Independent Practitioners Research Articles

Exploring the use of point-of-care ultrasound by pelvic health physiotherapists in the UK

National and international surveys have highlighted point-of-care ultrasound (PoCUS) as an emergent technology that is being utilized by physiotherapists across a variety of clinical specialities. It confers advantages beyond traditional physiotherapy assessment and increases treatment options for patients with pelvic health conditions. What is not known is how pelvic health physiotherapists are routinely using PoCUS, or the barriers and enablers to its use that exist specifically within this population. The aim of this service evaluation was to explore the current use of PoCUS by pelvic health physiotherapists who are part of the POGP professional network to identify barriers and enablers to wider use within clinical practice across the UK. An online survey with both multiple-choice and free-text responses was shared. Questions covered four domains of interest: (1) demographic and professional characteristics; (2) current use of PoCUS; (3) perceived barriers and enablers; and (4) training. One hundred and two pelvic health physiotherapists with varied levels of experience responded from different sectors and areas of the UK. Only 30.4% reported routine use of PoCUS in their clinical practice despite consensus that PoCUS is an important tool for the rehabilitation of pelvic health conditions. Most barriers to the use of PoCUS identified could be linked to resource limitations, training or lack of support, and were also reflected in suggestions for enablers. Most users had formal training and felt that this had been sufficient to be competent in using PoCUS in their service. Physiotherapists recognize the advantages that PoCUS offers for rehabilitation in pelvic health populations, but are often unable to access the equipment or training required. Ongoing support after training is needed to ensure that users maintain confidence and competence, especially as many work as independent practitioners and are without a direct peer network. Updates to national recommendations or guidelines to include PoCUS as a recommended tool within rehabilitation may provide the impetus needed to support its adoption across more public healthcare settings.

How do pig veterinarians view technology-assisted data utilisation for pig health and welfare management? A qualitative study in Spain, the Netherlands, and Ireland

BackgroundApplication of data-driven strategies may support veterinarians’ decision-making, benefitting pig disease prevention and control. However, little is known about veterinarians’ need for data utilisation to support their decision-making process. The current study used qualitative methods, specifically focus group discussions, to explore veterinarians’ views on data utilisation and their need for data tools in relation to pig health and welfare management in Spain, the Netherlands, and Ireland.ResultsGenerally, veterinarians pointed out the potential benefits of using technology for pig health and welfare management, but data is not yet structurally available to support their decision-making. Veterinarians pointed out the challenge of collecting, recording, and accessing data in a consistent and timely manner. Besides, the reliability, standardisation, and the context of data were identified as important factors affecting the efficiency and effectiveness of data utilisation by veterinarians. A user-friendly, adaptable, and integrated data tool was regarded as potentially helpful for veterinarians’ daily work and supporting their decision-making. Specifically, veterinarians, particularly independent veterinary practitioners, noted a need for easy access to pig information. Veterinarians such as those working for integrated companies, corporate veterinarians, and independent veterinary practitioners expressed their need for data tools that provide useful information to monitor pig health and welfare in real-time, to visualise the prevalence of endemic disease based on a shared report between farmers, veterinarians, and other professional parties, to support decision-making, and to receive early warnings for disease prevention and control.ConclusionsIt is concluded that the management of pig health and welfare may benefit from data utilisation if the quality of data can be assured, the data tools can meet veterinarians’ needs for decision-making, and the collaboration of sharing data and using data between farmers, veterinarians, and other professional parties can be enhanced. Nevertheless, several notable technical and institutional barriers still exist, which need to be overcome.

Developing a consensus guide to toilet training all children.

June Rogers, Independent Practitioner and Consultant, Down Syndrome UK (junerogersmbe@hotmail.com), and Davina Richardson, Children's Nurse Specialist, Bladder and Bowel UK, The Toilet Training Team, were winners of the Gold Award in the Continence Nurse of the Year category of the BJN Awards 2024.

