Referral Source Research Articles

Mind the gap. Service evaluation and improvement: The management of children and young people in a private physiotherapy clinic

Keywords: Service evaluation; Children and Young People; Scope of practice Purpose: As autonomous practitioners, physiotherapists are responsible for assessing, developing and maintaining their competence in their areas of practice. This needs to be acknowledged by the organisations in which they work, to support and optimise the skillset of their workforce. It was identified that the number of children and young people (CYP) presenting to a large private physiotherapy company (seeing predominantly adult patients) had risen significantly in recent years, and it was unclear what competence and confidence existed among staff to be managing this cohort safely and effectively. Objective: To understand the needs of the CYP attending the clinics, and evaluate this against the competence and confidence of the physiotherapists they presented to. Methods: A multi-methods design was used. A notes audit was conducted across three one month periods: collecting data on patient age, referral source, diagnosis and subsequent pathway (immediate onward referral, discharge, further physiotherapy). This was followed by a series of focus groups involving staff in the physiotherapy clinics, to evaluate their competence and confidence in managing CYP. Physiotherapists were presented five case studies and asked to rate their perceived confidence on a 4-point Likert scale before and after a discussion around diagnosis, differential diagnoses, appropriate management and clinical reasoning. Results: 138 new-patient contacts were included in the notes audit. Over 97% over these were aged between 8 and 17 years. 35% were classified as ‘MSK pain’, 22% apophysitis, 14% sports injury/trauma and 8% orthopaedic/post fracture. ‘Outliers’ to these groups had a much higher rate of being referred onwards, or back to source (deemed an inappropriate referral): 71%, compared to <10% for all other groups. 27 physiotherapists took part in the focus groups. Open questions revealed ambiguity around expectation to accept referrals for CYP, and policies/procedures relating to CYP. The case studies highlighted a trend for confidence scores to be lower where staff were less accurate with diagnosis. Factors such as age <8 years, paediatric-specific red flags, and self-referral led to lower confidence levels. Across all case studies, confidence levels were lower following discussion. This was identified as having a positive impact on physiotherapists engagement with the projects next steps. Conclusion(s): A structured service evaluation demonstrated a disparity between the CYP attending physiotherapy, and the skillset of physiotherapists: potentially jeopardising the safety and quality of service delivered. It was agreed with key stakeholders that developing a minimum competence framework specific to the physiotherapists seeing CYP at the company would be a prudent starting point. Adjustments to policy and procedures/administrative tasks alongside this, would signpost to those referring in to the service and better reflect the capacity of all staff to manage CYP attending the clinics. Impact: The implementation of a minimum competency framework seeks to improve the lowest quality patient-physio interactions, improving safety and staff satisfaction. A secondary effect will be to improve the average interaction and ultimately create a platform from which gold–standard, effective physiotherapy can become the norm for CYP. The process may highlight the merit of a similar approach for other patient groups at risk of being marginalised. Funding acknowledgements: This work was not funded.

A Quality Improvement Initiative: A Nurse Practitioner-Led Interdisciplinary Approach to Reducing Readmissions in the Subacute Population.

To decrease the 30-day Subacute Readmissions in an outpatient facility by using an Advanced Practice Nurse (APN) Project Leader while applying evidence based transitional care processes. Determine the effects of APN leadership within the Interdisciplinary Team in the subacute setting. Immersion of an APN as Project Leader over a 12-week period. Outcomes were divided into three groups. They were reorganized and analyzed. The new breakdown included patients readmitted plus hospice referrals (n = 5) and those not readmitted (n = 4). A significant difference in the 30-day outcomes as well as the LACE variable comorbidity scores t (4) = 2.95, p = 0.0418 were identified. The 30-day readmission rates were decreased using hospice as a referral source. Application of the Lippitt's Model of Planned Change and the use of the LACE Scoring Tool were instrumental to the success of this project. To improve optimal outcomes it is necessary for the APN/Doctor of Nursing Practice (DNP) and other healthcare professionals to engage in collaborative practices that result in effective policy changes. This quality improvement project restructured the existing Interdisciplinary Team processes to include the APN Project Leader with improved patient-centered outcomes.

