Scope Of Practice Research Articles

Exploring Healthcare Provider Recruitment in a Rural and Frontier Community in Northern Idaho.

Limited U.S. research has been conducted examining factors affecting healthcare provider recruitment in rural settings, necessitating community-level investigations due to community differences. The aim of this study was to explore the factors involved in healthcare provider recruitment in a rural community in Northern Idaho. A retooled version of the Nursing Community Apgar Questionnaire (NCAQ) was used to collect data from 50 healthcare providers to assess items influencing provider recruitment. Items were categorized into five factors: geographic, economic, scope of practice, medical support, and facility and community support classes. Healthcare providers ranked items based on perceived importance and how advantageous or challenging it was to recruitment. A "Community Apgar" score is a composite score calculated using the advantage/challenge and importance scores. In our sample, medical support was rated as the most important class. Additionally, facility and community support was rated as the highest advantage class and had the most impactful Apgar scores, meaning it contained the most important advantage and challenge. Our findings suggest that these classes contain dominant factors related to the recruitment of providers in rural areas. Rural healthcare organizations seeking to improve the recruitment of healthcare providers should consider the potential impact of these factors on their population. Further investigations should be conducted on diverse rural samples across the U.S. to enable comparisons of research findings.

A longitudinal study of tick infestations and management practices in young stock smallholder dairy cattle in the Tanga region, Tanzania

A longitudinal study involving cohorts of young stock animals (<3 years old) kept on smallholder dairy farms in the Tanga region, Tanzania, was conducted to identify and quantify tick infestations and describe on-farm tick management practices. A total of 549 young stock were followed for 23 months, and 3127 grazing and acaricide treatment observations were obtained. Tick counts were low in the present study, and while more than 30% of animals had a tick on one occasion, most animals had no ticks at most examinations. The most commonly encountered spp. were R. appendiculatus, Boophilus spp., A. variegatum and R. evertsi. Most animals were zero-grazed, a management system that significantly limits animal exposure to ticks; however, grazed calves were more than three times more likely to carry R. appendiclatus and Boophilus spp. ticks than zero-grazed calves were (OR [odds ratio] = 4.4, P < 0.001; 3.6, P < 0.001). There were no significant differences among sampling rounds in the numbers of animals carrying R. appendiculatus ticks (likelihood ratio test P = 0.520). Hand spraying was the common method used, acaricides that require on farm dilution were most commonly used, and most farmers used this method at concentrations considerably less than those recommended by the manufacturer, most likely due to poor understanding, high cost (tempting them to over dilute) and weak extension/veterinary services. Variation in acaricide treatment frequency was not associated with variations in tick attachment, suggesting that most farms were under a strong acaricide regime or at irregular intervals or with tick-building resistance. Our findings suggest that geographic variations in vector densities might partly influence the extent of infection caused by tick-borne pathogens. The applicability of this study to large and extensive cattle production systems is recommended to widen the scope of tick management practices while generating additional data that will inform national tick and tick-borne disease control policy reform in Tanzania.

Reasons for encounters, diagnoses, and admission rate among emergency referrals at an urban primary care clinic in Japan: A retrospective cohort study

AbstractBackgroundComprehensive understanding of emergency referrals (EmR), encompassing reasons for encounters (RFEs) and diagnoses, is crucial for primary care physicians (PCPs). Comparing EmR rates and subsequent admission rates can potentially enhance the quality of primary care for EmR practice. However, no study has evaluated RFEs among patients with EmRs. This study aimed to identify RFE/diagnosis in relation to subsequent admission among patients receiving EmR.MethodsWe conducted a retrospective cohort study at an urban family physician teaching clinic in Kawasaki City, Japan. Our cohort recruited consecutive EmR episodes with their medical records and admissions confirmed through response letters from receiving hospitals. Using the 2nd edition of the International Classification of Primary Care, we explored the frequency of RFEs and diagnoses, calculating EmR rates and admission rates as primary outcomes. Bivariate analyses were employed to compare admission and non‐admission cases.ResultsThe present study encompassed 162 EmR episodes out of 47,901 visits, yielding an EmR rate of 3.38/1000 visits. Among 153 completely followed episodes, 99 patients were emergently admitted, resulting in a 64.7% admission rate. The admission group exhibited significantly higher age and a greater prevalence of dementia. Descriptive analysis revealed fever and pneumonia as the most frequent RFE and diagnosis, respectively, with significant differences between admission and non‐admission groups.ConclusionsThe present study reports EmR and admission rates following EmR, highlighting differences in patient characteristics, RFEs, and diagnoses. The findings offer insights to enhance PCPs' EmR practices and serve as a benchmark for the scope of EmR practice.

