Specialist Practitioners Research Articles

Competence to capability: An integrated career framework for sonographers

IntroductionWithin the United Kingdom sonographers, with ultrasound as their core role, currently have a primary registration as a radiographer or another health professional. Entering with masters level qualifications, and often exhibiting a higher career banding, the sonographer career structure does not align comfortably with the existing health professional frameworks. This study aimed to explore the attitudes and opinions of a sample of practicing sonographers concerning a potential graduate sonographer role and the development of a clinical competence framework required to provide a skills escalator. MethodsA qualitative study using an interpretative framework was undertaken using semi-structured interviews. A homogeneous sample population of ten participants was selected using theoretical purposive sampling. The interview transcripts were thematically analyzed and coded. ResultsThe themes of implementing change and clinical frameworks were identified along with a sub-theme of clinical competence boundaries. All participants found it challenging to identify a role or clinical competences that a band 5/graduate sonographer could undertake, though more suggestions were offered for a band 6 sonographer. ConclusionWhilst, within the literature, clinical competences were agreed to provide the cornerstone for defining clinical roles there was some dispute as to the appropriateness of the use of core clinical competences for defining the scope of practice of health professionals above entry level to the profession. The data collected in this study demonstrated that there were skills development between graduate, specialist, advanced and consultant practitioners. Participants were focussed on clinical skills rather than wider capability skills. It is recommended that in order for advanced practice sonographers to map to the new ACP framework less focus on competence and a greater consideration of capabilities is required.

Adaptação transcultural para uso no Brasil do Instrumento Survey of Technology Use (SOTU Br)

A taxa de abandono ou não uso de recursos de tecnologia assistiva adquirido é considerada alta, apesar dos esforços dos profissionais no momento da prescrição. A literatura tem apontado que o uso de instrumentos de avaliação padronizados e baseados em modelos conceituais tem contribuído para maior aceitabilidade desses recursos. O estudo teve como objetivo traduzir e adequar culturalmente o instrumento Survey of Technology Use (SOTU) que compõe o modelo conceitual Matching Person and Technology (MPT) para utilização no Brasil (SOTU Br). Trata-se de uma pesquisa do tipo metodológica. Participaram do estudo profissionais especialista em dispensação de recursos de tecnologia assisitiva e pessoas com deficiência que fazem uso de tecnologia assistiva. O estudo foi dividido em cinco etapas: 1) tradução para o português; 2) tradução conciliada; 3) retrotradução; 4) análise de equivalência de itens; 5) pré-teste. Os resultados indicaram que a versão traduzida e adaptada para o português do Brasil teve um alto índice de concordância e uma boa aceitabilidade. Conclui-se que a versão em português do SOTU pode ser utilizada por profissionais da educação e da saúde para avaliar a predisposição de uso de tecnologia assistiva e tecnologia de comunicação e informação, de adultos e crianças com deficiência, por meio de suas atitudes e experiências.

A survey of the provision of orthodontics in Ireland 2018

Workforce planning is important in all aspects of healthcare; in orthodontics, this must take into account several issues including the need for orthodontic treatment, the number of specialist personnel available to provide treatment and the role of orthodontic auxiliaries. The aim of this study was to collect information on the orthodontic workforce in Ireland and to compare this information with previous studies (2001, 2007) in order to determine longitudinal trends in the orthodontic workforce in Ireland. The study was carried out in the form of a survey. The survey included orthodontic specialists practising in the Republic of Ireland. A list of these practitioners was obtained via the Orthodontic Society of Ireland (OSI) and the orthodontic specialist register of the Dental Council of Ireland. The study was circulated both via email and post for completion by March 31, 2018. The electronic version used SurveyMonkey software, which provides a user-friendly interface between the operator and the target population. Data was then collated using both hard copy and online survey responses. The survey showed that the number of orthodontists in Ireland has increased since 2007, with the practitioner ratio to the number of 12-year-olds remaining stable. It also highlights the increasing role for orthodontic auxiliaries, which may affect future workforce levels. Workforce planning must consider current specialist practitioner numbers, population growth and the increasing role of auxiliaries in orthodontic practice, along with the older age profile of practising orthodontists.

