Clinical Responsibilities Research Articles

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. Mixed studies systematic review. Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Helping Patients Die: Implementation of a Residency Curriculum in Medical Aid in Dying.

As more states legalize medical aid in dying (MAID), there is an ever-increasing need of physicians trained in this type of end-of-life care. However, resident curricula in MAID have not been previously reported or assessed. The authors describe a residency curriculum in MAID and evaluate the resident outcomes of this program. Since 2018, the Sutter Family Medicine Residency Program in California has offered training in MAID to its residents. Residents attend lectures, evaluate patients for MAID, write prescriptions for aid-in-dying medications, and attend the planned deaths of their patients if desired. In February 2023, an anonymous branching survey was sent to graduates of the program from 2019 to 2022 to evaluate residency graduation year, receipt of MAID training, currently practicing MAID, how rewarding MAID is compared with other clinical responsibilities, how stressful MAID is compared with other clinical responsibilities, comfort discussing MAID with colleagues, comfort discussing end-of-life care generally, personal view of MAID as a practice, and works where MAID is permitted. The authors surveyed 28 graduates and collected data from 21 former residents (response rate, 75%). Of these 21 former residents, 17 (81%) reported having opted to receive training in MAID during residency. Of the 12 residents who received training and were currently practicing in a location that allowed MAID, 7 (58%) were still practicing aid in dying, and of these 7 residents, 5 (71%) reported that their aid-in-dying work was more rewarding than their other clinical responsibilities. Overall, there was high resident interest in this training and robust skill use after graduation. Additional studies will need to focus on patient outcomes, explore resident reasons for opting out of training, and investigate other effects of instituting a MAID curriculum.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

The Gap Year for College Students Interested in Medicine: Can They Contribute to Your Mission?

Gap years taken between undergraduate completion and entrance into medical school have become increasingly popular. We examine the role of gap years among college graduates interested in medicine and how they might contribute to academic research productivity within clinical environments. Recently, academic faculty have struggled to balance increasing clinical responsibilities with their scholarly endeavors. Academic medical departments may have incentives to hire pre-medical students to help ease the research burden on faculty. Properly motivated pre-medical students may view research positions in academic medical departments as ideal opportunities to learn in areas that will broaden their scientific knowledge and help prepare them for medical school, while greatly enhancing their medical school applications through distinguishing themselves as co—authors published in medical journals. Our experience, with two co-authors working as research associates while preparing for their medical school applications and careers, suggests that pre-medical students can strengthen their medical school applications during their gap year(s) while proving instrumental in enhancing research output thus alleviating the workload of clinical faculty.

Full‐body skin examination in screening for cutaneous malignancy: A focus on concealed sites and the practices of international dermatologists

AbstractBackgroundFull‐body skin examination (FSE) is fundamental to the diagnosis of cutaneous malignancy but may not always include concealed site examination (CSE).ObjectivesTo determine the approach of international dermatologists to CSE during FSE and examine influencing factors, barriers and attitudes toward CSE.MethodsMembers of the International Dermoscopy Society were surveyed using an online 12‐question survey disseminated via email.ResultsThere were 706 completed responses among 1249 unique clicks to the survey, representing a completion rate of 56.5%. Fifty‐four percent of respondents reported always examining the breasts, while 52.8%, 18.8%, and 11.8% always examined the scalp, oral, and anogenital mucosa, respectively. The most frequent reason for examining concealed sites was patient concern, whilst common reasons for not examining concealed sites included low incidence of pathology and concern regarding allegations of sexual misconduct.ConclusionsOur findings allude to the need for international consensus guidelines regarding the conduct and inclusion of concealed or sensitive sites in routine FSE. This is essential to define clinician responsibilities, inform patient expectations of care, and thereby mitigate potential medicolegal repercussions.

Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility.

We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region. Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Single health system and region. Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation≤6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence. A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs85.9%, OR: 0.15, 95%CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95%CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95%CI: 0.18-0.70, P = .003). Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region.

Exploring Volunteer Pharmacists' Experiences in Responding to 2023 Türkiye Earthquakes: A Qualitative Phenomenological Study.

