Individual Practitioners Research Articles

The urgent need for diagnostic criteria and further understanding of burnout syndrome

The term burnout is widely used and accepted worldwide, but its existence as a distinct clinical entity remains poorly understood and is the source of controversy within academic circles. The existence or nonexistence of burnout has significant implications for individuals, families, organizations, communities, and societies. There is an urgent need for further descriptive research to determine consensus-driven diagnostic criteria that will aid in high-quality research to guide nonpharmacologic and pharmacologic treatment and to aid in the development of individual, organizational, and societal prevention strategies. This urgency is driven by recent changes in the occupational-social contract and highlighted by the ongoing COVID-19 pandemic. To address this need, the authors performed a narrative, nonsystematic review to obtain an overview of the current body of literature regarding the symptoms, diagnosis, and treatment of burnout symptoms. A literature search was conducted in PubMed for relevant articles in English since 1974 with the following search terms: “occupational burnout,” “professional burnout,” “career burnout,” “assessment,” “inventory,” “measure,” “instrument,” “diagnosis,” “treatment,” “guideline” in different combinations. Hand searching was also performed. Retrieved records were reviewed, and the relevant studies were summarized. Burnout, whether a distinct clinical entity or an occupationally triggered manifestation of an already defined mental health condition, is an urgent public health priority. There is peril in waiting for a follow-on epidemic of its manifestations before embarking on high-quality research into diagnostic criteria, treatment, and prevention, as this takes time. However, this information is vital for individual practitioners, health-care systems, governments, and societies to meet this pressing need.

Patient view of the advanced practitioner (AP) role in primary care: A realist-informed synthesis.

Approximately 30% of general practitioner consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat a range of MSKDs, and could provide the first point of contact for primary care patients. There is limited evidence on whether this role is acceptable to patients; however, previous research has explored advanced practitioner (AP) roles in primary care, which could inform this new initiative. This study used realist synthesis to explore factors that influence patient acceptability of AP roles in primary care. MATERIALS& METHODS: A realist synthesis was undertaken to identify initial programme theories regarding acceptability. Databases were searched to identify relevant literature. Identified studies were subject to inclusion and exclusion criteria, resulting in 38 studies included for synthesis. Theory-specific data extraction sheets were created and utilised. Data were analysed through identifying contexts, mechanisms and outcomes to formulate hypotheses. Hypotheses were validated through consultation with expert stakeholders. Eight theory areas were identified that potentially impacted on patient acceptability of the role: patient's prior experience of condition management; patient's expectations of condition management; communication; continuity of the individual practitioner; practitioner's scope of practice; accessibility; professional hierarchy and promoting the role. Nineteen hypotheses on the AP role were developed around these theory areas. Role acceptabiliy was influenced significantly by context and may change as the role develops, for instance, as waiting times change. Hypotheses will inform a subsequent realist evaluation exploring the physiotherapy AP role in primary care. Future research is needed to understand the acceptability of first contact physiotherapists delivering certain skills.

The standards treatment

The standards treatment

AUTOESTIMA Y PRÁCTICA DEPORTIVA EN ADOLESCENTES

El estudio planteó como objetivos analizar la autoestima y su relación e influencia con la práctica deportiva, género y edad de los escolares. La muestra estuvo compuesta por 715 adolescentes, de entre 12 y 16 años (54.12% mujeres), clasificados en sedentarios, practicantes deportes individuales y practicantes deportes colectivos. Para los sujetos activos se diseñó un programa de intervención de 16 semanas de duración. Se utilizaron la Rosenberg Self Esteem Scale y el international questionnaire MVPA. La mayor autoestima corresponde con la autoestima positiva, evidenciándose diferencias significativas favorables a los hombres y a los adolescentes activos físicamente. Los adolescentes practicantes de deportes colectivos presentan mayor autoestima que los practicantes de deportes individuales. Concluyendo que la cantidad y el tipo de deporte practicado modulan la autoestima. La edad no es un factor determinante y el sexo sí influye en la autoestima. Se confirma el modelo bifactorial de la Rosenberg Self Esteem Scale.

Electronic medical records and primary care quality: Evidence from Manitoba

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.

Impact of the intersection of anaesthesia and gender on burnout and mental health, illustrated by the COVID-19 pandemic.

