Challenges Faced by Female Healthcare Professionals in the Workforce: A Scoping Review.

BACKGROUND: The number of women entering the medical and healthcare workforce globally has increased in the past several decades. Women have many roles and positions in healthcare organizations, hospitals and healthcare education settings. Although there has been an increase in the number of women, female workers continue to face many workplace challenges. This scoping review aimed to explore the challenges female healthcare professionals face in the workforce. METHODS: A scoping review utilizing Arksey and O'Malley's six-step framework was undertaken to identify and map available literature addressing challenges faced by female healthcare professionals in the workforce. The databases searched included Embase, EmCare, Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Business Source Complete (BSC). Additional searches were performed using Google Scholar, Trove and grey literature. RESULTS: The initial search yielded 2455 publications (Medline n=369; EmCare n=276; Embase n=612; CINAHL n=1088; Business Source Complete n=109; mixed grey literature n=1). After removal of duplicates, 1782 citations remained. Abstract and title screening reduced the field to 36 publications, following which full-text reviews were conducted. Consensus was reached on 16 publications for final review. After analyzing the articles, three themes were identified: i) family responsibilities, ii) workplace environment and iii) stereotyping. CONCLUSION: Findings confirm that female healthcare professionals face circumstances that may affect their family lives, as well as factors relating to the workplace environment and stereotypes. Implementing strategies such as reduced work hours, flexible timing and part-time work can support women in the workplace, which then enhances and supports gender equality in healthcare organizations.

Assessment of a new tool to improve case manager identification of delayed return to work in the first two weeks of a workers' compensation claim.

OBJECTIVE: To determine whether the Plan of Action for a Case (PACE) tool improved identification of workers at risk of delayed return to work. DESIGN: Prospective cohort of workers with accepted workers' compensation claims in the state of New South Wales, Australia. INTERVENTIONS: The 41-item PACE tool was completed by the case manager within the first two weeks of a claim. The tool gathered information from the worker, employer and treating practitioner. Multivariate logistic regression models predicted work time loss of at least one and three months. RESULTS: There were 524 claimants with complete PACE information. A total of 195 (37.2%) had work time loss of at least one month and 83 (15.8%) had time loss of at least three months. Being male, injury location, an Orebro Musculoskeletal Pain Screening Questionnaire-Short Form score >50, having a small employer, suitable duties not being available, being certified unfit, and the worker having low one-month recovery expectations predicted time loss of over one month. For three months, injury location, a Short Form Orebro score >50, no return-to-work coordinator, and being certified unfit were significant predictors. The model incorporating PACE information provided a significantly better prediction of both one- and three-month outcomes than baseline information (area-under-the-curve statistics-one month: 0.85 and 0.68, respectively; three months: 0.85 and 0.69, respectively; both P < 0.001). CONCLUSION: The PACE tool improved the ability to identify workers at risk of ongoing work disability and identified modifiable factors suited to case manager-led intervention.

Experiential education enhancing paramedic perspective and interpersonal communication with older patients: a controlled study.

BACKGROUND: Paramedics are required to provide care to an aging population with multidimensional and complex issues. As such educators need to prepare undergraduate paramedics to recognise, assess and manage a broad range of psychosocial care and support issues beyond somatic conditions. Experiential educational interventions with older people provide realistic and contextualised experience which can improve the provision of holistic patient focused care. METHODS: This was a single institution controlled before-after study with parallel groups, conducted in Australia in 2017. It was designed to compare the effectiveness of an educational program related to older people (intervention), verses no intervention (control) on paramedic student attitudes, knowledge and behavior with older patients. RESULTS: A total of 124 second year paramedic students were included in this study; 60 in the intervention and 64 in the control group. Their demographics and Time 1 baseline results were homogeneous. Both groups showed improvement in communication skills with real older patients (p < 0.001, η2 = 0.41) and (p < 0.001, η2 = 0.35). The intervention group showed greater improvements in the 'understands the patient's perspective' element for both the self-assessment (p < 0.001) and the clinician assessment (p = 0.01). Multiple linear regression Model 1 found gender (ß = - 0.25; p = 0.01) was the best predictor of clinician-assessed communication, with females having higher scores. Knowledge and attitudes remained relatively unchanged for both groups. CONCLUSIONS: As the first study to observe, measure and report on the interpersonal communication skills of paramedic student's with 'real' older patients we can report that these skills were from fair to good at baseline and improved from good to very good post the intervention. Overall improvement was notably better in the 'understanding the patients perspective element' for the intervention group who had conducted one-one visits with an older person.

Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture.