Beyond Xs and Os: The Role of an Athletic Trainer in Supporting Disordered Eating in College Athletes

One subset of the college population that is at-risk of developing an eating disorder or signs of disordered eating are college athletes. College athletes face both internal and external pressures to remain fit. Of particular importance for this study is the role of the athletic trainer (ATs) in helping college athletes with a diagnosed eating disorder or patterns of disordered eating. This study followed a logical, systematic, and multiphase phenomenological approach to capturing reflections of athletic trainers’ (n = 7) subjective experiences related to managing student-athletes who have a diagnosed eating disorder. Using an open-ended interview guide, athletic trainers participated in an intensive interview with one of the researchers. Researchers categorized statements into one of three themes: (1) AT and college athlete relationship, (2) barriers to care, and (3) opportunities for improvement. These results provide insight concerning the intersection of ATs and their role in addressing eating disorders with college athletes. ATs play an important role in providing both support to aid physical recovery from ailments and injuries and also serve as a source of psychosocial referral and support.

The COVID-19 pandemic is associated with a change in origin of pathways to diagnosis of pancreatic cancer: a single-centre retrospective analysis

Background: Pancreatic cancer presents through a variety of pathways including suspected diagnosis from primary care and through assessment of symptomatology on an acute inpatient basis. Emergency, symptomatic presentations are associated with a poorer prognosis; therefore a change in the pathway to diagnosis could have a significant impact on patient diagnoses and outcomes. The COVID-19 pandemic has altered access to healthcare, and the effect of the COVID-19 pandemic on the source of pancreatic cancer referrals has not been explored.

CLINICAL AND SOCIODEMOGRAPHIC PROFILE OF PATIENTS PRESENTING TO CONSULTATION LIAISON PSYCHIATRY CARE IN A TERTIARY CARE HOSPITAL IN SOUTH KASHMIR

Background: Consultation-liaison psychiatry is a sub specialty of Psychiatry that involves the study, practice and teaching of the relation between medical and psychiatric disorders. There is relatively insufficient data that studies the profile of consultation-liaison psychiatry across developing nations. Aims:To study the clinical and sociodemographic profile of patients presenting to consultation-liaison psychiatry care in a tertiary care hospital in south Kashmir. Materials &amp; Methods:The present study included all the patients who were referred to Psychiatric department ,both inpatients as well as outpatients ,over a period of one year from January 2020 to December 2020.Data was collected using a semi structured pro forma and diagnosis was made using ICD-10 diagnostic criteria. Results:600 patients were included in our study, 332 of whom were females. Majority of patients belonged to age group of 21-40 and were residents of urban areas. The most common source of referrals included Cardiology followed by General Medicine. Depressive symptoms followed by suicidal attempts formed the majority of reasons for referral. The most common diagnosis established was Major Depression followed by Substance Use disorders. Conclusion: C L Psychiatry plays a significant role in bridging the gap between physical and mental illness and is vital for providing an integrated health service to the patients.

Impact of COVID-19 pandemic on ophthalmic presentations to an Australian outer metropolitan and rural emergency department: a retrospective comparative study

BackgroundTo analyse ophthalmic presentations to an outer metropolitan and a rural emergency department (ED) during the first wave of the COVID-19 pandemic in New South Wales (NSW), Australia.MethodsA retrospective comparative study of ophthalmic emergency presentations to Campbelltown Hospital (fifth busiest NSW metropolitan ED; population 310,000) and Bowral and District Hospital (rural ED; population 48,000) before and during COVID-19 was conducted. Patient demographics, triage category, referral source, diagnosis, length of stay, departure status, and follow-up location were assessed from coding data between March 1st to May 31st in 2019 and 2020, corresponding to the peak case numbers and restrictions during the first wave of the COVID-19 pandemic in NSW. Differences before and during COVID-19 were analysed using chi-squared tests or independent sample t-tests.ResultsThere was no change in ophthalmic presentations at Campbelltown (n = 228 in 2019 vs. n = 232 in 2020; + 1.75%, p = 0.12) and an increase at Bowral (n = 100 in 2019 vs. n = 111 in 2020; + 11%, p < 0.01) during COVID-19. Urgent ophthalmic presentations (Triage Category 3) decreased at Bowral (p = 0.0075), while non-urgent ophthalmic presentations (Triage Category 5) increased at both hospitals (Campbelltown p < 0.05, Bowral p < 0.01).ConclusionsThere was no change in the total number of ophthalmic presentations to an outer metropolitan and an increase to a rural ED during the first wave of the COVID-19 pandemic in New South Wales, Australia. A change in the type of ophthalmic presentations at these peripheral EDs suggest that a high demand for ophthalmic services remained despite the pandemic and its associated gathering and movement restrictions. A flexible healthcare delivery strategy, such as tele-ophthalmology, may optimise patient care during and after COVID-19.