SummaryPhysician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender‐related risk factors for and experiences of burnout and poor mental health remain under‐researched and under‐reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID‐19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID‐19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

Conceptualising transdisciplinary integration as a multidimensional interactive process

Integration is a key process in transdisciplinary research and knowledge co-production. Nonetheless, it is often used as a buzzword without specifying what exactly it means or what actually happens during integration. We propose conceptualizing integration as a multidimensional interactive process. We characterize it as an open-ended learning process without pre-determined outcomes. Integration designates relations established throughout a transdisciplinary research process between elements that were not previously related. Those elements are participants in the process and their thought-styles and thought-collectives and more specifically pieces of knowledge, ideas, or practices from different thought-collectives as well as views of individual researchers and practitioners. Integration can happen at manifold instances of a transdisciplinary research process. It can take place among two, several, or all participants and can be one-sided or mutual. It might include insights, practices, frameworks, or concepts shared by two, several, or all participants. Consensus is only one along with other ways of retaining plurality of thought-styles and seeing integration as a balance between them that remains subject to continuous revision. To analyse or achieve effective integration, further dimensions beyond the cognitive have to be taken into account including at least an emotional and a social-interactional dimension.

Aftermath of Covid-19 Pandemic on oral surgery and orthodontic practices in Northern India

The scuttlebutt is already churning out projections about what the post COVID-19 work environment might look like. While we get ‘old-school’ in tackling challenges, we may also want to consider getting ‘tech savvy’ in regards to oral health delivery via teledentistry for prior consultation ultimately decreasing footfall in OPDs. The COVID-19 outbreak serves as both a reminder and an opportunity to assist. This is an ever evolving dynamic situation, and recommendations discussed herein are based on the best currently available information. However, the decision of the treatment of patients still rests with the individual practitioner. The blanket instruction is to dodge all aerosol related procedures in dental setups. It’s dentist prerogative to install all fail-safes and perform restorative procedure requiring AGPs with all efforts to mitigate the risk of transmission of the SARS-Cov-2 virus and for minimal working times with the appropriate PPE and infection control protocols. Even when not using AGPs, it is important that robust infection control measures are employed as this isn’t a perfect world, and we’re still in the throes of a pandemic, making it imperative to cultivate the right mind-set within ourselves. The intent of the present review is to consider changes in the clinical oral and maxillofacial surgery and orthodontic workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel.

The influence of institutional factors on patient–provider communication and interactions in the U.S. healthcare system

Communication and interactions between patients and healthcare providers are important components in the provision of healthcare services. In this study, we assessed the effects of institutional factors, defined as a usual source of care and the type of a usual source of care, on perceived patient–provider communication and interactions. We used individual-level data for adults (N = 89,725) from the Medical Expenditure Panel Survey for the years 2001 to 2012 and employed multivariate logistic regressions to assess the relationship between institutional factors and four communication and interaction outcomes: provider listened to patient, provider explained so that patient understood, provider showed respect to patient, and provider spent enough time with patient. Adults who report having a usual source of care have significantly higher odds of reporting positively on their communication and interactions with their healthcare providers in comparison to adults who do not have a usual source of care. We also find that having an individual physician or nurse practitioner as a usual source of care further improves patient–provider communication and interaction in comparison to having an outpatient clinic, a hospital, an emergency department, or any other type of clinic as a usual source of care. Our study shows that having a usual source of care is an important component in patient–provider communication and interactions, beyond patients’ personal characteristics. We also show that having a physician (or any other individual practitioner) rather than a healthcare facility, such as an outpatient clinic, as a usual source of care further improves patient–provider communication and interactions.

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

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

Peripheral intravenous cannulas for blood drawing: Nurses' views through content analysis

BackgroundPeripheral intravenous cannulas are commonly used for blood sampling. Conflicting evidence on the safety and reliability of blood sampling from peripheral intravenous cannulas provides little support to guide practice of clinicians. AimTo elicit views of nurses working in acute care of their opinions on the safety and efficacy of obtaining blood samples from peripheral intravenous cannulas. MethodsA cross-sectional electronic survey was utilised. Participants included nurses working in Australian acute care services nationally. The STROBE checklist was followed. The survey was distributed by two professional nursing bodies to their members between September and December 2017. Content analysis was used to analyse open-ended responses. FindingsOf the 338 participants who completed the survey, 269 provided comments. Themes supporting the use of peripheral intravenous cannulas for blood sampling included ‘efficiency’, ‘patient care’, ‘last resort’, and ‘other’. Reasons for not using a peripheral intravenous cannula for sampling provided themes of ‘PIVC use’, ‘dwell time’, ‘test type required’, ‘patency/insertion site care’, ‘preference’, and ‘other’. DiscussionThe choice regarding method of blood sampling is left to the discretion of individual practitioners. Diverse rationales were provided by respondents to support their practice in sampling blood. This may be influenced by variations in hospital policies and conflicting research evidence to support or refute the practice. ConclusionBlood sampling from peripheral intravenous cannulas or venepuncture is practiced differently between nurses based on multiple rationales. Research is needed to provide evidence for safe practice and support hospital policies.