The case for a broader approach to AI assurance: addressing “hidden” harms in the development of artificial intelligence

AbstractArtificial intelligence (AI) assurance is an umbrella term describing many approaches—such as impact assessment, audit, and certification procedures—used to provide evidence that an AI system is legal, ethical, and technically robust. AI assurance approaches largely focus on two overlapping categories of harms: deployment harms that emerge at, or after, the point of use, and individual harms that directly impact a person as an individual. Current approaches generally overlook upstream collective and societal harms associated with the development of systems, such as resource extraction and processing, exploitative labour practices and energy intensive model training. Thus, the scope of current AI assurance practice is insufficient for ensuring that AI is ethical in a holistic sense, i.e. in ways that are legally permissible, socially acceptable, economically viable and environmentally sustainable. This article addresses this shortcoming by arguing for a broader approach to AI assurance that is sensitive to the full scope of AI development and deployment harms. To do so, the article maps harms related to AI and highlights three examples of harmful practices that occur upstream in the AI supply chain and impact the environment, labour, and data exploitation. It then reviews assurance mechanisms used in adjacent industries to mitigate similar harms, evaluating their strengths, weaknesses, and how effectively they are being applied to AI. Finally, it provides recommendations as to how a broader approach to AI assurance can be implemented to mitigate harms more effectively across the whole AI supply chain.

A COMPREHENSIVE ANALYSIS OF KINESIO TAPING'S EFFICIENCY IN VARIOUS MUSCULOSKELETAL DISORDERS

Background: Kinesio tape is a stretchable medical tape used to treat a different of conditions, including musculoskeletal problems. To summarise all relevant data regarding the therapeutic efficacy of Kinesio taping for the treatment of improving pain and functional skills in various musculoskeletal conditions, a systematic review and network meta-analysis approach were employed. Aim: To ascertain whether Kinesio taping is a beneficial tool to decrease pain and functional abilities in different musculoskeletal conditions. Method: A comprehensive research on PubMed, Medline, Google Scholar, and Science Direct database using keywords kinnesiotaping, musculoskeletal conditions, disorders, injuries, and physiotherapy evidence-based database was utilized for assessment. Results: This reviews findings demonstrate that Kinesio taping will improve in the pain and functional abilities in the Musculoskeletal conditions. Conclusion: This reviews findings provide enough proof that Kinesio taping will improve in the pain and functional abilities in the different musculoskeletal conditions. KEYWORDS: Kinesio taping, taping techniques, musculoskeletal conditions, sham taping, scope of practice, evidence-based practice.

Vaginal Birth After Cesarean Section: Outcomes of Women Receiving Midwifery Care in Ontario

Providing care to women with a history of cesarean section is within the scope of practice of Canadian midwives, and midwifery care may be of benefit to women who plan a vaginal birth after cesarean section. This retrospective cohort study describes the birth outcomes of women with a history of cesarean section cared for by a midwife in Ontario between April 1, 2003 and March 31, 2008 (n= 3262). The primary outcome was cesarean section, and the secondary outcome was perinatal mortality. The overall rate of cesarean section in this cohort was 46.1%, but among women who laboured the rate of cesarean section was 28.8%. There was not a statistically significant difference in perinatal mortality (excluding congenital anomalies and stillbirth prior to labour) when women with a history of cesarean section (0.18%) were compared to those without (0.20%), p=0.99. This study demonstrates positive outcomes for both mothers and babies when midwives are primary care providers during the intrapartum period for women with a history of cesarean section. There is a need to explore the factors contributing to the high rate of planned repeat cesarean section in this cohort.

The Development of an Opioid Misuse Training Program for Physical Therapists: A Learning Community Approach.