Pathways of Psychiatric Treatment in Rural Patients with Psychosis

Background: Pathways of care support the development of care partnerships and empower patients and their care providers along with necessary modifications in the existing health services. Aim: To examine the various pathways of psychiatric treatment in rural patients with psychosis and to know the source of referral, first contact for treatment, awareness about the signs and symptoms and various symptoms (complains) with which the patients presented themselves to the different modalities of treatment. Methods: It was a cross sectional hospital based study conducted at Out-Patient Department of Ranchi Institute of Neuro-Psychiatry & Allied Sciences (RINPAS) Kanke, Ranchi. Purposive sampling technique was used for the study, total 96 participants were selected in 1 month duration. Subjects were evaluated using socio demographic datasheet, WHO counter form and BPRS-24. Results: The present study found that the mean duration of untreated psychosis was 558.80±707.08 days. First symptoms appeared at onset of illness, in which fearfulness (13.5%) appeared in most patients. Time taken to decide to go for consultation after onset of illness was 417.67±621.11 days. Maximum first consultations were to native & faith healers (69.8%) and only 17.7% consulted psychiatric services at first contact. For the first referral, 64.6% patients shifted to psychiatric services from other modes such as native / faith healer, general hospital and medical practitioner. CONCLUSION: The study provides an insight into the nature of the pathway and referral taken by rural patients with psychosis and their caregivers.Key Words: Pathways, Psychiatric treatment, rural patients.

Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors.

BackgroundPatient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons.ObjectiveThe purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level.MethodsThis was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information.ResultsPatient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups.ConclusionsThis study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors.

Demographics and outcome of dogs and cats enrolled in the PetSafe program at the Purdue University College of Veterinary Medicine: 2004-2019.

To determine the number and species of animals cared for by the PetSafe program at the Purdue University College of Veterinary Medicine (a community service offered to meet the short-term housing needs of pets, especially pets owned by victims of intimate partner violence) from 2004 through 2019 and collect information on duration of stay, outcome, health problems, and expenses. 229 animals cared for by the PetSafe program. Medical records were reviewed for information on species, breed, age, duration of stay, outcome of stay, client referral source, whether the animal had been cared for previously, health problems, medical interventions, and expenses incurred. There were 124 dogs, 95 cats, 6 ferrets, and 4 sugar gliders; 187 of the animals were returned to their owners, 37 were rehomed, and 5 were euthanized because of medical conditions. The most common health problems were dental disease and dermatological complaints (eg, flea infestation and resulting fleabite dermatitis). None of the animals had physical evidence of abuse. Mean duration of stay was 22 days (range, 1 to 93 days), and mean ± SD cost per animal was $368 ± $341. Over the 16-year period of the study, the number and species of animals cared for by the PetSafe program at Purdue and the health problems encountered in those animals were relatively stable, and the program was able to meet the relatively predictable financial costs incurred through existing sources of funding.

The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis.

IntroductionEarly intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement.MethodsThis cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017.ResultsTwenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments’ epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance.ConclusionIncreased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.

Agreement in the reporting of General Practitioner requested musculoskeletal radiographs: Reporting radiographers and consultant radiologists compared with an index radiologist

IntroductionThis study assessed the inter-observer agreement of reporting radiographers and consultant radiologists compared with an index radiologist when reporting General Practitioner (GP) requested musculoskeletal radiographs. The potential effect of discordant reports on patient management and outcome was also examined. MethodsThree reporting radiographers, three consultant radiologists and an index radiologist reported on a retrospective randomised sample of 219 GP requested musculoskeletal radiographs, in conditions simulating clinical practice. A speciality doctor in radiology compared the observers’ reports with the index radiologist report for agreement and assessed whether any discordance between reports was clinically important. ResultsOverall agreement with the index radiologist was 47.0% (95% CI, 40.5–53.6) and 51.6% (95% CI, 45.0–58.1) for the consultant radiologists and reporting radiographers, respectively. The results for the appendicular and axial skeleton were 48.6% (95% CI, 41.3–55.9) and 40.9% (95% CI, 27.7–55.6) for the radiologists, and 52.6% (95% CI, 45.2–59.8) and 47.7% (95% CI, 33.8–62.1) for the radiographers, respectively. The difference in overall observer agreement between the two professional groups with the index radiologist was not statistically significant (p = 0.34). Discordance with the index radiologist's reports was judged to be clinically important in less than 10% of the observer's reports. ConclusionReporting radiographers and consultant radiologists demonstrate similar levels of concordance with an index radiologist when reporting GP requested musculoskeletal radiographs. Implications for practiceThese findings contribute to the wider evidence base that selected radiographers with appropriate postgraduate education and training are proficient to report on musculoskeletal radiographs, irrespective of referral source.

Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer.

Background The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than 100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public system aids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients with oral cancer is associated with socioeconomic factors.Material and Methods A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019. Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementary education; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) were analyzed by multiple logistic regression (p<0.05).Results Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018 (OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender, men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-white individuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referred by the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796).Conclusions It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associated with socioeconomic factors. Key words:Mouth neoplasms, oral diagnosis, health service coverage.

A Better Way to Run a Tongue Tie Service: A 10 year Service Evaluation

Introduction: The majority of OMFS units do not have a specific referral pathway for tongue ties, with many patients being seen on an ad hoc basis. Data collated from a 10 year service review highlights the service need for designated tongue tie clinics. Specific clinics reduce waiting times and provide a clear referral pathway for healthcare professionals involved in infant feeding. Objectives: To determine main source of tongue tie referrals, reasons for referrals and to assess complication rates. Methods: Data analysis captures 1159 babies who had tongue ties released between 2011 and July 2021 by one surgeon. The following data was analysed: referral source, gender, age, current feed, main problem (reason for referral) and complication rates. Data was stored on a secure NHS hard drive. Results: Average age at release in a one-stop clinic was 44 days, ranging from 1-275 days old. A 3:2 male to female ratio was observed. The most common source of referral was from midwives (31.8%). The main reasons for referral were issues with breastfeeding (74.2%) and bottle feeding (18.3%). Time from referral to procedure was reduced after dedicated clinics were started. There were no serious complications, and a low rate of minor complications. Conclusions: The release of tongue ties is a quick, safe procedure. Waiting times were reduced once dedicate clinics started. Clinics were able to run safely through the pandemic, with direct access from the car park to the clinic, without need to use corridors or lifts. Introduction: The majority of OMFS units do not have a specific referral pathway for tongue ties, with many patients being seen on an ad hoc basis. Data collated from a 10 year service review highlights the service need for designated tongue tie clinics. Specific clinics reduce waiting times and provide a clear referral pathway for healthcare professionals involved in infant feeding. Objectives: To determine main source of tongue tie referrals, reasons for referrals and to assess complication rates. Methods: Data analysis captures 1159 babies who had tongue ties released between 2011 and July 2021 by one surgeon. The following data was analysed: referral source, gender, age, current feed, main problem (reason for referral) and complication rates. Data was stored on a secure NHS hard drive. Results: Average age at release in a one-stop clinic was 44 days, ranging from 1-275 days old. A 3:2 male to female ratio was observed. The most common source of referral was from midwives (31.8%). The main reasons for referral were issues with breastfeeding (74.2%) and bottle feeding (18.3%). Time from referral to procedure was reduced after dedicated clinics were started. There were no serious complications, and a low rate of minor complications. Conclusions: The release of tongue ties is a quick, safe procedure. Waiting times were reduced once dedicate clinics started. Clinics were able to run safely through the pandemic, with direct access from the car park to the clinic, without need to use corridors or lifts.

Delay in presentation and reperfusion therapy in ST-segment elevation myocardial infarction: Gaps between practice and the guidelines

Developing an efficient regional ST-segment elevation myocardial infarction (STEMI) network in our country has become a challenging priority. In our study, we aimed to assess the factors associated with prolonged delays to reperfusion in STEMI patients treated with Primary PCI or rescue PCI. Patients with STEMI treated with PCI from 2018 until 2019 were prospectively enrolled. Subjects were classified according to the presence of diabetes and according to the origin of the referral. Delays from chest pain onset to the diagnosis of STEMI as well as delays from the diagnosis of STEMI to reperfusion therapy were analyzed. Our population consisted of 225 patients. Baseline characteristics were similar. Diabetes was not associated with longer delays to reperfusion while the source of referral was significantly associated with longer patient delays. In fact, patients out of Sousse had received lytic therapy 5,77 ± 4,12 hours after chest pain onset versus 3,76 ± 2,5 hours for patients in Sousse; P = 0,03. Also, it took 13,09 ± 6,44 hours for patients out of Sousse to diagnose STEMI and thus, decide to perform a primary PCI versus 5,36 ± 4,84 hours for patients in Sousse; P < 0,001. For the system delays, there was no significant difference in the delay from the failure of the lytic therapy to the rescue PCI for patients in Sousse compared to patients out of Sousse (4,5 ± 4,68 hours vs. 6,5 ± 4,34 hours; P = 0,069). However, the delay from the diagnosis of STEMI in the emergency department to the primary PCI was significantly longer for patients out of Sousse (0,76 ± 0,81 hours vs. 2,5 ± 0,64 hours; P < 0,001). Shortening the time from symptoms to reperfusion is a great challenge in STEMI care. To improve the overall care of patients with STEMI particularly in our country, improvements should be focusing on how to minimize the total ischemia time.