6851 Rapidly Increasing Use of Anti-Obesity Medications among Veterans in the Veterans Health Administration (VA)

Abstract Disclosure: V. Vimalananda: None. S. Qian: None. R. Bolton: None. A. Hung: None. V. Smith: None. M. Maciejewski: None. Introduction: Obesity is a prevalent and costly chronic disease that compromises quality of life; increases risks of cardiometabolic disease, osteoarthritis, and several cancers; and accounts for 28% of U.S. health care costs. Anti-obesity medications (AOMs) may fill the treatment gap given the low uptake of bariatric surgery and limited effectiveness of behavioral interventions, and are guideline-recommended as part of a comprehensive obesity treatment plan. The landscape for obesity treatment has changed with introduction of the highly effective and in-demand glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1 + GIP receptor agonists (GIP/GLP-1 RAs). Given limited knowledge of use patterns, we describe use of AOMs among patients receiving care in the Veterans Health Administration (VA), which is the largest integrated health system in the United States. Methods: In a retrospective cohort study of VA patients from 7/1/2021-6/30/2023, we examined data from the VHA Corporate Data Warehouse separately for patients on AOMs without and with diagnosed diabetes, since the newer AOMs can be used at lower doses for the diabetes indication. Results: There were 31,106 patients without diabetes and at least one AOM prescription in the two year study period, who were 60% male and 62% White. AOM prescriptions from Year 1 to Year 2 among this group increased 215%. Overall, prescriptions were: semaglutide 34%, liraglutide 18%, orlistat 18%, phentermine/topiramate 14%, bupropion/naltrexone 12%, phentermine 4% and tirzepatide 0.03%. Prescribers were physicians 60%, LIPs 25%, and pharmacists 13%. There were 188,017 patients with diagnosed diabetes and at least one AOM prescription, and they were 92% male and 67% white. AOM prescriptions from Year 1 to Year 2 among this group increased 14% and were primarily (87%) for semaglutide. Prescribers were physicians 63%, licensed independent practitioners (LIPs) 23%, and pharmacists 10%. Conclusions AOM use is increasing in VA across all AOM classes, particularly among patients without diabetes, indicating growing interest in medical treatment of obesity. As AOM use spreads, real-world evidence on weight loss and clinical outcomes is needed among patients like those in VA who tend to be older and less healthy than the highly selected patients included in randomized clinical trials. Data is especially needed to guide practice among patients with obesity and without diabetes, given the dramatic increase in use among that group over the past 2 years. Presentation: 6/1/2024

Teprotumumab for the Treatment of Thyroid Eye Disease: Why Should We Keep Our Eyes "Wide Open"?-A Clinical and Pharmacovigilance Point of View.

Objectives: Thyroid eye disease (TED) treatment has been recently revolutionized with the approval of teprotumumab, a targeted insulin growth factor 1 receptor (IGF1R) inhibitor. To date, teprotumumab is the only FDA-approved drug for treating TED. In this article, we would like to temper the current enthusiasm around IGF1R inhibitors. Methods: critical review of the literature by independent academic practitioners. Results: several questions should be raised. First, "how an orphan drug has become a blockbuster with annual sales exceeding $1 billion?" Teprotumumab infusions are expensive, costing about USD 45,000 for one infusion and USD 360,000 for eight infusions in a 75 kg patient. Teprotumumab approval was based on two randomized clinical trials investigating active (clinical activity score ≥ 4) TED patients. Despite this, teprotumumab was approved by the FDA for "the treatment of TED" without distinguishing between active and inactive forms. The second question is as follows: "how can a new drug, compared only to a placebo, become the new standard without being compared to historically established gold standard medical or surgical treatments?" Teprotumumab has never been compared to other medical treatments in active TED nor to surgery in chronic TED. Up to 75% of patients may experience proptosis regression after treatment discontinuation. Finally, ototoxicity has emerged as a potentially devastating side effect requiring frequent monitoring. Investigation into the long-term side effects, especially in women of childbearing age, is also warranted. Conclusions: Teprotumumab is undoubtedly a major treatment option in TED. However, before prescribing a drug, practitioners should assess its benefit/risk ratio based on the following: (i) evidence-based medicine; (ii) their empirical experience; (iii) the cost/benefit analysis; (iv) the long-term outcomes and safety profile.

