Consultation Support Research Articles

Early recognition and response to increases in surgical site infections using optimised statistical process control charts-The early 2RIS trial: A multicentre stepped wedge cluster randomised controlled trial.

SummaryBackgroundTraditional approaches for surgical site infection (SSI) surveillance have deficiencies that delay detection of SSI outbreaks and other clinically important increases in SSI rates. We investigated whether use of optimised statistical process control (SPC) methods and feedback for SSI surveillance would decrease rates of SSI in a network of US community hospitals.MethodsWe conducted a stepped wedge cluster randomised trial of patients who underwent any of 13 types of common surgical procedures across 29 community hospitals in the Southeastern United States. We divided the 13 procedures into six clusters; a cluster of procedures at a single hospital was the unit of randomisation and analysis. In total, 105 clusters were randomised to 12 groups of 8–10 clusters. All participating clusters began the trial in a 12-month baseline period of control or “traditional” SSI surveillance, including prospective analysis of SSI rates and consultative support for SSI outbreaks and investigations. Thereafter, a group of clusters transitioned from control to intervention surveillance every three months until all clusters received the intervention. Electronic randomisation by the study statistician determined the sequence by which clusters crossed over from control to intervention surveillance. The intervention was the addition of weekly application of optimised SPC methods and feedback to existing traditional SSI surveillance methods. Epidemiologists were blinded to hospital identity and randomisation status while adjudicating SPC signals of increased SSI rates, but blinding was not possible during SSI investigations. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated via generalised estimating equations with a Poisson regression model. Secondary outcomes compared traditional and optimised SPC signals that identified SSI rate increases, including the number of formal SSI investigations generated and deficiencies identified in best practices for SSI prevention. This trial was registered at ClinicalTrials.gov, NCT03075813.FindingsBetween Mar 1, 2016, and Feb 29, 2020, 204,233 unique patients underwent 237,704 surgical procedures. 148,365 procedures received traditional SSI surveillance and feedback alone, and 89,339 procedures additionally received the intervention of optimised SPC surveillance. The primary outcome of SSI was assessed for all procedures performed within participating clusters. SSIs occurred after 1171 procedures assigned control surveillance (prevalence rate [PR] 0.79 per 100 procedures), compared to 781 procedures that received the intervention (PR 0·87 per 100 procedures; model-based PR ratio 1.10, 95% CI 0.94–1.30, p=0.25). Traditional surveillance generated 24 formal SSI investigations that identified 120 SSIs with deficiencies in two or more perioperative best practices for SSI prevention. In comparison, optimised SPC surveillance generated 74 formal investigations that identified 458 SSIs with multiple best practice deficiencies.InterpretationThe addition of optimised SPC methods and feedback to traditional methods for SSI surveillance led to greater detection of important SSI rate increases and best practice deficiencies but did not decrease SSI rates. Additional research is needed to determine how to best utilise SPC methods and feedback to improve adherence to SSI quality measures and prevent SSIs.FundingAgency for Healthcare Research and Quality.

PO120 / #873 AUGMENTED REALITY TECHNOLOGY IN NEUROMODULATION SURGERY: E-POSTER VIEWING

The advancement of wearable integrated augmented reality (AR) devices has rapidly progressed over recent years. We describe the first use of AR goggles during a revision neuromodulation surgery, which enabled specialist consultant support from remote despite ongoing coronavirus pandemic restrictions.

Recommendation of Active Employment Policy Based on Entrepreneurship and Social Innovation: Social Entrepreneurship Support Model for Youth in Turkey

In this study, the social entrepreneurship support model will be designed in Turkey as an active employment policy proposal based on entrepreneurship and social innovation in the fight against youth unemployment. Within this framework, the model aims to organize a social entrepreneurship training program for unemployed youth and NEET (neither employed nor in education or training) youth by the Turkish Public Employment Agency (ISKUR). Based on this, it is envisaged that similar support to the ISKUR Entrepreneurship Training Program implemented by the state for young people will be implemented under the name of the Social Entrepreneurship Support Program in cooperation with ISKUR-KOSGEB and ASHOKA. The model also suggests to give financial and consultancy support for those who successfully complete training. This support is thought to be important for start-up social entrepreneurs. Finally, this study aims to discuss the possibility to implement a social entrepreneurship support model for youth in Turkey. Especially in terms of developing countries, the model is believed to be an alternative means of struggle with the fight against youth unemployment.