Pharmacists are vital in disaster response efforts, dispensing essential medications, managing pharmacy services, consulting, and educating survivors regarding their medications. Their contributions, however, are often underrepresented in scientific literature. This study aimed to explore the experiences of pharmacists who provided pharmacy services to meet the pharmaceutical needs of the survivors after 2 major earthquakes in Türkiye in 2023. This study adopted a phenomenological approach. Data were collected using semi-structured interviews. Purposive sampling was used to invite pharmacists who provided pharmacy services to survivors. Interview transcripts were analyzed following an inductive, reflexive thematic analysis. In total, 15 pharmacists were interviewed. Four main overarching themes "response to the earthquake," "preparedness for the earthquake," "experiences during service delivery," and "mental and physical experiences" were developed. From participants' experiences, it is essential to expand the clinical responsibilities of pharmacists and train them in providing wound care, administering immunization, and prescribing. Pharmacists should be integrated as essential members of disaster health teams. International health organizations, nongovernmental organizations, and governments are encouraged to work collaboratively and develop disaster management plans including pharmacists in early responders. This might help mitigate the deficiencies and overcome challenges in health-care systems to provide effective patient-centered care by health professionals and respond effectively to disasters.

Perceptions, knowledge, and perceived barriers to practicing evidence‐based medicine among pharmacists in Japanese community hospitals: A cross‐sectional multicenter survey

AbstractIntroductionEvidence‐based medicine (EBM) skills are required for pharmacists. However, the current status of EBM skills and its education in Japanese pharmacists remains unknown.ObjectivesWe investigated the perceptions, knowledge, and barriers for EBM in Japanese pharmacists.MethodsWe conducted a cross‐sectional survey of pharmacists employed by four community hospitals in Japan. A questionnaire including 55 questions to evaluate pharmacists' perceptions, knowledge, exposure, access, terminology, and barriers for EBM was developed based on our previous research.ResultsThe questionnaire was provided to 70 pharmacists and the response rate was 90% (n = 63). Regarding the 5As (Ask, Acquire, Appraise, Apply, Assess) skills, only 30.2% of pharmacists were confident in their skills for Ask, 17.5% for Acquire, 19.0% for Appraise, 34.9% for Apply, and 25.4% for Assess. Additionally, although less than 20% of pharmacists felt comfortable teaching EBM to pharmacy residents and were confident to explain to others any EBM‐related terms, more than 90% of the pharmacists recognized the importance of EBM education for patient care. Furthermore, they reported many barriers to EBM, such as skills, statistical knowledge, training, English, and opportunities to practice EBM.ConclusionAlthough most Japanese pharmacists in this study were not confident in their EBM skills and in teaching them, they acknowledged the importance of EBM. Our study suggests that providing EBM training, and the clinical roles and responsibilities could address the identified barriers, such as, lack of skills, knowledge, and opportunities to practice EBM, and pharmacists could better embrace EBM in their practice to optimize patient care.

IJCM_336A: Academic burnout and coping: A questionnaire based cross-sectional study among undergraduate students of a medical college in western Uttar Pradesh

Background: Academic burnout is a significant concern in undergraduate medical students due to the demanding nature of their coursework, clinical responsibilities, and the pressure to excel in their studies. Medical students, in particular, are believed to be more stressed and burnt out than their non-medical peers. Academic burnout can affect medical students academic performance and psychological well-being. Coping strategies are essential for students to manage stress and attempts are being made to control and mitigate the same. Objective: 1) To assess the prevalence of academic burnout among undergraduate medical students; 2) To find out coping mechanisms adopted by the students. Methodology: This is a cross-sectional anonymous survey, medical students were recruited from four professional MBBS groups. Based on prevailing prevalence of burnout (16.84%), sample size calculation was done, which came out to be 216; which was rounded off to 220. The 220 completed questionnaires were collected and included in analysis. The Maslach Burnout Inventory-Student Survey (MBI-SS) and Brief COPE questionnaire were used. Sociodemographic profile was assessed by semi-structured proforma. Results: High emotional exhaustion was present in nearly 35% of the students while low professional efficacy over 65% of them reported. However, majority of them practiced active coping. The data is still being analysed for final findings. Conclusion: As concluded, majority of the students reported high academic burnout and low professional efficacy. For coping, most of them adapted active coping while substance use was less commonly used.

