Survey Of Clinicians Research Articles

Mitigating Disputes Originated by Multiple Discordant Systematic Reviews and Meta-Analyses: A Survey of Methodologists and Clinicians.

BackgroundOverlapping systematic reviews (SRs) are increasingly frequent in the medical literature. They can easily generate discordant evidence, as estimates of effect sizes and their interpretation might differ from one source to another.ObjectiveTo analyze how methodologists and clinicians make a decision when faced with discordant evidence formalized in structured tables.MethodsWe conducted a 16-item survey exploring how methodologists and clinicians would react when presented with multiple Summary of Findings (SoF) tables (generated using the GRADE tool) derived from 4 overlapping and discordant SRs and meta-analyses on thrombolytic therapy for intermediate-risk pulmonary embolism. SoF tables reported 4 different magnitudes of effects and overall certainty. Participants were asked to provide their recommendations regarding the intervention and the reasons behind their conclusion.ResultsOf the 80 invitees, 41 (51%) participated. The majority described themselves as “somewhat familiar” or experts with SoF tables. The majority recommended the therapy (pharmacological systemic thrombolysis), grading the recommendation as weak positive. Certainty of evidence and benefit-risk balance were the two criteria that prevailed in generating the recommendation. When faced with overlapping meta-analyses, the preferred approach was to use only high-quality SRs and exclude redundant SRs. Several participants suggested integrating the SoF tables with additional information, such as a more comprehensive evaluation of the risk of bias of systematic reviews (71%), heterogeneity/inconsistency (68%) and studies included within each SR (62%).ConclusionWhen faced with multiple controversial SR results, the type and completeness of reported information in SoF tables affect experts' ability to make recommendations. Developers of the SoF table should consider collating key information from overlapping and potentially discordant reviews.

Driving and glaucoma in the UK: a national survey of clinicians' advice and guidance to patients.

Driving standards policy is set by the Department for Transport and executed by the Driving and Vehicle Licensing Agency (DVLA). Professional bodies recognise the challenges that clinicians face when advising patients with glaucoma about driving. This study explored clinicians' knowledge and confidence around driving standards and their approach to advising and guiding patients. Cross-sectional online survey of all United Kingdom and Eire Glaucoma Society (UKEGS) members. The survey remained open for five weeks (22/02/21-27/03/21). Anonymised data were exported to Microsoft Excel for analysis. Out of 91 respondents (minimum response rate 20.2%), 53 (58.2%) were glaucoma consultants, 2 (2.2%) general consultant ophthalmologists, 4 (4.4%) ophthalmology fellows, 5 (5.5%) ophthalmology trainees, 19 (20.9%) optometrists, and 8(8.8%) 'other' categories (one SAS doctor, six specialist doctors, one nurse specialist). 58.2% reported that the visual standards for driving were 'very familiar'; 40.5% were 'moderately familiar'; one(1.2%) was only 'somewhat familiar'; none were completely unfamiliar. A total of 38 (41.8%) respondents were highly confident in giving advice on fitness to drive; 51 (56.0%) were moderately confident; 2 (2.2%) had only limited confidence. Over 25% review patients not meeting driving standards in every glaucoma clinic, over 50% identifying abnormal visual fields as the main reason. Our study found that most clinicians are familiar with DVLA driving standards. However, busy clinical environments limit detailed discussion about this, leading to only one in four clinicians being very confident to broach the subject with patients in clinic. A range of patient education modalities were suggested, which may help simplify advice provision for glaucoma patients.

Improving the Knowledge of X-linked Hypophosphatemia among Clinicians in the Arabian Gulf and African Countries

Rare bone disorders comprise ∼5% of all rare disorders.[1] These diverse and heterogeneous disorders are often progressive and associated with impaired mobility, chronic pain, and poor quality of life. Thus, patients often require lifelong multidisciplinary care, including medical therapies, surgeries, and the provision of aids for activities of daily living. X-linked hypophosphatemia (XLH) is one such rare bone condition. In the current issue of JDEP, Beshyah et al[2] undertook an online survey of clinicians in the Middle East and African countries to determine their knowledge of rare metabolic bone disorders and, more specifically, about XLH. While more than 80% of respondents were aware of XLH, the survey identified significant gaps in the clinicians' knowledge of symptoms of the condition and its management during the life course. The findings of this survey are broadly similar to those reported by Deeb et al.[3] They undertook an online survey to determine the awareness, knowledge, and management of XLH among members of the Arab Society for Pediatric Endocrinology and Diabetes.