Health care delivery - Revisiting the concept of area wide planning with application to Guntur District of Andhra Pradesh

For many marginalised families, availability of healthcare is uncertain leading to catastrophic costs. To meet the need in an orderly and efficient manner without duplication, Areawide / Regional planning was envisioned by health planners in the 1950s. This paper aims to revisit the above concept in healthcare with application to the existing system of Guntur district. A search was made for available health facilities and bed strength in the public sector of the district. An effort is made to apply the arewide planning concept to the district in strategic locations. The recent pandemic has shown the need for preparedness across the district in terms of bed strength, equipment and personnel. The urban population of the district is 33.8% (1.5 beds/1000 ) and the rural population is 66.19% (0.5/1000). Areawide planning envisages Mandal, Division and District level hospitals. The PHCs at the mandal level can be upgraded to have Maternal and Child health units and ICUs with the necessary specialists and equipment in place. The division level hospital must have all primary specialities with consultative support to the lower facilities. The District level hospital must have all the super specialities and provide referral services.Regionalisation also looks at creating one special care unit like burns, mental health, cancer etc at each strategically located hospital. Areawide planning will improve efficiency and economy in health care delivery. Gaps in healthcare and wastage due to overlapping can be avoided.

Characteristics of Primary Care Providers' Consultations With a Statewide Child Psychiatry Access Program Regarding Autism Spectrum Disorder.

Child Psychiatry Access Programs (CPAPs) provide consultative support for pediatric primary care providers (PCPs) to treat co-morbid mental health (MH) symptoms among patients with Autism Spectrum Disorder (ASD). We examined differences in illness severity, comorbidity, and psychotropic medication use between patients with and without ASD for whom primary care providers sought consultation from Maryland's CPAP. We examined N=3641 Maryland's CPAP consultations from 2012 to 2019; n=311 were consultations for ASD. Demographics, treatment recommendations, diagnoses, and Clinical Global Impression-Severity scores were collected. Patients who received psychotropic medication or psychotherapy by any mental health provider were defined as comanaged. Descriptive statistics and logistic regression were conducted. Sample size for regression was N=1854. Compared with non-ASD, patients with consults for ASD were more often male (P < 0.001), aged 0-5 years (P < 0.001), severely ill (Clinical Global Impression-Severity > 4) (P < 0.001), and prescribed stimulants, nonstimulant attention-deficit hyperactivity disorder medications, and antipsychotic medications (P < 0.001). Controlling for key covariates, consultations for youth displaying aggression were 3.02 times (P < 0.001) more likely, with Clinical Global Impression-Severity > 4 were 2.36 times (P < 0.001) more likely, and prescribed antipsychotics were 4.30 times more likely to concern an ASD patient (P<0.001). A larger proportion of ASD patients (vs. non-ASD) had comorbid psychiatric diagnoses of attention-deficit hyperactivity disorder, a learning disability, and disruptive behavior disorder vs. a smaller proportion with major depressive disorder. ASD patients for whom primary care providers sought Maryland's CPAP consultation were more severe and complex than non-ASD patients in terms of comorbid diagnoses and medication regimen.

“I often have to explain to school staff what she needs”. School experiences of non-autistic siblings growing up with an autistic brother or sister