Musculoskeletal pain and opioid misuse frequently co-occur. The US Preventive Services Task Force calls for all health care providers to be trained to screen for misuse and/or opioid use disorder. The purpose of this study was to develop and implement an opioid misuse training program that could be used by physical therapists. Thirteen practicing physical therapists were invited to participate in a curriculum development project. Using the Curriculum Framework, a collaborative learning approach was used to develop an opioid misuse training program and training manual for physical therapists. Four training sessions were provided virtually every 2 weeks. Topics included an introduction to the opioid crisis, screening, assessing, and communicating with patients and with the health care team about opioid misuse. Each didactic session was followed by a participant feedback session where participants provided recommendations on improving the training content and their impressions on the barriers and facilitators to incorporating the training into practice. A companion training manual was created and sent to participants for comment. Participants were asked over email to describe whether and how they incorporated training materials into clinical practice during the training curriculum. All participants attended sessions 1-3. Twelve (92.3%) attended the fourth session. Based on the participants' feedback, training sessions were edited, and a companion training manual was finalized and distributed to each participant. After the fourth session, 9 participants (69.2%) reported using what they learned in the training. During the participant feedback sessions, participants regarded the training as important. Some participants expressed barriers to discussing opioids with patients and concerns about whether the training was within physical therapists' scope of practice. An iteratively developed training program for physical therapists to address opioid misuse was acceptable, feasible, and provided immediate practice change by most participants.

Scope of Practice: Shared Decision-Making For Patient-Centered Care

Shared decision-making (SDM) represents a collaborative model of healthcare decision-making, contrasting the traditional unidirectional approach where physicians solely determine medical choices. SDM engages patients in evaluating options based on individual goals and values. In various clinical scenarios, SDM proves indispensable, enhancing patient satisfaction, treatment adherence, and reducing the likelihood of blaming physicians for adverse outcomes. Illustrated by the BRAN questions in the UK, SDM serves as a tool to explore benefits, risks, alternatives, and the option of doing nothing. Notwithstanding its benefits, SDM encounters implementation challenges, including time constraints and varying patient priorities. Elderly patients may face cognitive barriers, exacerbated by limited clinical trials catering to diverse geriatric needs. Nevertheless, SDM offers significant advantages, fostering strong patient-physician relationships, aligning with patient-centered care principles, and yielding positive outcomes. Physicians must integrate SDM consciously into clinical practice, recognizing its potential to improve patient satisfaction, quality of life, and overall healthcare outcomes. Bangladesh J Medicine 2024; 35: 122-123

Missed care or missed opportunities in general practice nursing

BackgroundResearch into missed care has been conducted in various acute and some community healthcare settings; however, the experiences of general practice nurses (GPNs) are poorly represented in the literature. AimTo explore the role of the GPN and whether care activities are missed. MethodsA qualitative descriptive design was used, employing semistructured interviews with 10 participants. The participants were GPNs working in a metropolitan or regional general practice in Australia, with a minimum of three years of experience in the role. A six-step process for thematic analysis was utilised for the extraction and presentation of findings. FindingsGPNs rarely miss care; it is either delayed or rescheduled. Findings illustrate missed opportunities to provide care and enhance the role of the GPN. Factors contributing to missed opportunity are as follows: (i) difficulties navigating the GPN–general practitioner (GP) relationship, (ii) GPNs lack ongoing education commensurate with their scope of practice, (iii) Medicare policy fails to fund the GPN role, (iv) a rise in the number of salaried GPs leads to time pressures that limit the GPN role, (v) scope of practice constrained by time deficits, and (vi) communication problems within a siloed healthcare system limit GPN scope of practice. DiscussionThe initial aim was to identify missed care; however, findings suggest that GPNs rarely miss care, but they do miss opportunities to provide care and practice to their full scope. ConclusionInternal and external factors specific to the general practice context can contribute to missed opportunities for the work of the GPN.

Advanced Practice Pediatric Oncology Nursing as Imagined or In Place in Four Lower- and Upper-Middle-Income Countries

The implementation of pediatric oncology advanced practice nurse (s) roles in low- and middle-income countries (LMICs) presents opportunities and challenges. The authors explore the implications of pediatric oncology advanced practice nursing roles in Pakistan, Cameroon, Turkey, and Mexico. Potential benefits and drawbacks of advanced practice nursing roles, impacts on nursing care, and strategies for advanced practice nursing role development in LMIC settings are considered. Information from scholarly articles, policy documents, and four LMIC pediatric oncology nurse expert perspectives on existing and imagined advanced practice nursing roles in pediatric oncology in LMIC were synthesized. Current literature and policies point to efforts across LMICs to establish a wide variety of advanced nursing practices, not necessarily aligned with internationally accepted advanced practice nursing standards of practice or education. The LMIC nurses describe a wide range of national general nurse education and government advanced practice nurse recognition/licensing. Challenges to achieving or strengthening advanced practice nursing roles include, for example, healthcare professional resistance, government unwillingness to recognize/license advanced practice nurses, and lack of advanced practice nursing faculty. To promote a pediatric oncology advanced practice nursing role in LMICs requires navigating the national nursing scope of practice and nursing culture. The strategic introduction of pediatric oncology advanced practice nursing roles in LMICs has the potential to significantly enhance patient care by, for example, addressing healthcare workforce shortages and facilitating timely care delivery. However, challenges related to role complexity, resistance from traditional healthcare structures, and role overlap must be considered. Tailoring these roles to local contexts and fostering stakeholder collaboration are essential for successful implementation. The adoption of advanced practice nursing roles can lead to improved quality of care for pediatric oncology patients and their families in LMICs, where cancer care is challenging. The positive impact of pediatric oncology advanced practice nurses on patient outcomes and healthcare delivery cannot be discounted but must align with local nursing and healthcare culture and expectations.