INTRODUCTION: Tibial plafond fractures represent a small but complex subset of fractures of the lower limb. The aim of this study was to describe the health related quality of life, pain and return to work outcomes 12 months following surgically managed tibial plafond fracture. METHODS: The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) database was used to identify patients with tibial plafond fractures. All patients captured by VOTOR with a tibial plafond fracture between September 2003 and July 2009, were identified consecutively and comprised the initial cohort. The radiographs of all identified patients were classified using the AO/OTA fracture classification. A review of the included patient's medical records was performed. Data were collected on the injury event, management and complications. Outcomes at 12 months were prospectively collected by telephone interview and included return to work, a numerical rating scale for assessment of pain and the Short Form 12 (SF-12). RESULTS: There were 98 unilateral tibial plafond fractures; 91 fractures were managed operatively, 4 non-operatively and 3 underwent amputation. The 91 operatively managed patients were the focus of this study. A two-stage management approach, involving temporary external fixation, followed by definitive open reduction and internal fixation, was the most common operative treatment. The follow-up rate at 12 months was 70%. 57% had returned to work by 12 months post-injury, the median (IQR) pain score was 2 (0-5) and 27% reported moderate to severe persistent pain. Mean PCS-12 scores were significantly lower than Australian norms (p=0.99), 38.2 for males and 37.5 for females. CONCLUSIONS: The presence of persistent pain, loss of physical health and a low return to work rate highlights the profound impact of tibial plafond fractures on patients' lives. Although this study looked at the early 12 month results, it is expected these outcomes will continue to improve over time. Further studies, with larger patient numbers, must focus on how to improve not only the operative management of these fractures, but also patient's mental and overall physical health in the long term. Improved management techniques and early identification of injury patterns known to perform poorly may help long-term outcomes.

The perception of injury risk and safety in triathlon competition: an exploratory focus group study.

OBJECTIVE: To explore stakeholder perceptions of triathlon competition safety and injury risk. DESIGN: Qualitative focus group study. SETTING: Triathlon stakeholders from Melbourne, Australia. PARTICIPANTS: Competition organizers, coaches, and competitors of various skill levels, age, gender, and experience (n = 18). INTERVENTIONS: Focus groups were conducted, recorded, and transcribed for analysis. MAIN OUTCOME MEASURES: Key themes were identified using content analysis. RESULTS: The perceived risk of serious injury was highest for cycling. Running was most commonly linked to minor injuries. Physical and environmental factors, including course turning points, funneling of competitors into narrow sections, and the weather, were perceived as contributing to injury. Experience, skill level, feelings of vulnerability, personal awareness, club culture, and gender issues were perceived as the competitor-related factors potentially contributing to injury. The cycling mount/dismount area, cycling, and swim legs were the race sections perceived as the riskiest for competitors. Competition organizers were considered to generally have the competitors' best interest as a priority. Triathlons were acknowledged as risky activities and individual competitors accepted this risk. CONCLUSIONS: This study has highlighted the main risks and concerns perceived by triathlon competitors, coaches, and competition organizers, which will help identify potential, context-relevant intervention strategies to reduce injury risk.

Health professionals' perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: a factor analysis.

OBJECTIVE: This study investigated health professional perceptions of triathlon-related injury risk factors and injury prevention strategies, to inform prospective cohort studies investigating injury in triathletes. DESIGN: Exploratory factor analysis. METHODS: A questionnaire was developed and distributed to Australian sports medicine health professionals (n = 504). Information was collected about their perceptions of factors contributing to injury and injury prevention strategies relating to Sprint/Olympic (S/O) and Ironman/Long Course (I/LC) athletes. Factor analysis was performed to identify the number and nature of the constructs (factors) underlying the responses to the questions, and to ascertain whether these factors were similar for S/O and I/LC athletes. RESULTS: The response rate was 22.4% (n = 113). Five factors were extracted for injury risk accounting for 53% (S/O) and 56% (I/LC) of the variance. The factors were common across S/O and I/LC groups; biomechanics and technique, training factors, demographics, injury prevention and personal factors. Three common factors accounted for 54% (S/O) and 55% (I/LC) of the variance for injury prevention strategies; designated training regimes, health and medical monitoring and preparation of the triathlete. CONCLUSIONS: These results indicate that future studies into triathlon injuries should include, at a minimum, detailed training load and demographic factors to test their impact as injury risk factors in triathlete populations.

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients.

INTRODUCTION: To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population. MATERIALS AND METHODS: A prospective validation trial was completed at a Level 1 adult trauma centre in Melbourne, Australia. One hundred and fifty four patients with orthopaedic trauma managed or followed-up by an orthopaedic unit were prospectively recruited. Patients with pathological fractures related to metastatic disease and/or an isolated orthopaedic injury, a documented history of mental illness or dementia or those for whom follow-up was likely to be difficult were excluded. The SF-12, SIP and SMFA were administered by a trained interviewer at one and six months. Each questionnaire was scored for the physical and mental components and then compared for content and construct validity at each time point. RESULTS: Complete data were collected for 134 patients at one and six months. The one and six month component scores correlated strongly between the SF-12 physical, SIP physical (r=0.513-0.669) and SMFA dysfunction (r=0.529-0.778); the SF-12 mental, SIP mental (r=0.643-0.719) and SMFA bother (r=0.564-0.602) components. The strength of association was greater for the six month time point compared to the one month measure. The SF-12 demonstrated no ceiling or floor effects, and provided a lower time burden on participants and researchers when compared to the SIP and SMFA. CONCLUSIONS: For large population-based surveillance research into orthopaedic injury the SF-12 provides a valid and versatile tool.