The risk of being older: Working with risk in older adults mental health services

When working as healthcare professionals, we incorporate an array of narratives and structures which come with the role. It is our clinical responsibility to acknowledge and name different factors at play in different conditions, and we are trained to work and support teams with constructs such as vulnerability and power. Working with older people, other dynamics entering the picture are ageing, dementia and frailty. Risk is another example of such forces, an overarching concept which we need to be constantly aware of as professionals. This article will explore the concept of risk and what it means to be working with risk in community-based care for older people. The aim is to generate a conversation about common risks in the older population, challenging assumptions and offering a space for reflection on how to best explore and support.

153 Impact of the COVID-19 Pandemic on CTSA Training and Career Development

OBJECTIVES/GOALS: Immediate negative impact of the COVID pandemic on CTSA T trainees and K scholars was reported in 2020 to be lack of access to research facilities, clinics, human subjects, and team members, and a need for homeschooling. In this study we examined in more detail the perceived impact of the COVID pandemic on training and career development three years later. METHODS/STUDY POPULATION: CTSA T trainees and K scholars were surveyed in May-June 2023 to assess the impact of the COVID-19 pandemic on training and career development. Data were included from 309 T trainees and K scholars appointed in 2018-2023 at 50 institutions, with good representation from states that were heavily impacted by COVID. Respondents included 76 past and 64 current T trainees, and 56 past and 113 current K scholars. There were no significant differences in race, ethnicity, or gender between T and K respondents. Significantly more K scholars reported both being married or in a committed relationship, and having children. Survey items included the same questions asked in the 2020 survey, plus additional new questions. Results compare impact for T trainees and K scholars. RESULTS/ANTICIPATED RESULTS: K scholars were more negatively impacted for access to clinic/human subjects, home environment, child care, access to staff, increased clinical responsibilities, and other hospital service. T trainees and K scholars reported higher positive impact than in 2020, for having more time to think/write and develop new research ideas. About 2/3 of respondents reported returning to research full-time by April 2021, and the remaining by August 2021. Lasting changes in career progression or research direction were reported as both positive and negative (48%), negative (25%), or positive (10%). Most (2/3) respondents in faculty positions reported that a time extension was available for promotion and/or tenure. Additional in-depth analysis will be presented, based on qualitative analysis of open-ended questions. DISCUSSION/SIGNIFICANCE: Despite research shutdowns in response to the COVID-19 pandemic that lasted for about a year, CTSA T trainees and K scholars were remarkably resilient. They were able to continue some research activities and professional development activities, and developed strategies to maintain productivity and minimize impact on their training duration.

Perspectives of Oncologists on the Ethical Implications of Using Artificial Intelligence for Cancer Care

Artificial intelligence (AI) tools are rapidly integrating into cancer care. Understanding stakeholder views on ethical issues associated with the implementation of AI in oncology is critical to optimal deployment. To evaluate oncologists' views on the ethical domains of the use of AI in clinical care, including familiarity, predictions, explainability (the ability to explain how a result was determined), bias, deference, and responsibilities. This cross-sectional, population-based survey study was conducted from November 15, 2022, to July 31, 2023, among 204 US-based oncologists identified using the National Plan & Provider Enumeration System. The primary outcome was response to a question asking whether participants agreed or disagreed that patients need to provide informed consent for AI model use during cancer treatment decisions. Of 387 surveys, 204 were completed (response rate, 52.7%). Participants represented 37 states, 120 (63.7%) identified as male, 128 (62.7%) as non-Hispanic White, and 60 (29.4%) were from academic practices; 95 (46.6%) had received some education on AI use in health care, and 45.3% (92 of 203) reported familiarity with clinical decision models. Most participants (84.8% [173 of 204]) reported that AI-based clinical decision models needed to be explainable by oncologists to be used in the clinic; 23.0% (47 of 204) stated they also needed to be explainable by patients. Patient consent for AI model use during treatment decisions was supported by 81.4% of participants (166 of 204). When presented with a scenario in which an AI decision model selected a different treatment regimen than the oncologist planned to recommend, the most common response was to present both options and let the patient decide (36.8% [75 of 204]); respondents from academic settings were more likely than those from other settings to let the patient decide (OR, 2.56; 95% CI, 1.19-5.51). Most respondents (90.7% [185 of 204]) reported that AI developers were responsible for the medico-legal problems associated with AI use. Some agreed that this responsibility was shared by physicians (47.1% [96 of 204]) or hospitals (43.1% [88 of 204]). Finally, most respondents (76.5% [156 of 204]) agreed that oncologists should protect patients from biased AI tools, but only 27.9% (57 of 204) were confident in their ability to identify poorly representative AI models. In this cross-sectional survey study, few oncologists reported that patients needed to understand AI models, but most agreed that patients should consent to their use, and many tasked patients with choosing between physician- and AI-recommended treatment regimens. These findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions as well as decisional responsibility when problems related to AI use arise.