Nurse Practitioner Care, Scope of Practice, and End-of-Life Outcomes for Nursing Home Residents With Dementia

Nursing home residents with Alzheimer disease and related dementias (ADRD) often receive burdensome care at the end of life. Nurse practitioners (NPs) provide an increasing share of primary care in nursing homes, but how NP care is associated with end-of-life outcomes for this population is unknown. To examine the association of NP care with end-of-life outcomes for nursing home residents with ADRD and assess whether these associations differ according to state-level NP scope of practice regulations. This cohort study using fee-for-service Medicare claims included 334 618 US nursing home residents with ADRD who died between January 1, 2016, and December 31, 2018. Data were analyzed from April 6, 2015, to December 31, 2018. Share of nursing home primary care visits by NPs, classified as minimal (<10% of visits), moderate (10%-50% of visits), and extensive (>50% of visits). State NP scope of practice regulations were classified as full vs restrictive in 2 domains: practice authority (authorization to practice and prescribe independently) and do-not-resuscitate (DNR) authority (authorization to sign DNR orders). Hospitalization within the last 30 days of life and death with hospice. Linear probability models with hospital referral region fixed effects controlling for resident characteristics, visit volume, and geographic factors were used to estimate whether the associations between NP care and outcomes varied across states with different scope of practice regulations. Among 334 618 nursing home decedents (mean [SD] age at death, 86.6 [8.2] years; 69.3% female), 40.5% received minimal NP care, 21.4% received moderate NP care, and 38.0% received extensive NP care. Adjusted hospitalization rates were lower for residents with extensive NP care (31.6% [95% CI, 31.4%-31.9%]) vs minimal NP care (32.3% [95% CI, 32.1%-32.6%]), whereas adjusted hospice rates were higher for residents with extensive (55.6% [95% CI, 55.3%-55.9%]) vs minimal (53.6% [95% CI, 53.3%-53.8%]) NP care. However, there was significant variation by state scope of practice. For example, in full practice authority states, adjusted hospice rates were 2.88 percentage points higher (95% CI, 1.99-3.77; P < .001) for residents with extensive vs minimal NP care, but the difference between these same groups was 1.77 percentage points (95% CI, 1.32-2.23; P < .001) in restricted practice states. Hospitalization rates were 1.76 percentage points lower (95% CI, -2.52 to -1.00; P < .001) for decedents with extensive vs minimal NP care in full practice authority states, but the difference between these same groups in restricted practice states was only 0.43 percentage points (95% CI, -0.84 to -0.01; P < .04). Similar patterns were observed in analyses focused on DNR authority. The findings of this cohort study suggest that NPs appear to be important care providers during the end-of-life period for many nursing home residents with ADRD and that regulations governing NP scope of practice may have implications for end-of-life hospitalizations and hospice use in this population.

Professional regulation in the digital era: A qualitative case study of three professions in Ontario, Canada.

Technology is transforming service delivery and practice in many regulated professions, altering required skills, scopes of practice, and the organization of professional work. Professional regulators face considerable pressure to facilitate technology-enabled work while adapting to digital changes in their practices and procedures. However, our understanding of how regulators are responding to technology-driven risks and the impact of technology on regulatory policy is limited. To examine the impact of technology and digitalization on regulation, we conducted an exploratory case study of the regulatory bodies for nursing, law, and social work in Ontario, Canada. Data were collected over two phases. First, we collected documents from the regulators' websites and regulatory consortiums. Second, we conducted key informant interviews with two representatives from each regulator. Data were thematically analyzed to explore the impact of technological change on regulatory activities and policies and to compare how regulatory structure and field shape this impact. Five themes were identified in our analysis: balancing efficiency potential with risks of certain technological advances; the potential for improving regulation through data analytics; considering how to regulate a technologically competent workforce; recalibrating pandemic emergency measures involving technology; and contemplating the future of technology on regulatory policy and practice. Regulators face ongoing challenges with providing equity-based approaches to regulating virtual practice, ensuring practitioners are technologically competent, and leveraging regulatory data to inform decision-making. Policymakers and regulators across Canada and internationally should prioritize risk-balanced policies, guidelines, and practice standards to support professional practice in the digital era.