Triathlon related musculoskeletal injuries: the status of injury prevention knowledge.

Triathlon is a popular participation sport that combines swimming, cycling and running into a single event. A number of studies have investigated the incidence of injury, profile of injuries sustained and factors contributing to triathlon injury. This paper summarises the published literature in the context of the evidence base for the prevention of triathlon related injuries. Relevant articles on triathlon injuries were sourced from peer-reviewed English language journals and assessed using the Translating Research into Injury Prevention Practice (TRIPP) framework. This review highlights the significant knowledge gap that exists in the published literature describing the incidence of injury, the profile of injuries sustained and evidence for the prevention of injury in triathlon. Despite the number of studies undertaken to address TRIPP Stages 1 and 2 (injury surveillance, aetiology and mechanism of injury), most triathlon studies have been limited by retrospective designs with substantial, and unvalidated, recall periods, inconsistency in the definitions used for a reportable injury and exposure to injury, or a failure to capture exposure data at all. Overall, the paucity of quality, prospective studies investigating the incidence of injury in triathlon and factors contributing to their occurrence has led to an inability to adequately inform the development of injury prevention strategies (TRIPP Stages 3-6) for this sport, a situation that must be rectified if gains are to be made in reducing the burden of triathlon related injury.

The incidence of heat casualties in sprint triathlon: the tale of two Melbourne race events.

Triathlon is a popular participation sport combining swimming, cycling and running into a single event. The Triathlon Australia medical policy advocates the use of wet bulb globe temperature as the criterion for altering race distance and an ambient temperature of 35 degrees C as a criterion for consideration of cancellation of an event, but there is little empirical evidence detailing the effectiveness of this policy. Nor has the impact of environmental thermal stress on triathletes in shorter duration events been determined. During an injury surveillance investigation of a triathlon race series over the 2006/2007 seasons, two events with similar environmental conditions were completed. One thousand eight hundred and eighty-four participants competed in event 1 (December 2006) and 2000 competed in event 2 (February 2007). Maximum dry bulb (DBT), minimum vapour pressure (VP) and minimum relative humidity (RH) for event 1 were 37 degrees C DBT, 0.56 kPa VP and 9% RH measured by the Bureau of Meteorology. Fifty-three participants presented for medical aid, 15 due to heat-related collapse. The conditions measured for event 2 were 33 degrees C DBT, 1.16 kPa VP and 24% RH and there were no heat illness presentations despite 38 individuals presenting for medical aid. These observations suggest that the risk of heat-related collapse is greatest when high-environmental temperatures occur early in the competitive season when participants may be inadequately prepared and have not yet acquired natural acclimatisation to heat. Any Triathlon Australia policy revision could place stronger emphasis on the use of ambient temperature as a limiting criterion for race organisers.

Referencing and quotation accuracy in four manual therapy journals.

The aim of the study was to investigate the reference and quotation accuracy in four peer-reviewed manual therapy journals. A stratified random sample of original research (n=7) was collected from each of the journals spanning the years January 2000 to December 2001. A further random selection of 80 references from each journal paper sampled was then reviewed (Total N=320) for citation and quotation accuracy. Numbers of citations with errors were determined, then classified as either major or minor and categorized by bibliographic headings (author, title, journal, year, volume, page and irretrievable). Each quotation was individually assessed for accuracy and judged to be either correct or incorrect. A quotation was deemed correct if it accurately substantiated and reported the original authors assertions. One hundred and fifteen citations across all journals contained errors (35.9%). Some citations exhibited multiple major and minor errors. Bibliographically classified errors for all journals showed 61 author, 51 title, 6 journal, 4 year, 12 volume and 25 page errors. JMPT showed the lowest referencing error rate (20%) while JBWMT recorded the highest (58.8%). The total number of quotation errors across all journals was 69 (12.3%). JMPT showed the lowest quotation error rate of 6 (4.7%), MT had 12 errors (7.3%), JOM produced 21 errors (13.3%), while JBWMT recorded the highest error rate with 32 (27.6%). Poor citation and quotation is a reflection on the scholarly work of the authors and the journal. The trend for errors in quotation is more worrying than citation errors as it reflects poor diligence on the part of the investigators.