The use of a multimodal wound matrix to treat a variety of hard-to-heal wounds: a case series surveillance.

This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings.

Risk Factors Associated with Bell's Palsy in Faisalabad: A Retrospective Study

Background: Bell's palsy is a common neurological disorder characterized by sudden facial paralysis, leading to significant distress and reduced quality of life. Despite extensive research, the exact etiology remains unclear, with various factors such as age, gender, and comorbid conditions like hypertension and diabetes implicated.Objective: This study aimed to identify the risk factors associated with Bell's palsy in a specific population, focusing on demographic and clinical variables.Methods: A retrospective study was conducted on 98 patients diagnosed with Bell's palsy in Faisalabad, Pakistan. Data were collected from multiple healthcare settings, including government and private hospitals, polyclinics, and independent medical practitioners. Variables such as age, gender, BMI, comorbidities, and history of exposure to cold were analyzed. Statistical analysis was performed using SPSS version 25.Results: Of the 98 patients, 56.12% were female, and 43.88% were male. The right side of the face was affected in 67.3% of patients, while 32.7% had left-side involvement. Significant associations were found between Bell's palsy and hypertension (p < 0.05), diabetes mellitus (p < 0.05), and exposure to cold (p < 0.05).Conclusion: Bell's palsy was more prevalent in females and younger individuals. Hypertension, diabetes, and cold exposure were identified as significant risk factors. These findings contribute to understanding the potential causes and risk factors for Bell's palsy, informing clinical management and prevention strategies.

U.S. physician burnout and the proletarianization of U.S. doctors: A theoretical reframing

We delve into the escalating issue of U.S. physician burnout, arguing its roots lie in the proletarianization of the U.S. medical profession—a transition driven by the loss of autonomy and control under the shadow of capitalist systems. This process, aligned with Marx's concept of proletarianization, sees physicians morph from independent practitioners to exploited workers within a wage-labor system controlled by a corporatized U.S. healthcare system. We contend that contemporary factors attributed to U.S. physician burnout—loss of control, emphasis on productivity, increased clerical demands, and a diminishing sense of work's meaning—are not novel but deeply ingrained in the medical profession's socio-historical fabric. By juxtaposing burnout with proletarianization, we highlight macro-level sources of strain and advocate for reevaluating physician work through Marxist theory and, in turn, extend the argument that addressing burnout necessitates moving beyond individual or organizational solutions to encompass broader socio-economic structures as seen through the lens of work exploitation. We conclude by discussing “class consciousness” among U.S. physicians and posit that collective awareness and action could pave the way for substantial reforms for the practice of medicine, the organization of medicine as a profession, and the burnout epidemic among U.S. physicians.

Profile of Sport and Exercise Physician trainee’s clinical practice within Australasia in 2019: a cross-sectional study

ObjectiveTo identify the patient population profile and the spectrum of training activities and influencing factors of Australasian College of Sport and Exercise Physician (ACSEP) trainees.DesignRetrospective cross-sectional design.SettingTraining settings for ACSEP...

Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery.

SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom's most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings.

A framework for leadership practices and communication in the context of the construction sector

An ongoing debate in the leadership domain underscores the prevalence of project failures globally, prompting project managers to refine leadership strategies and create innovative practices to navigate project complexities, emerging technologies, artificial intelligence, evolving stakeholder expectations, shifting construction landscape, and brittle, anxious, nonlinear and incompressible environment challenges in the construction industry. This study aims to provide insights into the relationship mechanisms between leadership practices, communication, and project success, introducing a framework for behavioral practices to address challenges in the Australian construction industry, such as project complexities, inefficiencies, cash flow disruptions, supply chain issues, communication barriers, cultural diversity, digitalization, and regulatory protocols compliance. Exploratory factors/multivariate regression analysis on collected responses on 66 projects have identified four critical success factors: relationship management, communication effectiveness, leading by example, and self-management that impact and improve project success significantly using relationship and conflict management as mediators, help formulate creative practices using stakeholder analysis, conflict resolution strategies, and promoting collaboration enhancing the decision-making process to overcome challenges. Researchers validated and confirmed results through in-depth interviews with independent practitioners, encouraging project managers to modify behavioral practices using an explicit model for enhancing project success.