"Digital Health Earth": towards a global healthcare management geolocating human health condition by means of space technology

Healthcare providers such as the World Health Organization, transnational and global health initiatives, the national healthcare systems, down to the smallest villages and individual practitioners and professionals could benefit from geo referential data and metadata and 3D digital assets provided by space technology. Health prevention and literacy programs, mortality and morbidity rates, including contextual statistical data about populations and territories are being already produced and accessible. The hypothetical frame of a Digital Health Earth hereto presented could be performed as the interoperability of 3D representations of sectors of territories and geolocalized layers about health and environment. SDG Goals crossed with WHO programs and available data can become the premises for the design and development of a global representation of healthcare situations, highlighting priorities and disseminating data by intuitive and interactive modes of visualization as it is already happening with 2D dashboards about COVID-19 pandemic. Healthcare practitioners, professionals, health managers, but also patients, proxy, social workers, laypeople, stakeholders and media could benefit from visualizing and comparing Digital Earth health data. Concerns about privacy, digital divide and social exclusion from primary care services and how quality of lives might occur are considered here. As a consequence of Space Technology, especially for its connection with the Satellite industry, Digital Health Earth, will contribute to the development of a new added value economic branch inside the increasing market of the Space Economy Revolution.

Diagnostic radiographer advanced clinical practice in the United Kingdom - A national cross-sectional survey.

Objectives:To survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP).Methods:174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October–December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included.Results:A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification.Conclusions:Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts.Advances in knowledge:Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards.

The Pattern of Medication Usage in the Southern Region of Iran: A population-based Pharmacoepidemiological Study.

Objective:The purpose of this study was to document the demographic data, to assess the proportion of consumed medicines and the amounts and types of drugs available to households, and to to estimate the probable prevalence of certain diseases in the southern region of Iran.Methods:In this cross-sectional population-based study carried out in Shiraz (the central city in the Southern part of Iran), we documented and evaluated the drug usage details in a random sample of 1000 households during 2018–2020. We analyzed the usage of drug categories based on the anatomical therapeutic chemical classification, which the World Health Organization recommends.Findings:In the studied population, the average age (± standard deviation) was 45.54 ± 15.82, ranged 18–91 years. More than 90% had medical insurance coverage. About 81.8% of the participants had individual family medicine practitioners, and most of them (93.8%) received medications with a physician's prescription. The most frequently used medications were cough and cold preparations (12.9%), nervous system drugs (12.6%), and cardiovascular system drugs (11.6%).Conclusion:Despite the easy access to medications for most participants, few individuals (about 6%) received their medications without a prescription. The most frequently prescribed medicines were the common cold, acetaminophen, and metformin. Common cold, gastrointestinal (GI) disorder, and diabetes were the most commonly used medication classes. Furthermore, we have found a probably higher than average prevalence of cardiovascular, GI, and endocrine disorders. This information could be used by the local policymakers as a basis for the estimation and allotment of health-care resources.

Achieving cultural safety for Australia's First Peoples: a review of the Australian Health Practitioner Regulation Agency-registered health practitioners' Codes of Conduct and Codes of Ethics.

