices.

Drug desensitization in the coronavirus disease 2019 pandemic era: Local success to widespread potential

Drug desensitization in the coronavirus disease 2019 pandemic era: Local success to widespread potential

Ethics Consultation in U.S. Hospitals: Opinions of Ethics Practitioners

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted.

Ragazzi. Migrants and Staff in the Italian Asylum System

ABSTRACT Since the start of the Mediterranean refugee crisis in 2015, large numbers of migrants have been forced into the Italian accoglienza (reception) system, a muddled and ambiguous context describable as a camp. Based on our consultancy practice, we analyze the wide labeling of migrants – no matter their age, migratory journey, or family status – as ragazzi (boys/girls or kids), and what it reveals about the current Italian social imaginary: the effects of neoliberal emotional policies, the continuation of a colonialist mentality, the need for psychological defenses among staff, and the disempowerment of migrants in a camp-like institution.

Using a video annotation tool to enhance student-teachers’ reflective practices and communication competence in consultation practices through a collaborative learning community

This study investigated how peer comments made using a video annotation tool (VAT) through an online learning community improved student-teachers’ level of reflective thinking and communication competence throughout the simulated (i.e., role-play) context of consultation practice. Eighty student-teachers from two classes of the course “Comprehensive School Guidance” participated in this study, and all recorded two videos for their tripartite practice on parent consultation for self-evaluation and peer comment. Forty student-teachers were in the comparison class and provided general comments to their peers on the learning platform, while those in the experimental class used the VAT on the learning platform to provide specific comments to their peers. Two post-practice online questionnaires and reflective journal entries, which aimed to measure communication competence and reflective thinking ability, were administered to the student-teachers after the first and second consultation practice. The reflective journal entries were segmented into units of analysis that were scored using a 4-level model of reflective thinking (from 1 to 4), with a higher score indicating demonstration of a higher level of reflective thinking for that particular segment. Both the number of reflective notes made and the average level of reflective thinking in student-teachers’ journal entries were indicators of reflective thinking ability. Two mixed ANOVAs were conducted to examine whether student-teachers in the experimental (VAT) class improved their reflective thinking ability and communication competence more significantly than those in the comparison (non-VAT) class. The results showed that student-teachers in both the VAT and non-VAT classes had statistically higher scores for communication competence and reflective thinking in the second role-play practice. Student-teachers with the support of VAT, in comparison to those without, significantly improved their average reflective thinking ability. Focus group interviews were also conducted to investigate how VAT could support student-teachers’ learning process and to learn their perceptions of the strengths and limitations of the VAT. The results indicated that the VAT could enhance student-teachers’ learning by reducing communication barriers created by the tendency to avoid direct observations of peers’ weaknesses, enhancing reflection-in-action during practice, and contextualizing written comments by referring to specific video segments. However, student-teachers felt that the VAT should also allow users to draw on the video screens.

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains.

IntroductionAdvanced practice roles are well documented, and continue to respond to the changing landscape in radiotherapy and oncology. In the UK the highest level of AP for the therapeutic radiographer/radiation therapist (RTT) is the consultant radiographer. These posts should meet the four domains of practice, as set out in national guidance. Here we aim to describe well established roles that meet this criteria, and provide subgroups of examples.MethodologyThree AP post holders with over 10 years AP experience completed a questionnaire adapted from the consultant radiographer toolkit. These were completed in conjunction with guidance and framework documents. The examples were to demonstrate how they achieve a high level of practice in clinical and expert practice; professional leadership and consultancy; education, training and development; and practice and service development, research and evaluation. Participants then categorised results to add subgroups to each domain.ResultsThe questionnaire was completed by three RTTs specialising as a lung consultant radiographer (LCR), a neuro-oncology consultant radiographer (NCR) and a lead research radiographer (RR). Each post holder described how they meet the criteria by discussing the benefit they make to their profession, department and patients. All posts had examples for all criteria, achieving consultant practice. Clinical and expert practice was the dominant domain for the clinical specialist posts, and professional leadership and research evaluation was the strongest domains for the RR.ConclusionAll three consultant RTTs have demonstrated expert practice with clear and transparent examples of their professional practice which evidence the four domains of consultant practice. Following two decades of AP practice for RTTs there is a need to be strategic in the development of future posts with a prospective view on succession planning that safeguards their longevity.

Reflections on leadership in advanced and consultant radiographic practice within the UK

IntroductionThis Educational Perspective provides an overview of how leadership fits into advanced and consultant radiographic roles within the UK setting. It draws on research in the area as well as reviewing some of the wider healthcare literature beyond the medical radiation sciences. The reflections outlined suggest how leadership at these levels may look and differ in practice. DiscussionLeadership should be seen as fundamental to practice and not necessarily a discreet element to either role, but one that supports all other areas. The proportion of the role that leadership takes up, along with the degree of influence, increases from advanced to consultant practice. Consideration over conflict with management and leadership within roles is also important. Ultimately leadership is about relationships with people, for which interpersonal skills are required, along with establishing networks, supported by training and development to maximise effectiveness. ConclusionA clearer understanding of leadership is needed to help conceptualise and measure its impact at advanced and consultant levels of practice. The content is intended to provide an opportunity for reflection and discussion around the topic, serving as a development tool in practice.

Promoting Quality of Mixed Methods Consultation Research: A Synergistic Participatory Framework

ABSTRACT The purpose of this article is to provide researchers with a framework for promoting high quality mixed methods school-based consultation research. Furthermore, this article is intended for researchers and practitioners interested in evaluating their practice. To meet these objectives, we address quality criteria for quantitative (validity) and qualitative (trustworthiness). From there, we review also multiple schemes for quality (legitimation) criteria in mixed methods and propose a synergistic participatory approach that includes legitimation criteria for the integration of qualitative and quantitative work throughout the research process, from conceptualization to dissemination. Our view of integration also applies to the application of findings, which is an idea aligned with participatory processes inherent in our approach to consultation practice. Finally, we discuss and illustrate the application of legitimation criteria to consultation research and evaluation.