Characterizing Early and Late Return to Work after Traumatic Brain Injury.

Facilitating successful return to work (RTW) is a key rehabilitation objective following traumatic brain injury (TBI). This study modelled early (within 6 months) and late (7-34 months) RTW by leveraging a large and comprehensive compensation database. The sample comprised 666 participants with TBI, the majority of whom sustained a moderate or severe injury caused by a motor vehicle accident. Early RTW was more likely for individuals who were pre-morbidly employed in a managerial or professional occupation (odds ratio [OR] = 2.1, confidence interval [CI] = 1.29-3.37), and those who experienced shorter post-traumatic amnesia (PTA) (OR = 0.96, CI = 0.94-0.98). RTW was less likely in the late phase for individuals who were older (hazard ratio [HR] = 0.99, CI = 0.98-1.00), experienced longer PTA (HR = 0.98, CI = 0.97-0.99), had an abdominal injury (HR = 0.90, CI = 0.67-1.21) and used more specialist practitioner (HR = 0.99, standard error [SE] = 0.98-1.00) and analgesic services (HR = 0.91, CI = 0.82-1.00). Conversely, RTW in the late phase was more likely for individuals using a greater number of specialist RTW supports (HR = 1.03, CI = 1.01-1.05). Patterns of early service utilization may therefore contribute to prediction of RTW outcome. It is encouraging that RTW was more likely for individuals using vocational supports.

Health Educator Perspectives on Seeking Medicaid Reimbursement in Indiana.

Health education is a growing field. However, there is confusion about the role delineation of health education specialists (HES) and other health education (HE) providers. Additionally, recent reimbursement opportunities allow employers to bill for HE services but offer confusing language regarding eligible service-providing professionals. This study surveyed health educators in Indiana to assess knowledge, attitudes, and perceived abilities to bill Medicaid and other insurers for HE services. Using a cross-sectional research design, an original 22-item Web-based questionnaire was developed and distributed to all Certified Health Education Specialist/Master Certified Health Education Specialist (CHES/MCHES) practitioners residing in Indiana. Additional respondents were recruited using a snowball technique, as original respondents asked to share the survey with colleagues. A final data set of 61 respondents was analyzed. All respondents' organizations provided HE services, with the majority indicating they do not charge and do not bill for HE services. Additionally, 60% of the respondents agreed that HES should be reimbursed for services, and the vast majority believed reimbursement to be important for the field. With recent reimbursement opportunities for HE and preventative health services, it is important that HES advocate for the profession and for potential reimbursement opportunities, such as Medicaid, to enhance the field and support HES jobs.

Feline abdominal ultrasonography: what's normal? what's abnormal? The biliary tree.

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. The biliary tree encompasses the liver, gall bladder and bile ducts, although only diseases affecting the latter two are discussed here. Diseases of the bile ducts and gall bladder are more common than those of the liver parenchyma and ultrasound plays an important role in their diagnosis. Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. In addition, a lack of pathological change does not necessarily rule out disease; for example, absence of gall bladder and/or extrahepatic biliary distension is not sufficient to exclude the possibility of biliary obstruction, and in many cases of cholangitis the liver and biliary tree are unremarkable on ultrasound examination. Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. This review, part of an occasional series on feline abdominal ultrasonography, discusses the appearance of the normal and diseased biliary system. It is aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Percutaneous ultrasound-guided cholecystocentesis is also covered. Ultrasound examination of the liver was discussed in an article published in January 2019 and an upcoming article will cover hepatic vascular anomalies. Information provided in this article is drawn from the published literature and the author's own clinical experience.

Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner.