Characterisation of phenotypic patterns in equine exercise-associated myopathies.

Equine exercise-associated myopathies are prevalent, clinically heterogeneous, generally idiopathic disorders characterised by episodes of myofibre damage that occur in association with exercise. Episodes are intermittent and vary within and between affected horses and across breeds. The aetiopathogenesis is often unclear; there might be multiple causes. Poor phenotypic characterisation hinders genetic and other disease analyses. The aim of this study was to characterise phenotypic patterns across exercise-associated myopathies in horses. Historical cross-sectional study, with subsequent masked case-control validation study. Historical clinical and histological features from muscle samples (n = 109) were used for k-means clustering and validated using principal components analysis and hierarchical clustering. For further validation, a blinded histological study (69 horses) was conducted comparing two phenotypic groups with selected controls and horses with histopathological features characterised by myofibrillar disruption. We identified two distinct broad phenotypes: a non-classic exercise-associated myopathy syndrome (EAMS) subtype was associated with practitioner-described signs of apparent muscle pain (p < 0.001), reluctance to move (10.85, p = 0.001), abnormal gait (p < 0.001), ataxia (p = 0.001) and paresis (p = 0.001); while a non-specific classic RER subtype was not uniquely associated with any particular variables. No histological differences were identified between subtypes in the validation study, and no identifying histopathological features for other equine myopathies identified in either subtype. Lack of an independent validation population; small sample size of smaller identified subtypes; lack of positive control myofibrillar myopathy cases; case descriptions derived from multiple independent and unblinded practitioners. This is the first study using computational clustering methods to identify phenotypic patterns in equine exercise-associated myopathies, and suggests that differences in patterns of presenting clinical signs support multiple disease subtypes, with EAMS a novel subtype not previously described. Routine muscle histopathology was not helpful in sub-categorising the phenotypes in our population.

The challenge of adopting a collaborative information system for independent healthcare workers in France: a comprehensive study

This study aimed to explore the perception of an underutilised collaborative information system through qualitative research, utilizing semi-structured, in-depth interviews with independent midwives and physician. PROSPERO, is a collaborative information system designed to bridge the communication gap between community-based healthcare workers and hospital-based care teams for parturients in Lyon, France. Through 27 semi-structured in-depth interviews with midwives, obstetricians, and general practitioners, we identified key themes related to the system’s adoption: implementation challenges, utilisation barriers, interprofessional dynamics, and hidden variables affecting system use. Participants recognised the potential of PROSPERO to improve information sharing and care coordination but expressed concerns about the system’s integration into existing workflows, time constraints, and the need for adequate training and technical support. Interprofessional dynamics revealed differing perspectives between hospital and independent practitioners, emphasising the importance of trust-building and professional recognition. Hidden variables, such as hierarchical influences and confidentiality concerns, further complicated the system’s adoption. Despite the consensus on the benefits of a collaborative information system, its implementation was hindered by mistrust between healthcare workers (i.e. between independent practitioners and hospital staff). Our findings suggest that fostering trust and addressing the identified barriers are crucial steps towards successful system implementation. The study contributes to understanding the complex interplay of factors influencing the adoption of collaborative healthcare technologies and highlights the need for strategies that support effective interprofessional collaboration and communication.ClinicalTrials ID NCT02593292.

"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

Supporting newly qualified pharmacists in transitioning to independent practice: a qualitative analysis of the role of supervision