Teamwork Coaching in the Research Development Process

Proposal teams play a critical, yet understudied, role in team science. This study advances our understanding of teamwork coaching in the research development (RD) process by analyzing proposal support in a U.S. Medical School (2009–2019). We find that teamwork coaching mediates the positive association between team size and awarded outcomes. We also find that teams with proposer team familiarity need less teamwork coaching and that teamwork coaching is particularly valuable for teams with proposers who have both clinical and research responsibilities. We discuss contributions to team science and team coaching literatures as well as implications for training and educating RD coaches.

Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room

Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. ClinicalTrials.gov Identifier: NCT04701762.

Extending section 12 approval under the Mental Health Act to professions other than medicine.

Applications for detention under civil sections of the England and Wales Mental Health Act 1983 require at least one recommendation from a registered medical practitioner who is approved under section 12 of the Act. The Mental Health Act 2007 introduced multi-professional approved clinicians who may act as a patient's responsible clinician with responsibilities that include renewal of detention for treatment. Approved clinicians who are medical practitioners are automatically approved for section 12 purposes, whereas other approved clinicians are not. It is argued in this paper that this inconsistency is illogical, has implications for patient care and needs to be remedied.

Role of Medical and Nursing Practitioners in Times of Pandemic: Lessons Learned from the COVID-19 Crisis and Future Prospects

Context: The coronavirus disease 2019 (COVID-19) pandemic adversely affected the operation of health systems and services and dramatically increased the responsibilities of health professionals. Medical and nursing practitioners are an integral part of health care. They shouldered an important role in the fight against the novel coronavirus despite the potential risks. Evidence Acquisition: The present article applied a narrative approach to examine the nature and scope of the medical and nursing professions, especially during a pandemic or epidemic, and to describe the societal impact of the recent public health emergency. This study also analyzed the experience gained from the pandemic and how this could be used to ethically guide health services and clinicians through similar crises in the future. Results: The COVID-19 crisis revealed ethical dilemmas related to the retention of balance between the commitment to duty and the discretion to opt out. Health workers' obligation to treat derives from their professional role and is based on scientific, moral, and legal grounds. A pandemic mandates health staff to work at the limits of their competencies and entails the risk of infection with the pathogen, physical exhaustion, and emotional stress. The tremendous toll on society and health care due to the spread of a pathogen needs to be managed. The responsibility of clinicians to care for the sick is at the core of any successful response to a pandemic. Protective measures, safety training, sustainable working hours, and moral and fiscal compensation are essential prerequisites for the fulfillment of their tasks. Conclusions: Despite the reduced clinical severity associated with new variants, individual and collective fatigue among doctors and nurses continues to exist. The most recent epidemiological indicators show that the COVID-19 pandemic is still progressing but with a decelerating rhythm. In addition, preparation for a potentially catastrophic future pandemic is appropriate. Therefore, there is no time for complacency. All the involved parties need to ensure that health professionals uphold the mission of their profession.

Patients’ sense of security from clinical factors in Iran: a cross-sectional study