BackgroundRecent autism research has evidenced a shift from psychological outcomes to contextualised approaches to understanding the varying needs of non autistic siblings of autistic children across different systems. Yet, there is limited research exploring the lived experiences of siblings in their school context. MethodsFirst, a group of school aged sibling advisors worked with the first author to codesign research aims, methods and dissemination practices around the topic of the school experiences of siblings who grow up with an autistic brother or sister in the UK. Then, 28 school-aged siblings of autistic children completed adapted photo-elicitation interviews, to discuss their school experiences. A background questionnaire was also administered to their parents and carers. ResultsThematic analysis was employed. The master themes included: (i) Impact of home experiences in schoolwork, including limited personal time and sleep disruptions (ii) Siblings’ school interactions impact on overall school experience, including a wide range of both typical and difficult experiences such as school day disruptions, (iii) Varied perceived levels of support and understanding, including emotional and/or educational support by family members and a sense of connectedness with peers and teachers who are autistic themselves or connected to someone with a diagnosis of autism. ImplicationsThe results underline the ways home experiences can have an impact on school life of siblings, the positive contribution of the autistic school staff and/or staff who have an autistic family member and the need for an organisational culture of inclusivity and widespread acceptance and awareness around issues of neurodiversity. Our findings suggest several implications for school psychologists in core functions of the educational psychologists’ role including training, consultation, assessment, and whole school support. Data availability statementThe datasets generated for this study are not readily available because they include sensitive data (photos of siblings’ houses, family members, personal objects, and school timetables). Requests to access the datasets should be directed to corresponding author.

An Examination of Training in Ecological-Positive Support Consultation

ABSTRACT Although the NASP 2020 Standards emphasize consultation as a core competency, few studies have examined consultation preservice training on consultant outcomes. This article describes the content and implementation of a training program focused on ecological-positive behavior consultation, called Positive Environment and Behavior for Building Learning and Engagement (PEBBLE). PEBBLE incorporates (a) didactic instruction related to consultation and ecological-positive support strategies, (b) evidence-based strategy and consultation implementation resources, and (c) supervised in-vivo practice. Outcome measures assessed both trainee outcomes, including self-reported efficacy, knowledge, and confidence, and classroom outcomes (direct observations). Results show PEBBLE led to statistically significant improvements in trainees’ self-reported efficacy, knowledge, and confidence and had a positive impact on classroom environments. Additionally, students who participated in PEBBLE in their first year of school psychology training had self-efficacy and competency ratings comparable to more advanced students. Implications for consultative training based on ecological-positive support approaches and future research are addressed.

Taxation and Performance of Manufacturing Companies in Nigeria: Evidence from Flour Mills Plc

The study examined the impact of taxation on the performance of manufacturing company in Nigeria from 2005-2021. The study sought to determine if taxation has any impact on the return on asset (ROA) and earnings per share (EPS) using flour mills plc as a case study. The Ex-post research design was adopted and time series data were collected for the study. The ordinary least square regression analysis was used in the analysis. The findings revealed that there is no significant relationship between taxation and the performance of manufacturing company in Nigeria. From the result of the analysis, independent variable of tax showed a weak and negative relationship with ROA and weak and positive relationship with EPS. The study recommends that there should be improvement in the effectiveness of tax administration by ensuring proper assessment. Also, all Relevant Tax Authorities (ROA) should endeavour to have good relationship with the Professional Associations like Chartered Institute of Taxation of Nigeria (CITN) and Institute of Chartered Accountants of Nigeria (ICAN) involved in tax matters so as to increase their support in reducing tax malpractices perpetrated by tax payers with the connivance and often active support of external auditors and tax consultants. Also, the entire tax system as well as the taxes that affect the performance of manufacturing sectors should urgently be overhauled for more effectiveness to achieve the desired results.

Evaluation of a pilot consultation for maternity protection at work in Switzerland.