Abstract Introduction Newly qualified pharmacists (NQPs) face a demanding and challenging work environment during their transition to independent practice.[1,2] They also face challenges related to the changing nature of pharmacy practice, with pharmacists playing an increasingly important clinical role in patient care, which can be daunting for NQPs. Supporting NQPs during this transition period is essential for ensuring the sustainable development of health services. In 2021, Health Education England introduced the Newly Qualified Pharmacist Pathway, which included access to the Royal Pharmaceutical Society (RPS) e-Portfolio, formal learning of clinical and other skills, and access to educational supervision. The learning programmes were delivered by different providers in different settings/sectors. In hospitals, the Pathway was intended to complement existing programmes. Those in community pharmacy, general practice, community health services, health and justice, and care homes had access to a 12-month structured programme. Aim To discuss how supervision works and its contribution to supporting NQPs during their transition to independent practice. Methods Semi-structured qualitative interviews with NQPs (n=7) and supervisors (n=14). Email invitations were sent via learning providers. Participants were selected to capture NQPs and supervisors from various learning programmes and settings/sectors. Interviews were analysed thematically. Results The transition to independent practitioners meant NQPs were required to work with a high degree of autonomy in their practice. Yet, NQPs reported a lack of confidence in this. Supervisors reported that being an independent practitioner also meant that NQPs needed to be accountable for their decisions, learn to prioritise in a high-pressure environment, lead more experienced colleagues and manage a team. Supervision was an important part of the Pathway. Both NQPs and supervisors reported that supervisors provided NQPs with guidance, support, and feedback during their transition period. Supervisors added that they conducted learning needs assessments to foster a learner-centred approach that aided NQPs in expanding their skills and knowledge. They also supported NQPs in developing reflective practice as part of their professional development and progression to advanced practice. How supervision was conducted in practice varied across different settings/sectors. NQPs and hospital supervisors described that NQPs had a clinical work-based supervisor and an educational supervisor. In community pharmacies where NQPs often lacked access to support and structured learning opportunities, NQPs and supervisors claimed that remote educational supervision offered through the Pathway provided a support system for NQPs who would otherwise have been without any support structure. Conclusion Our study highlights that both NQPs and supervisors noted the importance of the support provided by educational supervisors to address learning/support needs in the early year of practice. However, the extent to which NQPs received what they needed varied widely. This support will likely become increasingly important from 2026, when pharmacists will require support as they become independent prescribers. We need to develop processes and infrastructure to ensure high-quality supervision is available to NQPs in all settings/sectors. The strength of the study lies in the in-depth interviews that provided rich and insightful data, effectively addressing the limitation posed by the relatively small number of participating NQPs.

Exploring perspectives and insights of experienced voyagers on human health and Polynesian oceanic voyaging: A qualitative study.

The Worldwide Voyage (WWV) was a 3-year (2014-2017) open-ocean voyage to circumnavigate the world using Indigenous knowledge and navigational skills aboard Hōkūle'a, a traditionally designed Native Hawaiian (NH) voyaging canoe (wa'a kaulua). Each WWV segment included experienced crew and leadership who were recognized by their voyaging peers as highly experienced in Polynesian oceanic voyaging. This study explored the perceptions and insights of WWV-experienced ocean voyagers on the interconnection between human health and oceanic voyaging. A constructivist approach with a storytelling-based moderator guide was used to conduct focus groups and informant interviews of experienced crew and voyaging leadership. Participants were interviewed and recorded transcripts were analyzed using content analysis. Triangulation of analysis included secondary thematic review by two independent NH cultural practitioners and participant member checking. Purposive sampling was used to enroll 34 of 66 eligible highly experienced voyagers (leadership n = 6; crew n = 28) in 5 focus groups and 4 informant interviews. Six themes emerged: 1) Indigenous context (spiritual and natural environment); 2) Importance of relationships and community; 3) Description of life on the canoe; 4) Holistic health; 5) Mindfulness, stress reduction and emotional health; and 6) Opportunities for intervention. Themes 1-5 were inductive and intricately interrelated, and theme 6 was deductive in that it directly resulted from a moderator guide question. Theme 6 offers strategies to improve the impact of voyaging and health well beyond the physical voyage with recommendations for improved transition back to land and developing a wa'a community context, which reflects a traditional voyaging experience. Polynesian oceanic voyaging is strongly perceived as a positive and transformative holistic-health-promoting experience. Recommendations to promote generalizable health benefits of a voyaging lifestyle offers a promising and culturally grounded approach warranting future studies to understand mechanism and potential impact for improving health inequities.