A retrospective audit of the introduction of a facial trauma admission Proforma

<b>Introduction</b>: Comprehensive documentation has particular pertinence when recording information for facial trauma patients. Patient records have a medico legal value, as a common aetiology of facial trauma is as a result of a criminal event. In addition notes ensure continuity of care whilst being reviewed by multiple members of the team and aid effective surgical decision. Commonly, documentation at presentation is incomplete and varied in format. This retrospective two-cycle audit analysed information captured at initial presentation of surgically managed mandibular fractures at the Queen's Medical Centre, Nottingham, to identify if an improvement in record keeping occurred using a dedicated trauma proforma. <b>Materials and Methods</b>: Ten clerking records before and after proforma introduction were accessed through Medway or DHR computer systems, and analysed against the minimum dataset for documentation stipulated by Royal College of Surgeons of England guidelines. These included dates of injury/assessment; referral source; mechanism of injury; medical history; occlusion; tenderness; dental trauma; imaging; diagnosis and management plan recording. The standard was that 100% of records were complete. <b>Results/Statistics</b>: Prior to the proforma, some data points were consistently not recorded; presence of pain (50%); dental trauma (30%); diagnosis (50%) and analgesia (30%). Overall, the proforma improved record keeping by 26% in data captured, particularly in domains that were poorly recorded. However it should be noted that one third of patients records examined in the second cycle, included completed proformas. <b>Conclusions/Clinical Relevance</b>: This audit demonstrated an increase in data quantity and quality, with the use of a dedicated proforma. With multiple handovers during shifts and frequent staff turnover, a structured proforma prevents information from being omitted and provides a way of obtaining the information needed, in a standardised, reproducible way. A structured proforma aids future audits and assessment of service performance. Furthermore, proformas provided a high education value to junior members of the team, who commonly admit trauma patients, and act as an aid-memoir to guide clinical examination. Consequently, digitalisation of this proforma on Medway, is planned to increase access to the proforma, which is particularly apt for this cohort of patients examined in this study, as access to a paper proforma has its limitations.

Strategic Vision for Business and Marketing in the Physical Therapy Industry

A thorough overview of healthcare, physical treatment, business growth, strategic planning, marketing tactics, and personal development is provided in this document. It covers push technologies, value propositions for patients, and a business model for wellness while addressing key issues in the physical therapy sector. It examines important healthcare hazards and presents a methodology for goodwill compensation. The work presents a strategic vision for business and marketing in the physical therapy sector, highlighting the significance of management, location, competitiveness, and technology adoption. Push technologies and patient value propositions are discussed, with an emphasis on improving patient care and working with referral sources. The business plan for wellness emphasizes the significance of controlling and preventing obesity. The document also explores the fundamental principles of physical therapy organizations and proposes five potential directions for practice growth. Additionally, it discusses important healthcare dangers, patient privacy issues, workplace violence, and infection preparedness, all of which are especially pertinent given the continuing COVID-19 pandemic. The significance of developing one’s own personal capital, including ongoing education and public speaking abilities, is emphasized. The article presents a strategy plan for health and wellbeing in a physical therapy facility with an emphasis on the mission, core values, current situation, goals, structure overview, particular tactics, and management. It discusses the development of human resources and financial resources and proposes a wellness program. The value of partnerships and the necessity of providing patients with helpful information regarding home exercise regimens are both stressed in the presentation of marketing tactics to ensure customer happiness. Indicators for a successful physical therapy practice and conditions for client satisfaction are provided in the document’s conclusion. This content, which focuses on enhancing patient care, expanding services, and fostering success and satisfaction in the industry, provides a thorough manual for healthcare professionals, organizations, and individuals looking to successfully navigate the industry’s constantly evolving landscape.

Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders.