The perceptions of first point of contact roles in primary care by pre-registration students of the allied health professions.

To develop a better understanding of the perceptions of first point of contact roles within primary care by pre-registration students of the Allied Health Professions (AHPs). General practice in the UK is under growing pressure from declining general practitioner (GP) numbers and increased service demand. The National Health Service (NHS) is attempting to mitigate this demand by making more effective use of its highly experienced workforce through the creation of first contact practitioners (FCPs). Working in primary care, FCPs are highly experienced AHPs with three or more years of relevant clinical experience. An abductive qualitative research approach underpinned by a descriptive phenomenological methodology was adopted. Thematic analysis was used to analyse the focus group transcripts. Twenty two final-year pre-registration AHP students participated in three focus groups. Two themes with sub-themes were identified: (1) Understanding of the role-pathway to the role; role clarity; and sources of knowledge. (2) Impact on service-positives and challenges. This study synthesised new findings from the previously unexplored FCP stakeholder of pre-registration AHP students. Participants generally understood the FCP's purpose of unburdening GPs and perceived the FCP model to contribute to the solution of rising clinical and financial pressures within the NHS, and primary care specifically. However, there was confusion regarding the scope of practice of an FCP. It is vital that the future workforce understand this role through effective education.

Identifying strategies to support implementation of interprofessional primary care teams in Nova Scotia: Results of a survey and knowledge sharing event

BackgroundInterprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada.MethodsHealthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning.ResultsIPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities.InterpretationThis research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients.

Perinatal Outcomes for Four Toronto Midwifery Practices: Exploring Best Practices for Normal Birth

This study explores outcomes from four Toronto midwifery practices from 2003 to 2007, using data from the Midwifery Outcomes Database to look at similarities and differences between the practices and with provincial averages. The goals of our project included establishing a university/community partnership with the participating practices, which included Ryerson and McMaster University faculty members; improving capacity among midwives with using a provincial database; and producing a comprehensive perinatal outcomes report for midwifery practices that could be used for internal review and for presentation at interprofessional forums such as hospital rounds and interprofessional conferences. A comparative analysis between the practices and with the provincial midwifery data showed several trends, including an increased incidence of late maternal age, low rates of intervention, and high rates of home birth. Our research raises questions about scope of practice and best practices for supporting normal birth. This article has been peer reviewed.

A Qualitative Assessment of Factors in the Uptake of Midwifery Among Diverse Populations in Thunder Bay, Ontario

Introduction: Although the uptake of midwifery in Thunder Bay, Ontario, is above the provincial average, it is well below the World Health Organization–suggested level. Midwifery is especially underutilized by Indigenous women and by recent immigrant, refugee, and asylum-seeking women. Objective: To explore factors shaping birth-attendant choices and decisions of diverse women in northwestern Ontario. Methods: Drawing on data from a larger pilot study, this paper discusses factors in choosing midwifery for Indigenous, Euro-Canadian, and visible-minority (VM) women in Thunder Bay. Using in-depth interviews, we explored where the women obtained information regarding birth-attendant options, how and why they chose their caregiver, and their perceptions of the quality of their maternal care experiences. Results: Participating women’s birth-attendant choices and experiences were influenced by (1) health care provider and/or social network awareness of (and attitudes towards) midwifery; (2) personal knowledge; (3) access to midwifery; and (4) understanding of the pregnancy as being on a medical risk continuum or as a normal, healthy process. Additional influences for VM women include a lack of formally educated midwives and social status gained through having a physician in their country of origin. Additional influences for Indigenous women were the effects of colonization, discrimination, and racism. Conclusion: Women (particularly VM and Indigenous women), their families, and health care providers in northwestern Ontario need more and easier access to midwives and to knowledge about their services and scope of practice. Also, increased focus on antiracist and culturally safe practice in health care provider curricula would help improve care for Indigenous women. This article has been peer reviewed.

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

Occupational therapy assessments and interventions for patients with ankylosing spondylitis: a scoping review protocol.