Switzerland's Labour Law and its Ordonnance on Maternity Protection aim to protect the health of pregnant employees and their unborn children while enabling them to continue to pursue their professional activities. Some companies encounter difficulties implementing the law's provisions. The Department of Occupational and Environmental Health, part of the Center for Primary Care and Public Health (Unisanté), has provided specialist occupational medicine consultations for pregnant employees since 2015. This study aimed to evaluate how well Swiss' maternity protection legislation is implemented by examining a list of relevant indicators measured during the occupational health consultation. The study also sought to investigate the consultation support provided to the relevant stakeholders and the adjustments made to pregnant employees' working conditions. Descriptive variables and indicators relative to the application of the Swiss maternity protection legislation for 83 pregnant employees were collected during the consultation's pilot phase (between 2015 and 2016). Descriptive statistics and cross-analyses of these indicators were made. Most pregnant employees faced multiple exposures to occupational risks. Preventive risk analyses were rare. Few adjustments to workstations were proposed. We found a tendency for employees to leave their workstations early on in their pregnancies due to sick leave certificate prescriptions. Specialist consultation and collaboration with occupational health physicians to recommend interventions for pregnant employees can provide significant benefits and help some pregnant women to continue at their workstations with appropriate adjustments. A specialised occupational health consultation is a useful instrument for identifying occupational hazards for both the pregnant woman and her unborn child. It is also an opportunity to explain employers' legal responsibilities and obligations to safeguard the health of their pregnant employees and to give specific advice for their company's situation. This consultation also enables employers to maintain their employees' valuable professional competencies in the workplace for as long as possible. Finally, occupational health consultation helps and supports healthcare providers who must, according to the law, make decisions about whether pregnant employees can continue working safely or not.

Psychiatrist-led treatment of hepatitis C (HCV) at an opioid agonist treatment (OAT) clinic in Stockholm - enhancing the HCV treatment care cascade

IntroductionPeople who inject drugs (PWID) and opioid agonist treatment (OAT) patients have an increased hepatitis C (HCV) prevalence. Studies among these populations show promising HCV treatment results, which is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030.ObjectivesTo introduce psychiatrist-led HCV treatment at an OAT clinic and to investigate HCV treatment results, i.e. sustained virological response at 12 weeks post treatment (SVR12) and numbers of reinfections.MethodsPrima Maria OAT clinic in Stockholm, provides OAT for 450 patients. The majority have a history of injection drug use. Baseline HCV prevalence (January 2018) was retrospectively investigated through medical charts. In January 2018, psychiatrist-led HCV treatment (with consultation support from infectious diseases specialists) was introduced at the clinic. Prospective treatment results, numbers of reinfections and incidence rates between January 2018 and April 2021 were further investigated.ResultsBaseline data (n=418), showed that 46% were not tested for HCV. Of those tested (n=225), 64% had a chronic HCV infection. By January 2021, 104 HCV treatments were initiated. 97/97 (100%) were HCV RNA negative at end-of-treatment. 78/88 (89%) reached SVR12. Overall, 2 reinfections were noted after SVR12 corresponding to a reinfection rate of 3.5/100 PY. Numbers of HCV treatment did not decrease during the COVID-19 pandemic.ConclusionsTo enhance the HCV treatment cascade, targeted HCV diagnosis efforts are needed. Bringing HCV treatment to OAT clinics enhance the HCV care cascade. HCV treatment education for psychiatrists/addiction specialists makes HCV treatment more sustainable, as specifically noted during the COVID-19 pandemic.DisclosureThis study was partly funded by Gilead Nordic Fellowship 2020. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the poster/manuscript.

Prioritising young peoples’ voices in research and work in youth offending services: Themes from free association research methods and a co-production project with young people

Aims:To influence educational psychology practice by sharing key themes from research and work capturing young peoples’ experiences of engaging with youth offending services (YOS).Rationale:The prioritisation of the voice of the child in educational psychology practice is central to inclusivity (Davie, 1993; Messiou, 2002). Professionals capture and respond to the voices of children and young people, with varying degrees of authenticity, accountability and longevity (Hart, 1992; Hart et al., 2004). It is important that adults facilitate and support meaningful participation (Hart, 2008) by employing appropriate methods to enable young people to share their narratives. This paper seeks to influence educational psychology practice through the authentic voice of young people; focusing on what they say works when they are engaging with youth offending services, and highlighting accessible methods used to elicit voices.Method:The author discusses their experience of using free associative methods; the Grid Elaboration Method (GEM) (Joffe &amp; Elsey, 2014) and the Free Association Narrative Interview (FANI) (Hollway &amp; Jefferson, 2008) as part of their qualitative doctoral research with five young people recruited through a local authority YOS, answering the research question ‘What do participants talk about when asked about their engagement experiences with youth offending services?’ The author describes how these approaches facilitated accessible means to hearing young peoples’ voices, capturing their views through codes and themes illuminated through thematic analysis. Prioritisation of child voice during this formative experience inspired a co-production project creating a whiteboard video describing young peoples’ experience of working with a YOS. It provided space, voice, audience and influence to young people involved (Lundy, 2007) and through it, an accessible resource exists for those who may engage with YOS in the future.Limitations:The small number of participants recruited for the original research study (five) and the co-production project in YOS (six), impedes generalisability. Further limitations relate to the interpretivist nature of the original piece of research and following co-production project. The psycho-social approach, inherently acknowledges the subjective nature of analysis undertaken, suggesting that each individual researcher may analyse the data from a subjective perspective and therefore may come to different themes than those illuminated by this researcher.Implications and discussion:Themes that emerged through the script and visual imagery during the co-production project are linked back to key themes from the author’s original research. Key considerations for educational psychologists working in YOS are shared, focusing on the role educational psychologists can play in supporting young peoples’ meaningful engagement through supporting relationship and identity development and the structural processes that serve psychological functions. Proposals for educational psychology roles in YOS that provide consultative and supervisory support as well as in strategic shaping of services are also shared.