Objectives Ankle brachial pressure index (ABPI) is an invaluable tool for assessing the severity of peripheral arterial disease. In addition, it can be used as an independent marker of cardiovascular risk, with a predictive ability similar to the Framingham criteria. Identification of an abnormal ABPI should therefore trigger aggressive cardiac risk factor modulation for a patient. Unfortunately, the significance of abnormal ABPIs is poorly understood within the general medical community. This is compounded by the influence of various comorbidities on accurate measurement of ABPI, potentially leading to a wide variability in readings that need to be considered before interpretation in these patient populations. We aim to address these issues by revealing several common misunderstandings and pitfalls in ABPI measurement, describing accurate methodology, and highlighting patient cohorts in whom additional or alternative approaches may be required. Methods We present a narrative review of the role of ABPI in both the community and hospital setting. We have performed a literature review, exploring the validity and reproducibility of methodology for obtaining ABPI, alongside the utility of ABPI in different clinical scenarios. Results The measurement of ABPI is often performed incorrectly. Common pitfalls include inadequate patient preparation, failure to obtain the blood pressure from the correct lower limb artery in patients with tibial disease, failure to account for differences in brachial blood pressure between the arms, inappropriately chosen equipment and patient factors such as highly calcified arteries. Standardisation of methodology greatly improves reliability of the test. Exercise ABPI can identify significant peripheral arterial disease in patients with normal resting ABPI. In addition to its role in peripheral arterial disease, ABPI measurement has a role in assessing venous ulcers, entrapment syndromes and injured extremities; conversely, it has a more limited utility in the diabetic population. Conclusions A thorough understanding of the correct technique and associated limitations of ABPI measurement is essential in accurately generating and interpreting the data it provides. With this knowledge, the ABPI is an invaluable tool to help manage patients with peripheral arterial disease. Perhaps more importantly, ABPI can be used to identify and risk stratify patients with asymptomatic peripheral arterial disease, itself a major indicator of significant underlying cardiovascular disease. With the emergence of best medical therapy, targeted pharmacotherapy and lifestyle changes can reduce the risk of major cardiovascular events in high-risk patients by approximately 30%, particularly in diabetic patients. Therefore, the utility of ABPI transgresses vascular surgery, with an essential role in general practice and public health.

Work in progress: adaptation of electronic medical records to the requirements of auniversity eye clinic : Individual extensions of the software "FIDUS" at the Department of Ophthalmology of the Saarland University Medical Center UKS

The implementation of electronic medical records (EMR) in the Department of Ophthalmology at the Saarland University Medical Center (UKS) in January 2016 was atimely response to growing documentation requirements and rapidly increasing electronic diagnostic data. The software system was primarily developed for private practices and cannot therefore meet the different requirements of various clinics out of the box. The purpose of this study was to identify features of the EMR beyond purely paper replacement that can assist in the clinical workflow and whether these features can be implemented in arunning system. The EMR was specifically individualized with respect to the work processes and documentation requirements of the Department of Ophthalmology at the UKS. In addition to aseamless integration into the hospital information system (HIS) the modifications included changes in the structure and visual presentation of the EMR as well as functional extensions. An internet-based platform was set up to enable adirect exchange of appointments and patient data with specialist practices. Due to the introduction of aso-called ghost list the position of patients within the hospital who are allocated to a physician, e.g. for diagnostics, can be reconstructed at any point in time. The logging of the individual treatment times enables tracking of patient flow within the clinic and areduction of waiting times. Existing paper documents particularly for the graphic recording of findings, such as sketches, are digitalized eliminating the need to scan documents. The UKS.AUGEN.NETZ is an internet-based portal to facilitate direct organization of appointments with specialist practitioners and for the exchange of digital examination data and medical correspondence. The permanent close cooperation between employees of the Department of Ophthalmology at the UKS and the manufacturer of the software enables acontinuous optimization of the EMR in afully operational clinical workflow. In addition, the web-based interface improves the cooperation between the hospital and private practices.

Collaboration for children with complex needs: What adolescents, parents, and practitioners tell us.

Children with complex needs require coordinated care and collaboration between the different sectors in child mental health care. These needs and service issues are individually defined and therefore challenging for the mental health system to respond effectively. Different barriers at the organizational and policy level to initiate and maintain collaborative relationships are reported. This research explores the reality of working with a protocol for collaboration (Client Network Consultation (CNC)) by questioning the experiences of adolescents, parents, and practitioners. A qualitative design with semistructured individual interviews is used, guided by the questions from the Wraparound Fidelity Index. Useful and practical insights on effective collaboration result from the in-depth analysis of the interviews. A neutral chairperson, the presence of specialist practitioners, visualization, participation of adolescents, and parents are among the effective elements reported. Some challenges remain; the principle of equality, monitoring the action points resulting from the collaboration and effective crisis management seem very difficult to fully achieve in practice. These results present experiences from adolescents, parents, and practitioners to support an effective collaborative process for working together with children and families with complex needs.