Cancer care clinicians' provision of smoking cessation support: A mixed methods study in New South Wales, Australia.

Given the importance of supporting cancer patients to quit smoking, we sought to ascertain cancer care clinicians' beliefs and practices regarding providing smoking cessation brief interventions. We used a cross-sectional sequential explanatory mixed method design, including a survey of multidisciplinary cancer care clinicians and semistructured interviews. One hundred and sixty-five cancer care clinicians completed the survey and 21 participated in interviews. Over half of survey respondents (53%) said they do not regularly undertake smoking cessation brief interventions and 40% rarely or never advise quitting. Nonmetropolitan clinicians were more likely to discuss medication options and refer to the Quitline. Physicians were more likely to do brief interventions with patients and radiation therapists were least likely. Barriers were lack of training and experience, lack of knowledge of the Quitline referral process, lack of role clarity, lack of resources and systems, and perceived psychological ramifications of cancer for patients. There is a need to upskill cancer clinicians and improve systems to provide smoking cessation brief interventions as part of routine clinical practice. All cancer care clinicians should complete brief intervention smoking cessation training relevant to the cancer context, including making referrals to Quitline, and be supported by systems to record and follow-up care.

Covid-19 First Wave Impact National Survey for HIV Clinicians by Public Health England (PHE), the British HIV Association (BHIVA) and the Children's HIV Association (CHIVA).

IntroductionThis short report describes the results of a survey that was developed by Public Health England (PHE), the British HIV Association (BHIVA) and the Children's HIV Association (CHIVA) and circulated to all UK national health service HIV providers in the UK following the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2; coronavirus disease 2019 [COVID‐19]) pandemic to assess the impact of the pandemic on HIV clinics.MethodsThe survey was created by BHIVA/CHIVA and PHE and was piloted prior to circulation to all HIV clinics within the UK on 3 July 2020. The survey questions were designed to assess the impact of the first wave of COVID‐19 on HIV clinics and lead/senior HIV clinicians. Clinicians’ responses were collected between 3 July 2020 and 17 September 2020. The survey responses were collated, and non‐statistical analysis was performed.ResultsThe results of the survey confirmed that services had undergone substantial changes, including a shift from face‐to‐face consults to predominantly virtual consultations. Some clinicians’ responses suggested that the first wave had many negative effects on people living with HIV, including their ability to access mental health services.ConclusionThe first wave of COVID‐19 caused significant changes to HIV services within the UK. There was a shift toward the use of technology in healthcare, and results from subsequent clinician surveys carried out since the first wave of COVID‐19 will reflect the ongoing transformation of care towards a more virtual service.

Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications

ABSTRACT Research on the efficacy of hypnosis applications continues to grow, but there remain major gaps between the science and clinical practice. One challenge has been a lack of consensus on which applications of hypnosis are efficacious based on research evidence. In 2018, 6 major hypnosis organizations collaborated to form the Task Force for Establishing Efficacy Standards for Clinical Hypnosis. This paper describes a Guideline for the Assessment of Efficacy of Clinical Hypnosis Applications developed by the Task Force, which makes 10 specific recommendations. The guideline is intended to be a tool for those who want to assess the quality of existing evidence on the efficacy of clinical hypnosis for any particular indication. The paper also discusses methodological issues in the interpretation and implementation of these guidelines. Future papers will report on the other products of the Hypnosis Efficacy Task Force, such as best practice recommendations for outcomes research in hypnosis and an international survey of researchers and clinicians on current practice and attitudes about hypnosis.

A Patient Outcomes-Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP).

BackgroundThe availability of patient outcomes–based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning.ObjectiveThis study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use.MethodsThis multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ≥30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR.ResultsAn initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63% respondents identified as useful), escalation of care (20/24, 83%), and return to ED (16/24, 67%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from “not easy” to “very easy” to obtain and from “not confident” to “very confident” in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague.ConclusionsThis study demonstrates the potential for human-centered design of a patient outcomes–driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning.

GRAPPA Treatment Recommendations: 2021 Update.