P021 Development of a Rheumatology Hot Clinic in the Midst of a Pandemic

Background/AimsThe COVID-19 pandemic has had a significant impact on emergency and scheduled care, affecting both inpatient and outpatient services for all specialities, including Rheumatology. During the first pandemic peak, rheumatology outpatient clinics all became virtual (i.e. telephone or video), except for a single emergency clinic per week. However, this face-to-face clinic, quickly became oversaturated resulting in a waiting list extending above 4 weeks for our patients.MethodsIn the lead-up to the second COVID-19 peak during the winter, we developed a novel, urgent, hot Rheumatology Clinic within our Ambulatory Emergency Care (AEC) department. This whole-day weekly clinic was delivered by a Rheumatology registrar, with consultant support. Its purpose was to provide a service for patients who did not require hospitalisation but required urgent face-to-face Rheumatology speciality review that could not wait for an outpatient appointment. Referrals came from General Practice, Urgent Care (i.e. Emergency Care, Acute Medicine and AEC) and from the Rheumatology department. Pathologies reviewed included vasculitides, inflammatory arthritis and inflammatory connective tissue diseases. The clinic facilitated for patients with suspected new diagnoses or flares of established rheumatological diseases. Furthermore, patients could also undergo urgent joint and soft tissue procedures. All referrals were directed to the Rheumatology registrar to triage. Because of the success of the clinic, it continued beyond the second peak with data gathered from its inception.ResultsData was collected between November 2020 and June 2021, covering 23 hot clinics. A total of 118 patients were reviewed during this period. The highest number of referrals occurred during the second peak of the pandemic (38 patients over seven clinics compared to 48 patients over ten clinics post-peak). The majority of referrals were from Rheumatology directly (70%) compared with Urgent Care (14%) and General Practice (12%). Most (60%) were seen within 7-days of referral; a further 27% were seen within 7- 14 days. The main reasons for review delays beyond seven-days were lack of available clinic (46%) or lack of space (29%). The most common disease encountered was a chronic inflammatory arthropathy (48 patients).ConclusionThe service has generated positive feedback from all patients. Furthermore, this clinic has benefited both Rheumatology and AEC. Firstly, it ensured timely face-to-face reviews of patients requiring urgent Rheumatology assessments. Secondly, it eased pressure on the Rheumatology department, particularly the outpatient emergency clinic. Thirdly, it ensured that the Rheumatology registrar continued to have Rheumatology training opportunities, particularly when redeployed during the Winter wave on other days of the week. Fourthly, the AEC department have had easier access to Rheumatology reviews. Finally, it has empowered the registrar to manage their own workload and organise the clinic enhancing management and leadership experience. The success of the clinic has resulted in its ongoing continuation.Disclosure A. Khan: None. C. Murdoch: None. I. Wamuo: None.