The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change?

The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who apply evidence-based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom-reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans-syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom "cured" and are better framed as vulnerabilities. Important gains in well-being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small-scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans-syndromal symptom reduction, tailored to serve the higher-order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e-communities providing information, peer and citizen support and a range of user-rated self-management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service.

Future of Specialist Practice Qualifications in district nursing for band 6 leadership roles.

District nurse numbers in the UK are rapidly declining. To overcome this severe staff shortage, one community trust in a rural county appointed 'case managers' (nurses without Specialist Practice Qualifications in district nursing [SPQDN]) in band 6 leadership roles that were traditionally held by district nurses. Here, we aimed to establish the value of the SPQDN to determine if there is a future for the conventionally accepted DN role, instead of case managers. The study used an exploratory mixed-methods design. Using the classic e-Delphi technique, data were collected over 5 months from 10 purposively sampled senior nurse managers employed by the community trust who formed an expert panel. In round one, the panellists provided three responses each to the question 'what is the future for district nurse specialist practitioner qualifications in [the trust] for band 6 leadership roles?' In rounds two and three, they answered a close-ended questionnaire using a 3-point Likert scale. The core findings suggest that SPQDN and the district nurse role are considered extremely valuable (both achieving 100% consensus). Additional findings are linked to four core themes, namely, (1) SPQDN, (2) clinical practice educators, (3) workforce and (4) leadership. This study recommends continued investment in SPQDN and the district nurse role with the use of succession planning for workforce management.

Reconceptualising product life-cycle theory as stakeholder engagement with non-profit organisations

ABSTRACTThe paper critically re-examines product life-cycle (PLC) theory, developed over 50 years ago. Despite prevalence in marketing pedagogy and continued popularity within empirical research, PLC is seldom challenged. The paper identifies the organisation-centric construct underpinning the theory and highlights a disconnection between PLC theory and the recent academic insight around customer engagement.It reconceptualises the life-cycle concept based on engagement between stakeholder and non-profit organisation (NPO), structured upon both the market orientation and social exchange constructs. The revised framework maps stakeholder engagement with the NPO through the five stages of incubation, interaction, involvement, immersion, and incapacitation. The paper concludes with identifying a roadmap for future empirical research to develop and validate the re-envisaged conceptual model. The methodology used is narrative literature review supported by secondary research from specialist practitioner reports.

A Graduated Responsibility Supervising Resident Experience Using Mastery Learning Principles [Correction

MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

Benefits of a dedicated ultrasound education for medical students: A 3 year experience [Correction

MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

Self-explanation to support knowledge development for clinical reasoning: Perspectives from third year medical clerks [Correction

MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

Getting Value from Open Educational Repositories [Correction

MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

Thinking Thinking Literature Across Continents Across Generations

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Feline abdominal ultrasonography: what's normal? what's abnormal? The liver.

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the liver can be key in the diagnosis of diseases such as hepatic lipidosis and hepatic neoplasia. Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. When assessing the liver via ultrasound, a diffuse alteration in liver echogenicity may be difficult to detect unless the change is marked and, although comparisons can be made with the spleen and kidneys, this relies on these organs being normal. Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. This review, the first in an occasional series on feline abdominal ultrasonography, discusses ultrasonographic examination of the normal and diseased liver, with focus on the liver parenchyma. It is aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Ultrasound-guided sampling of the liver is also covered. Future articles will discuss the biliary tree and hepatic vascular anomalies. Information provided in this article is drawn from the published literature and the author's own clinical experience.