Since its inception, one of the central missions of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has been the development of treatment recommendations for patients with psoriatic arthritis (PsA). The initial guidelines, developed in 2009, were updated in 2015. Because of the abundance of new data concerning the therapeutic approach to PsA, GRAPPA members have been working throughout 2020-2021 to once again update the recommendations. At the GRAPPA 2021 annual meeting, the full committee presented proposals from each of the treatment domain groups, including the comorbidities and related conditions groups, based on previous systematic literature reviews. Overarching principles and summary evidence tables were presented, including results from a GRAPPA membership survey of patients and clinicians to assess levels of agreement. A draft of the figure for the treatment recommendations was presented and discussed with the wider membership.

Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians

Background Benefits of the prone position in ARDS are well established, and the evidence of its benefits for the COVID-19 patients are growing. However, the clinical utilization of such a maneuver is less established. We attempted to analyze the clinician’s utilization and attitude of the prone position and what is the main drive for its usage. Methods An international survey of eight questions. The questionnaire was anonymous and included the country of practice, percentage of patients with COVID-19 they have placed in the prone position while undergoing mechanical ventilation, most important factor that determined the need for the prone position (SpO2, PaO2:FiO2, FIO2, PEEP), duration of prone position in hours/day, use of neuro-muscular blocking agents, body position (flat, trendelenburg, reverse trendelenburg), the use of a specific protocol for the prone position, if they believe that prone position is beneficial, and if their practice will change or not. The survey was active for five months. Statistical analysis included frequencies of each response, as well as subgroup analyses designed to identify potential correlates of longer or shorter proning durations. The questionnaire assessed clinicians optimism regarding the continuing use of proning in the future, and how different cutoffs for proning initiation may be associated with attitudes towards proning. Associations between categorical variables were analyzed using Fisher’s exact test. A P-value of < 0.05 was considered statistically significant. Results are expressed in Means ± Standard Deviation (SD) Results 294 questionnaires were collected from 35 countries with 78% of responders from the USA. Median duration of proning was 14.8 ± 2.8 hours per day. 74% of clinicians utilized an established protocol for proning their patients. The decision to initiate proning was non-significant and split between the use of oxygen saturation SpO2 (30%) mean 92.44 ± 5.61, PaO2:FiO2 ratio (28%) mean 188.44 ± 57.36, FiO2 mean 78.6 ± 15.65, PEEP mean 12.96 ± 4.66, or immediate prone positioning following intubation (22%). 41.2% of surveyed utilize the prone position in 25-50%, average percent patients proned calculated at 7.1%. Estimated 77% of respondents reported prone positioning to be helpful in 50% or less of cases. 91% of responders used NMB either always or frequently, and there was statistical significance between the use of NMB and perceived benefits of proning (P < 0.001). 74% of those surveyed use a protocol for proning, the use of protocol and the perceived benefits of proning was statistically significant (P <0.001). Conclusion There are few agreements between clinicians on the duration of the proning sessions and use of NMB and using a protocol for proning. There was no agreement on the trigger of the prone position or the belief of its usefulness. This ambiguity should trigger an evidence-based ARDS management using the prone position in COVID-19 patients.

Emergency Clinicians' Comfort Levels in Caring for Transgender Patients.

Transgender individuals report negative experiences in emergency department settings, but little is known about emergency clinicians' barriers to treating transgender patients. The purpose of this study was to explore emergency clinicians' experiences with transgender patients to better understand their comfort with caring for this population. We conducted a cross-sectional survey of emergency clinicians in an integrated health system in the Midwest. To assess the relationship between each independent variable and the outcome variables (i.e., comfort level generally and comfort level asking transgender patients about their body parts specifically), Mann-Whitney U test or Kruskal-Wallis analysis of variance was conducted for categorical independent variables and Pearson correlations were conducted for continuous independent variables. Most participants (90.1%) were comfortable caring for transgender patients, whereas two-thirds (67.9%) were comfortable asking transgender patients about body parts. Although none of the independent variables was associated with increased clinician comfort level caring for transgender patients in general, White clinicians and those who were unsure how to ask patients about their gender identity or transgender-specific care they had received were less comfortable asking about body parts. Having skills to communicate with transgender patients was associated with emergency clinicians' comfort levels. In addition to offering traditional classroom-based didactics about transgender health care, providing opportunities for clinical rotations that allow clinicians-in-training to treat, and perhaps more importantly, learn from transgender patients will likely be higher yield in bolstering clinician confidence in serving this patient population.