The proposed scoping review aims to explore the literature on the occupational therapy (OT) scope of practice for patients with ankylosing spondylitis (AS), including assessment methods and intervention approaches used by OT practitioners, areas of impairment addressed, and practice settings where OT practitioners provide services. AS is a type of spondyloarthritis primarily involving inflammation of the spine. Studies have begun to examine the role of OT in addressing pain, function, and disability among AS patients. Given the increased recognition of OT services for this population, a comprehensive understanding of the assessment methods and intervention approaches used by OT practitioners when working with AS would benefit clinicians, providers, and patients and support future research efforts. The review will consider studies that include participants of any age diagnosed with AS and any form of OT assessment and intervention. All relevant published and unpublished studies will be considered, without date or language limitations, including all primary studies, gray literature, text and opinion papers, and clinical guidelines. The review will follow the JBI methodology for scoping reviews. Searches will be conducted in MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), Scopus (EBSCOhost), PsycINFO, ProQuest Dissertations and Theses Global, SportDiscus (EBSCOhost), OTDBase, OTSeeker, and Google Scholar. Two independent reviewers will extract data from selected papers using a standardized tool modified for the review. The results will be presented using frequency tables and will be accompanied by a narrative summary. https://doi.org/10.17605/OSF.IO/VPY56.

Ontario Midwives’ Attitudes About Abortion and Abortion Provision

Objective: In Ontario and across Canada, midwives do not provide pregnancy termination but provide referrals and support for clients. This differs from a number of international jurisdictions where abortion has been added to the midwifery scope of practice, resulting in safe outcomes for women and improved access to services. This study sought to survey Ontario midwives’ general attitudes towards abortion and willingness to incorporate abortion into the midwifery scope of practice. Ethics approval for the study was obtained from the Ryerson University Research Ethics Board. Methods: An Internet-based cross-sectional survey was sent to all registered midwives in Ontario via the Association of Ontario Midwives. The survey consisted of seven sections, with a total of 43 Likert scale questions, 17 general questions, and space for open-ended comments at the end of each section. Comments were coded and analyzed for common themes. Results: The survey was distributed to 523 midwives, all of the midwives registered in Ontario at the time of the study (2011). A total of 359 midwives participated, representing a response rate of 68% of all registered midwives in Ontario. The majority of respondents identified themselves as pro-choice; however, there were “limits to choice” expressed by many participants. Abortion was considered less acceptable at later gestations or for specific reasons such as gender selection or minor fetal anomalies. Study participants were divided over whether abortion should be added to midwifery scope of practice. Comfort with providing abortion services decreased as procedures were perceived to be more invasive or as requiring more medical expertise. The addition of misoprostol to Ontario midwives’ pharmacopoeia for early medical terminations was the most favoured expansion for midwifery scope of practice. Respondents were less willing to add surgical techniques to midwifery scope of practice. Midwives identified the current models of compensation and practice in Ontario, issues related to hospital integration, and opposition from clients as significant barriers to the provision of abortion services. Limited education about abortion during midwifery training and the desire for more learning opportunities were additional themes that emerged in this study. Conclusion: This is the first study in Canada about midwives’ attitudes towards abortion and the inclusion of abortion within midwifery scope of practice. Further research in other Canadian jurisdictions would be useful to examine systemic issues, barriers, and attitudes at a national level. For abortion to be included within the scope of practice of Ontario midwives, issues related to the current model of care, compensation, and supplemental education would need to be addressed. This article has been peer reviewed.

A Transdisciplinary Approach to the Occupational Therapist and Speech-Language Pathologist Collaboration

ABSTRACT In the United States, occupational therapy and speech-language pathology are two school-based therapeutic disciplines with clear guidelines and scopes of practice set forth by both federal and state regulatory boards. Although the scopes of practice are specific to each discipline, the boundaries often blend, requiring therapists to depend upon one another and be respectful of each other’s perspectives to transcend expected therapeutic outcomes. Multidisciplinary, interdisciplinary, and transdisciplinary are three levels of occupational therapy and speech-language pathology collaboration in the school environment. A transdisciplinary approach is the optimal level of collaboration occupational therapists and speech-language pathologists should strive for in order to improve student outcomes. SpOT Group provides a framework for occupational therapists and speech-language pathologists to incorporate differentiated lesson plans to meet the diverse needs of students while documenting services for billing and licensing purposes. SpOT Group also examines the common barriers to a transdisciplinary collaborative approach including funding, competency, and role release. Following the SpOT Group framework occupational therapists, speech-language pathologists, and their respective students can collectively support goals and support student outcomes.