BackgroundOne of the clinical responsibilities and goals of hospitals is to provide patients with comfort and security. The present study aims to assess patients’ sense of security among patients in Iranian hospitals.MethodsThe present research employed a cross-sectional design. The sample consisted of 830 patients visiting public, private, and social security hospitals in Mazandaran in the North of Iran. The required data were collected using a questionnaire developed by the researcher of this study.This questionnaire consisted of 4 dimensions:nursing, medical, advanced facilities and patient rights. The participants were selected using a proportional stratified random sampling method. Exploratory factor analysis, confirmatory factor analysis, descriptive statistics, and ANOVA were used for data analysis using SPSS version 22.ResultsThe mean scores of patients’ sense of security in social security, private, and public hospitals were 4.16 ± 0.89, 3.78 ± 0.67, and 3.60 ± 0.89, respectively. Medical factors with a mean and standard deviation of 3.92 ± 0.76, advanced facilities and equipment with 3.89 ± 0.89, nursing factors with 3.87 ± 0.73, and patient rights with 3.71 ± 0.90 were the highest to the lowest scores, respectively. The results showed that the type of hospital significantly affected the mean dimensions of security (p < 0.05).ConclusionsThe study revealed variations in the sense of securityacross the sampled hospitals. Particularly, the sense of security attributed to the patient rights factors was lower than other factors. Therefore, to enhance the sense of security for patients, it is recommended to focus on staff training and fostering a culturethat emphasizes obtaining informed consent, demonstrating respect for the patient, and introducing the medical team to the patient before initiating any treatment.

Supporting unpaid carers around hospital leave for people detained under the Mental Health Act (1983) in England: carer and practitioner perspectives

BackgroundWhen an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers’ instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave.MethodsSemi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis.ResultsThree themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers.ConclusionImplications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a ‘S.17 Standard’, a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.

Barriers and Facilitators to Collecting Surgical Outcome Data in Low- and Middle-Income Countries: An International Survey

Background: Perioperative data are essential to improve the safety of surgical care. However, surgical outcome research (SOR) from low- and middle-income countries (LMICs) is disproportionately sparse. We aimed to assess practices, barriers, facilitators, and perceptions influencing the collection and use of surgical outcome data (SOD) in LMICs. Methods: An internet-based survey was developed and disseminated to stakeholders involved in the care of surgical patients in LMICs. The Performance of Routine Information Systems Management framework was used to explore the frequency and relative importance of organizational, technical, and behavioral barriers. Associations were determined using χ 2 and ANOVA analyses. Results: Final analysis included 229 surgeons, anesthesia providers, nurses, and administrators from 36 separate LMICs. A total of 58.1% of individuals reported that their institution had experience with collection of SOD and 73% of these reported a positive impact on patient care. Mentorship and research training was available in &lt;50% of respondent’s institutions; however, those who had these were more likely to publish SOD (P = 0.02). Sixteen barriers met the threshold for significance of which the top 3 were the burden of clinical responsibility, research costs, and accuracy of medical documentation. The most frequently proposed solutions were the availability of an electronic data collection platform (95.3%), dedicated research personnel (93.2%), and access to research training (93.2%). Conclusions: There are several barriers and facilitators to collection of SOD that are common across LMICs. Most of these can be addressed through targeted interventions and are highlighted in this study. We provide a path towards advancing SOR in LMICs.

Clinical Full-Time Equivalent in PICUs: Survey of the U.S. Pediatric Critical Care Chiefs Network, 2020-2022.

To inform workforce planning for pediatric critical care (PCC) physicians, it is important to understand current staffing models and the spectrum of clinical responsibilities of physicians. Our objective was to describe the expected workload associated with a clinical full-time equivalent (cFTE) in PICUs across the U.S. Pediatric Critical Care Chiefs Network (PC3N). Cross-sectional survey. PICUs participating in the PC3N. PICU division chiefs or designees participating in the PC3N from 2020 to 2022. None. A series of three surveys were used to capture unit characteristics and clinical responsibilities for an estimated 1.0 cFTE intensivist. Out of a total of 156 PICUs in the PC3N, the response rate was 46 (30%) to all three distributed surveys. Respondents used one of four models to describe the construction of a cFTE-total clinical hours, total clinical shifts, total weeks of service, or % full-time equivalent. Results were stratified by unit size. The model used for construction of a cFTE did not vary significantly by the total number of faculty nor the total number of beds. The median (interquartile range) of clinical responsibilities annually for a 1.0 cFTE were: total clinical hours 1750 (1483-1858), total clinical shifts 142 (129-177); total weeks of service 13.0 (11.3-16.0); and total night shifts 52 (36-60). When stratified by unit size, larger units had fewer nights or overnight hours, but covered more beds per shift. This survey of the PC3N (2020-2022) provides the most contemporary description of clinical responsibilities associated with a cFTE physician in PCC. A 1.0 cFTE varies depending on unit size. There is no correlation between the model used to construct a cFTE and the associated clinical responsibilities.