System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access.ObjectiveThis study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites.MethodsWe conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session).ResultsWe collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001).ConclusionsPersonal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine.

Improving communication and teamwork during labor: A feasibility, acceptability, and safety study.

TeamBirth was designed to promote best practices in shared decision making (SDM) among care teams for people giving birth. Although leading health organizations recommend SDM to address gaps in quality of care, these recommendations are not consistently implemented in labor and delivery. We conducted a mixed-methods trial of TeamBirth among eligible laboring patients and all clinicians (nurses, midwives, and obstetricians) at four high-volume hospitals during April 2018 to September 2019. We used patient and clinician surveys, abstracted clinical data, and administrative claims to evaluate the feasibility, acceptability, and safety of TeamBirth. A total of 2,669 patients (approximately 28% of eligible delivery volume) and 375 clinicians (78% response rate) responded to surveys on their experiences with TeamBirth. Among patients surveyed, 89% reported experiencing at least one structured full care team conversation ("huddle") during labor and 77% reported experiencing multiple huddles. There was a significant relationship between the number of reported huddles and patient acceptability (P&lt;0.001), suggestive of a dose response. Among clinicians surveyed, 90% would recommend TeamBirth for use in other labor and delivery units. There were no significant changes in maternal and newborn safety measures. Implementing a care process that aims to improve communication and teamwork during labor with high fidelity is feasible. The process is acceptable to patients and clinicians and shows no negative effects on patient safety. Future work should evaluate the effectiveness of TeamBirth in improving care experience and health outcomes.

Do policies affect management? Evidence from a survey of clinicians of the Italian National Health Service.

Since the early 1990s, New Public Management ideas have deeply influenced reforms and their implementation in the Italian NHS. We compare doctors' perceptions about management systems in two Italian regions which differ in the dominant values of the regional political environment. In total 220 doctors, orthopaedists and cardiologists, working in public hospitals in Lombardy and Emilia-Romagna, were surveyed. Doctors in Emilia-Romagna perceived their organization to be more managerially driven in comparison to their colleagues in Lombardy. Doctors from Lombardy perceived their professional freedom to be higher, regardless of their specialization. The divergence of professionals' perception between these two Italian regions, which operate within the same Beveridge model, shows that dominant values of regional politics may have tangible effects on hospital management.

Assessing the educational needs of physicians in the management of patients with Tourette syndrome: results of a United States survey on practicing clinicians and caregivers.

To better understand current practices of U.S.-based physicians in the management of Tourette syndrome (TS) and identify gaps that may be addressed by future education. Two survey instruments were developed to gather data on management of TS and perceptions from physicians and caregivers of children with TS. The clinician survey was developed in consultation with a TS physician expert and utilized clinical vignettes to assess and quantify practice patterns. The caregiver survey was adapted from the clinician survey and other published studies and gathered details on diagnosis, treatment, and perceptions regarding management. Data included responses from 138 neurologists (including 57 pediatric neurologists), 162 psychiatrists (including 42 pediatric psychiatrists), and 67 caregivers. Most (65%) pediatric neurologists rely solely on clinical findings to make a diagnosis, whereas the majority of other specialists utilize additional testing (eg, neuroimaging, lab testing, and genetics). Most psychiatrists (96%) utilize standardized criteria to make a diagnosis, whereas 22% of neurologists do not. Many physicians (44% of psychiatrists and 20% of neurologists) use pharmacotherapy to treat a patient with "slightly bothersome" tics and no functional impairment, whereas caregivers favored behavioral therapy. Most (76%) caregivers preferred to make the final treatment decision, whereas 80% of physicians preferred equal or physician-directed decision-making. This study provides insight into practice patterns and perceptions of U.S.-based neurologists and psychiatrists in managing TS. Results highlight the potential value of physician education, including diagnostic approach, tic management and monitoring, involvement of caregivers in decision-making, and updates on TS management.