Blockchain is a Team Sport

Brian M. Thornley leads the global supply strategy from plant to patient. He oversees Merck’s digital supply chain strategy including blockchain enabled pharma, organization development and enterprise segmentation to optimize service, cost, earnings and return on capital employed. Previously, he was AVP Supply Chain Operations EMEA &amp; AP, including Planning and Strategy for Merck MSD, developing the strategic approach to deliver internal efficiencies and external transformation of the supply chain from factories to end customer. Before joining MSD he was the COO of Aegate Ltd, implementing integrated data and information networks directly with pharmacies across Europe and the first commercial pharmaceutical authentication system across the European pharmacy network. Brian provided consultancy support to the PGEU, the representative body of pharmacies in Europe.

46. What Pediatric Primary Care Providers Need to Support Gender Diverse Youth: Perspectives on Consultative Support for Gender-Affirming Care

The demand for pediatric gender-affirming care has increased throughout the COVID-19 pandemic, highlighting the need for telehealth-based specialist-to-primary care provider (PCP) consultative support. Accordingly, the purpose of this study was to identify PCPs’ perspectives on receiving training and consultation in pediatric gender-affirming care using three telehealth modalities, with the larger goal of informing the development of future consultative support offerings.

Evaluation of Diplopia by Emergency Medicine Physicians and Consulting Neurologists.

Appropriate evaluation of diplopia requires separating serious from benign causes. If providers are not adept in this task, diagnosis of critical conditions may be delayed and unnecessary testing may result. We studied the records of 100 consecutive patients who presented to an emergency department between 2010 and 2020 with diplopia as a prominent symptom. We rated the performance of emergency medicine physicians (EMPs) and consulting neurologists (CNs) in the examination, diagnosis, and ordering of diagnostic tests according to standards based on neuro-ophthalmologic consultation and the neuro-ophthalmologic literature. EMPs made no diagnosis or an incorrect diagnosis in 88 (88%) of 100 encounters. They ordered 14 unindicated and 12 incorrect studies, mostly noncontrast computed tomography scans. CNs made an incorrect diagnosis in 13 (31%) encounters. They ordered 6 unindicated and 2 incorrect studies. The total charge for unindicated and incorrect studies ordered by EMPs and CNs was $119,950. EMPs and CNs made frequent errors in the examination, diagnosis, and ordering of diagnostic studies, leading to inefficient care and unnecessary testing. EMPs largely delegated the evaluation of diplopia to their consultants. If such consultative support were not available, the care of diplopic patients would be delayed. CNs performed more complete examinations, but rarely enough to allow appreciation of the pattern of ocular misalignment, contributing to misdiagnoses and ordering errors. The identification of these provider errors allows for more targeted teaching in the evaluation of diplopia.

Physician trainee research collaboratives: a mixed methods exploration of UK experience

Physician trainee research collaboratives (TRCs) help trainees develop research skills and establish peer networks. We aimed to identify the structure, activity and views of physician TRCs in the UK. Representatives from physician TRCs in the UK were invited to complete an online survey and participate in a focus group. Representatives from 23 physician TRCs completed the survey. There was wide variation in collaborative structure, senior input and funding resources. Seventy-four per cent of physician TRCs had published peer-reviewed articles, with 70% reporting ongoing projects at the time of the survey. The survey and focus group identified improved patient care, research and leadership skills as benefits of collaborative work; while institutional and consultant support, limited time for research, funding opportunities and restrictions on group authorship were cited as challenges to collaborative success. Physician TRC activity continues to grow and demonstrates a dynamic approach to research for all trainees.