Sex/gender-related factors contribute to contextual issues influencing the recognition of autism and attention-deficit/hyperactivity disorder (ADHD), and modulate how neurodevelopmental characteristics are manifested. This review summarizes the empirical literature to provide directions for improving clinical diagnostic practices. Timing of autism and/or ADHD diagnosis, particularly in girls/women, is related to the individual's developmental characteristics and co-occurring diagnoses, and expectancy, alongside gender stereotype biases, of referral sources and clinicians. This is further compounded by sex and gender modulations of behavioural presentations. The emerging 'female autism phenotype' concept may serve as a helpful illustration of nuanced autism phenotypes, but should not be viewed as essential features of autism in a particular sex or gender. These nuanced phenotypes that can present across sexes and genders include heightened attention to socially salient stimuli, friendship and social groups, richness in language expression, and more reciprocal behaviours. The nuanced female-predominant ADHD phenotypes are characterized by subtle expressions in hyperactivity-impulsivity (e.g., hyper-verbal behaviours). Optimizing neurodevelopmental diagnoses across sexes and genders also requires an understanding of sex-related and gender-related variations in developmental trajectories, including compensation/masking efforts, and the influences of co-occurring conditions on clinical presentations. Equitable diagnoses across sexes and genders for autism and ADHD require understanding of the nuanced presentations and the Gestalt clinical-developmental profiles, and addressing contextual biases that influence diagnostic practices.

Experiences of Canadian mental health providers in identifying and responding to online and in-person sexual abuse and exploitation of their child and adolescent clients

BackgroundSex offenders often use the internet to communicate with children to facilitate in-person sexual abuse or to create and distribute sexual images of children. Mental healthcare providers are a major source of referrals to child welfare authorities and are well-positioned to identify sexual exploitation. ObjectiveThis study investigated the perceived ability of mental healthcare workers to recognize and respond to concerns about online and in-person sexual exploitation of their pediatric clients. Participants and settingThe authors administered a cross-sectional survey to 209 mental healthcare providers within the public health system of Alberta, Canada. MethodsThe survey contained four sections related to sexual exploitation: two of which can take place online or in-person (grooming and sexual abuse) and two of which require the internet or a digital device (luring and sexual image distribution). Each section asked whether the mental healthcare provider had experience working with clients affected by these concerns, what barriers they encounter, how confident they are in their abilities and whether they have formal training in a topic. ResultsThe vast majority of participants (83%) worked with a client impacted by grooming, luring, sexual abuse or sexual image distribution in the last year. Participants reported more training, more confidence and fewer barriers when identifying and responding to sexual abuse as compared to grooming, luring or sexual image distribution. ConclusionsThere is a need to improve mental health providers understanding of how technology is being utilized to exploit children, so that they can respond effectively to protect their clients.

Social Work Training Intervention to Increase Referral Rates for Preventive Psychosis Services: A Randomized Trial

Purpose Social workers are employed in a broad range of community settings, in which they may be able to identify youth with emerging psychotic symptoms and facilitate connection to specialized services. Methods: This randomized controlled trial tested the efficacy of a training intervention for social workers ( N = 959) intended to increase the volume of referrals and rate of successful referrals to specialized early psychosis services. Results: During the 2-year study period, referrals to the early intervention program nearly doubled, t (df = 11) = 5.46, p &lt; 0.001. Additionally, the rate of successful referrals was greater among social workers who received the active training (41.7%) compared to the other referral sources (19.2%), X2 (df = 1, n = 311) = 3.69, p = 0.055. Conclusions: The active training was associated with a marginally greater rate of successful referrals. Overall referrals increased greatly during the training period although this could not be linked to specific participants, suggesting contamination effects may have increased community awareness of early intervention services.

The Challenge of Identifying Representative Samples in Research Involving Minority Participants

Determining participants' demographics, cognition, and functional performance by race is crucial to understanding disparities in clinical research on Alzheimer’s disease. We compared demographic and performance variables between Black/African American (B/AA; N=30; 41%) and White participants (N=43, 59%) in the UAB Alzheimer's Disease Center. Among 73 participants, 38 (52%) were women, mean age was 65.7 (SD 9.47), and mean education was 16 (2.31) years. Significant differences in gender proportions across race groups were observed. B/AA women represented 70 % of their race group, white women represented 39.5 %. There were no statistically significant differences in age, education, cognitive or functional severity, reasons to participate in research, referral source, objective measures of cognition, or informant-rated daily function by race group. In conclusion, despite 50% oversampling of B/AA participants compared to the State population, no differences in cognitive and functional performance at the time of enrollment were associated with race.