Expert guidance for the rehabilitation of children with arthrogryposis: protocol using an integrated knowledge translation approach

BackgroundArthrogryposis multiplex congenita (AMC) is a group of rare congenital disorders characterized by multiple joint contractures present at birth. Contractures can affect different body areas and impact activities of daily living, mobility and participation. Although early rehabilitation is crucial to promote autonomy and participation in children with AMC, empirical evidence to inform best practice is scarce and clinical expertise hard to develop due to the rarity of AMC. Preliminary research involving stakeholders in AMC (youth with AMC, parents, and clinicians) identified priorities in pediatric rehabilitation. Scoping reviews on these priorities showed a lack of high quality evidence related to rehabilitation in AMC. The objective of this project is to provide rehabilitation expert guidance on the assessment and treatment of children with AMC in the areas of muscle and joint function, pain, mobility and self-care, participation and psychosocial wellbeing.MethodsAn integrated knowledge translation approach will be used throughout the project. Current rehabilitation practices in AMC will be identified using a clinician survey. Using the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) approach, a panel of interdisciplinary expert clinicians, patient and family representatives, and researchers will develop expert guidance on the assessment and treatment for pediatric AMC rehabilitation based on findings from the scoping reviews and survey results. Consensus on the guidance statements will be sought using a modified Delphi process with a wider panel of international AMC experts, and statements appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Theoretical facilitators and barriers toward implementing clinical guidance into practice will be identified among rehabilitation clinicians and managers to inform the design of dissemination and implementation strategies.DiscussionThis multi-phase project will provide healthcare users and providers with research-based, expert guidance for the rehabilitation of children with AMC and will contribute to family-centered practice.

How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty.

BackgroundPsychological safety—the belief that it is safe to speak up—is vital amid uncertainty, but its relationship to feeling heard is not well understood.PurposeThe aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty.MethodologyWe conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling.ResultsPsychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety’s relationship to burnout and process adaptation.ConclusionPsychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty.Practice ImplicationsFor health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.

Reconceptualizing schizophrenia in the Hierarchical Taxonomy Of Psychopathology (HiTOP)

The concept of schizophrenia, operationalized in diagnostic manuals, faces existential challenges of low reliability, arbitrary boundaries, overlap with other disorders, and heterogeneity. The Hierarchical Taxonomy Of Psychopathology (HiTOP) was developed to address these challenges. It conceptualizes psychotic disorders as continuous with normality. To alleviate heterogeneity, psychotic disorders are decomposed into 14 tightly-knit symptom and trait dimensions. These narrow dimensions form two broader spectra-psychoticism (e.g., positive symptoms, peculiarity, fantasy-proneness) and detachment (e.g., negative symptoms, emotional detachment, romantic disinterest)-that comprise the psychosis superspectrum. The full HiTOP model includes four other spectra that can be useful in a comprehensive evaluation. This model is undergoing rigorous validation. It has shown greater reliability, explanatory power, and prognostic value than schizophrenia diagnosis. The HiTOP approach produced promising evidence of clinical utility in surveys of clinicians. The HiTOP reconceptualization of schizophrenia suggests four major implications. First, schizophrenia spans two spectra, and therefore detachment is important to study including in people who have never been psychotic. Second, large population-based studies with comprehensive profiling of psychopathology can address shortcomings of case-control design. Third, elevations on psychoticism and detachment dimensions early in life offer opportunities for prevention. Fourth, actionable ranges can be identified on dimensions to guide specific clinical decisions. The elaborate HiTOP model may be unnecessary in acute treatment settings, but it can benefit prevention, long-term management, and research. The categorical schizophrenia concept offers valuable continuity and can be used in parallel with HiTOP, but we predict that eventually the dimensional approach will make this category obsolete.

Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting.

Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.

Remote-delivered services during COVID-19: A mixed-methods survey of college counseling center clinicians

Objective The COVID-19 pandemic has drastically increased use of remote-delivered mental health services. This study identifies advantages and limitations of remote-delivered services on college campuses to inform mental health delivery post-pandemic. Methods: Clinicians (n = 30) were asked to evaluate COVID-19’s impact on their work, environment, and wellness in an online survey. Qualitative data was coded using a thematic analysis approach, while quantitative data was analyzed using descriptive statistics. Results: Many clinicians reported benefits of remote services, including increased accessibility, greater convenience, no change in therapeutic alliance, and decreased stress for clinicians. Clinicians also experienced challenges such as social isolation, technological difficulties, and personal/family concerns. Clinicians envisioned a hybrid service combining online and in-person activities post-pandemic. Conclusions: Overall, remote-delivered mental health services on college campuses have potential in increasing treatment quality while highlighting a necessity for further research in hybrid mental health delivery. Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2038178 .

What information do patients need about their hip dysplasia? A UK survey of clinicians

What information do patients need about their hip dysplasia? A UK survey of clinicians