The Effectiveness of a Shared Reading Program Among Parents of Newborns

Early parent-child shared reading has been demonstrated to promote the development of literacy, reading skills and learning achievement in young children. Parent-child shared reading intervention programs may strengthen the willingness and reading competence of parents. To explore the attitudes and skills related to parent-child shared reading before and after an intervention program conducted in a nursery room and outpatient pediatric clinic. A single-group pretest-posttest quasi-experimental design was conducted. Seventy-five parents of newborns in the baby rooms from two hospitals in Hualien County were conveniently sampled. Parents who had just given birth received health education before discharge from the hospital from nurses focusing on the knowledge and skills of shared reading. Three age-matched picture books with reading fact sheets and consultation support were offered free to parents of children in three, respective, age groups (newborn, 4-months old and 6-months old) during parent-child visits to the pediatric clinic for regular health examinations and vaccinations. A self-designed questionnaire was administered to analyze the parents' demographic variables, reading environment, parents' attitudes toward parent-child shared reading, and familiarity with regard to parent-child shared reading skills. Parent-child reading attitudes were positively correlated with skill familiarity (r = .39). The presence or absence of children's books at home, the parent-child relationship, and parental reading habits explained 32.0% of the variance in parent-child shared-reading attitudes (R2 = .32). The presence or absence of children's books at home and the presence or absence of a library card for the child explained 44.0% of the variation in familiarity with co-reading skills (R2 = .44). Parent-child shared reading attitude scores (t = -5.14, p < .001) and skill familiarity of parents (t = -7.52, p < .001) both increased significantly after the intervention program. Parent-child shared reading educational intervention programs may be used to improve parental attitudes and skills related to parent-child shared reading.

Consultation and professional development within the prolonged exposure initiative.

Previous studies have identified that ongoing consultation and organizational support are key factors in sustaining evidence-based implementation initiatives in community mental health. Clinician-level factors likely influence implementation but are not well delineated. This study assessed clinician-reported professional development incentives for participating in consultation in prolonged exposure (PE) therapy to guide future evidence-based practice (EBP)initiatives. Providers in the PE initiative (N = 22) completed a survey asking about their motivations to participate, the impact of consultation on the implementation of PEand their professional development goals, and the impact of organizational-level support on their goals and on organizational-level clinician turnover. Of the respondents, 10 had decided to pursue additional training to become PE consultants at their agencies. Providers (response rate = 22/35) reported joining the PE Initiative to learn an evidence-based practice in general (not PE specifically) and increase their skill in treating posttraumatic stress disorder. Providers largely found ongoing consultation helpful and reported that consultation provided the feedback and support necessary to achieve their professional goals. Providers who decided to pursue PE consultant training reported that expanding upon supervision and clinical skills were strong motivators. Providers largely attributed clinician turnover within the PE Initiative to organizational-level factors. Ongoing consultation facilitated providers' professional development goals. The survey identified several areas for further exploration, including how consultation can reduce clinician turnover, and how taking on additional responsibility within implementation initiatives can facilitate provider engagement in the EBP.

Rapid and sustained effects of dupilumab in severe chronic rhinosinusitis with nasal polyps.

Rapid and sustained effects of dupilumab in severe chronic rhinosinusitis with nasal polyps.

Managing Implementation of the ERP Systems: The Importance of Technical and Consultant Support

Although the first adoptions of ERP systems in Morocco date back to at least the mid-1990s, the literature on ERP implementation is very scarce. It mainly addresses the topic of critical success elements for businesses implementing ERP systems. Indeed, a major problem that may cause the failure of ERP systems implementation is the non-acceptance of these systems by the users. Research on ERP implementation success and acceptance has attracted much interest in the information system field. While this study is very rare in developing countries, this paper proposes to fill this gap in the literature by exploring the important antecedents of users’ intention to use ERP systems. This research aims to explore whether the use of consultants and end-user technical assistance are important antecedents of end-user acceptance of ERP systems and to examine the mediating effect of perceived ease of use and perceived usefulness on the intention to use ERP systems. Using a longitudinal survey that was administered both via email and social networks to all persons willing to participate in the study, data from a matched sample of 284 end users across a range of Moroccan organization that uses the ERP system was analyzed. The authors examined the relationships between consultant support, technical support, and end users’ acceptance of ERP information systems. PLS structural equation modeling (SEM-PLS) analyses indicated a significant direct effect of perceived usefulness on the intention to use ERP. Technical support also strongly and significantly affected perceived ease of use. Perceived ease of use and perceived usefulness mediated the relationship between technical support, consultant support, and the intention to use ERP systems. The present empirical study supports the hypotheses of the TAM model. The three main constructs of the model, namely perceived ease of use, perceived usefulness, and intention of use, are significant with ERP technology in the Moroccan context. This study shows the importance of end-user technical assistance and support from consultants in successfully implementing ERP systems.