Objective Health practitioners' Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. Methods Following the release of the Australian Health Practitioner Regulation Agency's (Ahpra) Health and Cultural Safety strategy 2020-25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra's new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code partially met these objectives. Results Most Codes of Conduct (14 of 16) conflated Aboriginal and Torres Strait Islander peoples with culturally and linguistically diverse (CALD) communities undermining the sovereignty of Australia's First Peoples. Eleven professions had a Code of Ethics, including the Physiotherapy Code of Conduct, which outlined the values and ethical principles of practice commonly associated with a Code of Ethics. Of the 11 professions with a Code of Ethics, two (Pharmacy and Psychology) articulated specific ethical responsibilities to First Peoples. Physiotherapy separately outlined cultural safety obligations through their reconciliation action plan (RAP), meeting all Ahpra cultural safety objectives. The remaining eight advocated respect of culture generally rather than respect for Aboriginal and Torres Strait Islander cultures specifically. Conclusions The review identified multiple areas to improve the codes for cultural safety content for registered health professions, providing a roadmap for action to strengthen individual and systems practice while setting a clear regulatory standard to ensure culturally safe practice becomes the new norm. It recommends the systematic updating of all professional health practitioner Board Codes of Conduct and professional Codes of Ethics based on the objectives outlined in Ahpra's Cultural Safety Strategy. What is known about the topic? Systemic racism and culturally unsafe work environments contribute to poor health outcomes for Aboriginal and Torres Strait Islander peoples. They also contribute to the under-representation of Aboriginal and Torres Strait Islander peoples in the health workforce, denying the system, and the people who use and work in it, much needed Indigenous knowledge. Creating a culturally safe healthcare system requires all health practitioners to reflect on their own cultural background, to gain appreciation of the positive and negative impacts of individually held cultural assumptions on the delivery of healthcare services. Competence in cultural safety as a required standard of practice is therefore essential if broad, sustainable and systemic cultural change across the health professions and ultimately across Australia's healthcare system is to be achieved. Given that Codes of Conduct and Codes of Ethics are integral in setting the practical and moral standards of the professions, their contents with respect to cultural competence are of great importance. What does this paper add? A review of this type has not been undertaken previously. Following the establishment of the Ahpra Aboriginal and Torres Strait Islander Health Strategy Group, release of Ahpra's 2018 Statement of intent, and the 2019 Aboriginal and Torres Strait Islander Health and Cultural Safety strategic plan and Reconciliation Action Plan, we analysed the content of each of the 16 registered health professions Codes of Conduct and Code of Ethics looking for content and guidance in accordance with the new national cultural safety definition. Several opportunities to improve the Codes of Conduct and Codes of Ethics were identified to realise the vision set out in the statement of intent including through the application of the National Law. This analysis provides a baseline for future improvements and confirms that although some current health practitioner Codes of Conduct and Codes of Ethics have begun the journey of recognising the importance of cultural safety in ensuring good health outcomes for Australia's Indigenous peoples, there is broad scope for change. What are the implications for practitioners? The gaps identified in this analysis provide a roadmap for improvement and inclusion of Aboriginal and Torres Strait Islander Health and cultural safety as a required standard in Codes of Conduct and Codes of Ethics for all registered health practitioners. Although it is recognised that Codes alone may not change hearts and minds, codifying the clinical competency of cultural safety provides a portal, and a requirement, for each individual practitioner to engage meaningfully and take responsibility to improve practice individually and organisationally.

A mixed-methods study to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings.

This mixed-methods study sought to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings. The study first asked case planners about their perceptions of practitioner and organizational factors related to fidelity through an online survey. This survey was connected to case-level fidelity scores to understand the relationship between perceptions and fidelity. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a practitioner's ability to implement a maltreatment prevention intervention. Both methods of the study suggest that various aspects of supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of enhancing a practitioner's ability to learn and use the intervention. Additional components that influence the implementation for future research emerged from the qualitative phase related to system expectations and policies, individual practitioner attributes, and characteristics of the intervention.

A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice

We conducted a survey of Australian and New Zealand anaesthetists designed to quantify self-reported use of cricoid pressure (CP) in patients presumed to be at risk of gastric regurgitation, and to ascertain the underlying justifications used to support individual practice. We aimed to identify the perceived benefits and harms associated with the use of CP and to explore the potential impact of medicolegal concerns on clinical decision-making. We also sought to ascertain the views of Australian and New Zealand anaesthetists on whether recommendations relating to CP should be included in airway management guidelines. We designed an electronic survey comprised of 15 questions that was emailed to 981 randomly selected Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) by the ANZCA Clinical Trials Network on behalf of the investigators. We received responses from 348 invitees (response rate 35.5%). Of the 348 respondents, 267 (76.9%) indicated that they would routinely use CP for patients determined to be at increased risk of gastric regurgitation. When asked whether participants believed the use of CP reduces the risk of gastric regurgitation, 39.8% indicated yes, 23.8% believed no and 36.3% were unsure. Of the respondents who indicated that they routinely performed CP, 159/267 (60%) indicated that concerns over the potential medicolegal consequences of omitting CP in a patient who subsequently aspirates was one of the main reasons for using CP. The majority (224/337; 66%) of respondents believed that recommendations about the use of CP in airway management guidelines should include individual practitioner judgement, while only 55/337 (16%) respondents believed that routine CP should be advocated in contemporary emergency airway management guidelines.