Are Canadian Physiotherapy Graduates Ready for Private Practice? Faculty, Employer, and Recent Graduate Perspectives

Purpose: The transition from physiotherapy student to independent practitioner is challenging. New graduates experience difficulties working in private practice as many aspects of the workflow are difficult to prepare for during their education. The purpose of our study was to explore the work readiness of Canadian new graduate physiotherapists for private practice from the perspectives of key groups. Methods: We administered an online questionnaire to recent Canadian physiotherapy graduates, private practice employers, and academics exploring the work readiness of new graduates related to competencies and constructs relevant to private practice. Results: Our findings highlight gaps in education related to the business of private practice, managing complex caseloads, diagnosis, prognosis and establishing a plan of care, and autonomy in decision-making. A shared responsibility exists for the work readiness of physiotherapy graduates. Respondents suggest at least 1 year of practice before the majority of graduates are work-ready for private practice. Conclusion: Physiotherapy graduates struggle with the business of working in private practice, managing complex caseloads, and autonomy in decision-making. There is a shared responsibility between academics, clinical educators, employers, and new graduates to bridge the gap between the entry-to-practice education program and meeting the expectations of the private practice work environment.

Performance in Irish Selection and Future Performance in Surgical Training

Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity. To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments. This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022. Selection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview. Assessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses. Data were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (β = 0.31; 95% CI, 0.14-0.48) and simulated environments (β = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (β = 0.55; 95% CI, 0.22-0.87). In this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.

Viral Interstitiality and Unlikely Resources: Gender and Labour in Turkish Public Theatre During the Covid-19 Pandemic

The growing literature on Covid-19 and theatre has demonstrated how the pandemic has intensified gendered precarities in theatrical labour.1 However, the pandemic has also provided feminist theatre makers with unexpected or unlikely resources, albeit with limitations. The Istanbul Municipal Theatre's (İstanbul Büyükşehir Belediyesi Şehir Tiyatroları or İBBŞT) production of Melek that premiered in 2020 is an indicative example of such rare and largely invisible cases of pandemic theatre. Critically engaging with the archives and repertoires of tuberculosis (TB) melodrama and the Turkish lives of the genre, Melek conducts an experiential mapping of the performativity of death and the porous borders between everyday performance and artistic performance. The production offered independent feminist theatre practitioners, who otherwise maintain a precarious existence in Turkey's theatre world, access to new spaces, resources and audiences. Combining archival with ethnographic research, I will demonstrate how, in the case of Melek, the intersections between actual and fictive viral contagion – what I define as viral interstitiality – constitute inclusive economies amidst the Covid-19 pandemic. In somatics, the interstitial is theorized and enacted as suspensions of static schisms that shape relational empowerment.2 Drawing upon this grasp of the interstitial as connective thresholds, viral interstitiality sheds light on the practices and the economies of care that emerge from the porous dynamism between the viral and the theatrical.

A Survey of Medication Diffusion and Attitudes Among Indian Clinicians Toward Pharmacotherapies for Alcohol Use Disorder.

Alcohol use disorder (AUD) is a significant cause of morbidity and mortality globally. However, uptake of AUD pharmacotherapies among clinicians has remained low. There exists a research gap regarding clinician attitudes and the diffusion of AUD pharmacotherapies among Indian clinicians. We conducted a survey to assess the same. An online survey was sent to clinicians nationwide from February and April 2023 to assess attitudes and practices regarding various AUD medications. Logistic and ordinal regression models evaluate the clinician and caseload factors determining medication diffusion and attitudes. A total of 387 clinicians responded to our survey. Most of them were males (61.7%) and trained psychiatrists (56.3%). The diffusion for acamprosate, naltrexone, and disulfiram was 69.8%, 81.4%, and 58.2%, respectively. Baclofen had the highest diffusion. Female respondents had significantly lower perceived efficacy, acceptability, and safety for disulfiram. Independent practitioners were more likely to prescribe all pharmacotherapies except baclofen. Diffusion for alcohol pharmacotherapies was incomplete. Baclofen had the highest diffusion, probably reflecting its cost and safety profile. Despite its perceived efficacy, safety concerns impacted the diffusion of disulfiram. Female clinicians had lower perceived attitudes toward disulfiram. Specific training for AUD pharmacotherapies is warranted for female clinicians and nonpsychiatrists.