Addressing Challenges in Living with AML: Impact of Video-Based Patient Education on Knowledge and Behavior

Background: Delivering high-quality cancer care requires meeting the needs of cancer patients and their families. The Committee on Improving the Quality of Cancer Care has stated that systems should support all patients and families in making informed health care decisions that are consistent with their needs, values, and preferences (http://www.ncbi.nlm.nih.gov/books/NBK202146/). Fundamental to this is the need to foster good communication, developing and disseminating evidence-based information to inform patients, caregivers, and the cancer care team about treatment options. We created a patient education activity to empower patients with information and resources focused on: general facts about AML, testing and results interpretation, treatment options, and resources for self-care and support.Methods: A one-hour online video-based program targeting patients with AML and their caregivers was developed in July 2017 to address the identified audience needs. The program was video-based, and broadcast an interactive panel discussions with a physician specialist in AML, a nurse practitioner specialist in AML, and a patient advocate from the Leukemia & Lymphoma Society. The program integrated educational slides, live polling and Q&A with audience participants, and patient video vignettes that touched on real patient experiences regarding life with AML. Programs were initially broadcast live and were later “chapterized” into 4 smaller segments and made available on-demand at CancerCoachLive.com, LLS.org, and on social media platforms (e.g., LLS and Cancercoach Facebook pages, YouTube) for 6 months. Knowledge-focused test questions were administered at 3 time points (pre-activity, immediate post-activity, and 8-week [follow-up] post), in addition to behavioral and communication-focused questions being asked at the follow up point. Data from these questions, live polling responses, and learner-submitted questions during live Q&A were analyzed to determine engagement, lessons learned and continuing patient-education gaps.Results: In total, 8,935 learners took part in the program (262 on cancercoach platform/8,673 via social media platforms). 69% of respondents reported that communication and collaboration with their healthcare provider(s) improved as a result of participating in the educational program; 27% reported improvements in care for their health. Respondents reported examples of improved communication with their HCPs specific to: their disease, traditional and alternative forms of treatment, and side-effects. Reported changes in behavior and self-care included: being more active, altering self-care behaviors when undergoing chemotherapy, and keeping informed of research and treatments. Learners showed improvements on 4 knowledge questions, including questions pertaining to: 1) Common long-term or late side effects of treatment (45 and 74% relative increases); 2) Factors related to treatment for AML (26 and 33% relative increases); 3) Factors related to testing for AML (5 and 7% relative increases); and the relationship between AML symptoms and low blood count (1 and 3% relative increases). Although this study is limited to patient and caregiver self-report, educational evaluation results and participant questions indicate that patients and caregivers benefit from online education on AML.Conclusions: Education on AML specifically catered to patients and their families can yield immediate and sustained gains in knowledge and behavior, which may improve their adherence to treatment, quality of life, and patient outcomes. DisclosuresNo relevant conflicts of interest to declare.

Influenza vaccination: Uptake and associations in a cross-sectional study of children with special risk medical conditions

ObjectiveTo determine uptake of influenza vaccination in children with special risk medical conditions (SRMC) and to explore associations with vaccination. DesignCross-sectional study. Setting/participantsParents of children with a SRMC attending either outpatient department clinics or being an inpatient at the Women’s and Children’s Hospital (WCH), Adelaide, Australia from September 2015 to February 2016 were recruited using convenience sampling. MethodsData were collected using a face-to-face survey. Influenza vaccination was verified with providers. Characteristics associated with uptake were explored using univariable and multivariable analyses. ResultsThere were 410 participants with complete data. Confirmed influenza vaccination at least once in the last two years was 50%, annual uptake was 32.8%. 63.9% of parents were aware of the vaccination recommendation and 57.9% had been recommended by a specialist or general practitioner (GP). Characteristics strongly associated with uptake included: receiving a recommendation from a specialist or GP and having a parent receive the influenza vaccine annually. ConclusionsDespite a long standing funded program, influenza vaccination uptake in children with SRMC is suboptimal. Parental vaccination behaviour, along with medical practitioner recommendation, particularly specialist recommendation, appear to be key influences in facilitating vaccination. Potential interventions could target the family rather than just the individual child. Understanding the barriers to recommendation from the perspective of general medical practitioners and specialists who treat these children is needed.