Implementing YouthCHAT – evaluation and development of an implementation framework

Purpose A high proportion of indigenous Māori, a generally socioeconomically deprived population, live in Northland, New Zealand. Māori youth suffer a high rate of mental ill-health, substance misuse, and other risky behaviours. While evidence demonstrates that early detection and management of these issues leads to long-term positive health outcomes, implementation of systematic screening and intervention is challenging. YouthCHAT is a self-administered digital tool screening young people for mental health concerns and risky health behaviours. Our purpose was to implement YouthCHAT into Northland youth services using an iterative process of implementation, evaluation, and modification, and create a framework for national-level rollout. Approach A bicultural approach combined Kaupapa Māori research and co-design principles to inform implementation and evaluation. Informed by field notes, informal communications plus focus groups, and interviews with end-users, we identified and addressed barriers to uptake of YouthCHAT. Consolidated framework for implementation research and normalisation process theory was theoretical underpinnings of the project. We measured uptake by the number of YouthCHAT screens completed. Discussion It took three years to successfully embed YouthCHAT and implement it into usual practice. A change was needed at all levels, from the individual practitioner to the service team through to the over-arching health system. A bicultural co-design approach and programming remote functionality during coronavirus disease 2019 (COVID-19) lockdown contributed to YouthCHAT's ultimate acceptability and implementation. The cultural context in which an intervention is introduced is often overlooked. This partnership approach may be time-consuming and challenging. However, an intervention will only be adopted where there is local ownership and it is seen as fit for purpose. Our framework addresses the importance of communication and coordination in the acceptance and uptake of an innovation, with ongoing evaluation as an integral part of implementation. It is generalisable to other settings and augments other models such as the consolidated framework for implementation research currently available. Plain language summary The Northland region of New Zealand has a particularly socioeconomically deprived population with a high proportion of indigenous Māori. Māori youth suffer a high rate of mental ill-health, substance misuse, and other risky behaviours. Early detection of these issues means they can be addressed and youth are less likely to have future health and social problems. YouthCHAT is a self-administered digital tool screening young people for mental health concerns and risky health behaviours. We implemented YouthCHAT into Northland youth services using an iterative process of implementation, evaluation, and modification, and created a framework for national-level rollout. A bicultural approach combined Māori research and co-design principles, using information from many sources including focus groups, staff surveys, field notes, and informal communications to inform implementation and evaluation. It took three years to successfully embed YouthCHAT into usual practice. A change was needed at all levels, from the individual practitioner to the service team through to the over-arching health system. Programming remote functionality during COVID-19 lockdown contributed to YouthCHAT's ultimate acceptability and implementation. This bicultural partnership approach may be time-consuming and challenging. However, ultimately an intervention will only be enthusiastically adopted if there is local ownership and it is seen as fit for purpose. Our success is measured by the number of YouthCHAT screens now being completed. Our framework addresses the importance of communication and coordination in the acceptance and uptake of an innovation, with ongoing evaluation as an integral part of implementation. It is generalisable to other settings and augments other models currently available.

"Digital Health Earth": towards a global healthcare management geolocating human health condition by means of space technology

Healthcare providers such as the World Health Organization, transnational and global health initiatives, the national healthcare systems, down to the smallest villages and individual practitioners and professionals could benefit from geo referential data and metadata and 3D digital assets provided by space technology. Health prevention and literacy programs, mortality and morbidity rates, including contextual statistical data about populations and territories are being already produced and accessible. The hypothetical frame of a Digital Health Earth hereto presented could be performed as the interoperability of 3D representations of sectors of territories and geolocalized layers about health and environment. SDG Goals crossed with WHO programs and available data can become the premises for the design and development of a global representation of healthcare situations, highlighting priorities and disseminating data by intuitive and interactive modes of visualization as it is already happening with 2D dashboards about COVID-19 pandemic. Healthcare practitioners, professionals, health managers, but also patients, proxy, social workers, laypeople, stakeholders and media could benefit from visualizing and comparing Digital Earth health data. Concerns about privacy, digital divide and social exclusion from primary care services and how quality of lives might occur are considered here. As a consequence of Space Technology, especially for its connection with the Satellite industry, Digital Health Earth, will contribute to the development of a new added value economic branch inside the increasing market of the Space Economy Revolution.