Disseminated and Congenital Toxoplasmosis in a Mother and Child With Activated PI3-Kinase δ Syndrome Type 2 (APDS2): Case Report and a Literature Review of Toxoplasma Infections in Primary Immunodeficiencies.

Phosphoinositide 3-kinase (PI3K) plays an integral role in lymphocyte function. Mutations in PIK3CD and PIK3R1, encoding the PI3K p110δ and p85α subunits, respectively, cause increased PI3K activity and result in immunodeficiency with immune dysregulation. We describe here the first cases of disseminated and congenital toxoplasmosis in a mother and child who share a pathogenic mutation in PIK3R1 and review the mechanisms underlying susceptibility to severe Toxoplasma gondii infection in activated PI3Kδ syndrome (APDS) and in other forms of primary immunodeficiency.

A Systematic Scoping Review of Work Interventions for Hospitalised Adults with an Acquired Neurological Impairment.

Purpose Addressing return to work early after neurological impairment from stroke or moderate and severe traumatic brain injury may improve likelihood of returning to employment, yet little is known about how best to organize work interventions for delivery in the inpatient hospital setting. The purpose of this scoping review was to identify knowledge gaps and inform program development in hospital-based work interventions. Method We searched MEDLINE, CINAHL, OTSeeker and Embase for English-language articles published from database inception until March 2018. Citations were then manually searched using reference lists of included papers and Google Scholar. Articles were included if they described programs providing return to work intervention within a hospital to adults with newly acquired neurological conditions, such as traumatic brain injury or stroke. After identifying and selecting relevant studies, we charted the data and then synthesized the results. Results Twenty-eight articles explored work intervention in an inpatient hospital setting. Interventions targeted a diagnostically heterogeneous population, mostly including adults who had suffered either a traumatic brain injury or stroke. Most interventions included a structured process for assessment, highlighted the importance of collaboration, and aimed to improve performance of work skills that could be facilitated within a hospital setting only (as opposed to all work skills). Thematic analysis of included studies resulted in four themes: structure, collaboration, clinician training, and belief in future work capacity. Conclusion Return to work intervention appears to be an important component of neurological rehabilitation. While studies to date have identified enablers for the integration of work interventions into the inpatient hospital setting, there is limited description of specific components of programs, and a lack of studies evaluating program effectiveness.

Readiness for work injury management and prevention: important attributes for early graduate occupational therapists and physiotherapists.

BACKGROUND: Early graduate occupational therapists (OTs) and physiotherapists (PTs) are routinely employed in work injury management and prevention in Australia. However, our understanding is limited about employer requirements for early graduates entering the field, and how commencing practitioners manage transition to practice. In addition, employers have expressed concerns anecdotally about the preparedness of early graduates for work injury management and prevention. However, evidence is limited about early gradutate preparedness for the field. OBJECTIVES: The study aimed to develop a detailed qualitative account of the perceptions of employers and early graduates on the attributes required of early graduates in work injury management and prevention, and processes for effective transition to practice in this field. METHOD: A purposive sample of 12 employers and 12 early graduates in work injury management and prevention participated in semi-structured interviews. Questions to employers focused on recruitment, supervision and readiness for practice. Questions to early graduates focused on challenges in transition and effective learning methods. Transcripts were analysed by Leximancer™ and supported by manual coding and synthesis. RESULTS: Four themes with findings were, 1) 'Job and workplace requirements'; skills required by employers and support needed for early graduates, 2) 'Learning for work injury management and prevention'; options for early graduate development and learning methods early graduates found effective, 3) 'Employer expectations of early graduates in transition to work injury management and prevention', responses to transition; and 4) 'Early graduate perceptions on transition to work injury management and prevention'; early graduates responses to transition. CONCLUSION: Findings for employers and early graduates were similar to those expected in other areas of practice for OTs and PTs. Work injury management and prevention skills were not expected of early graduates by employers. Employers and early graduates shared similar views that clinical education in work injury management and prevention was useful to early graduates entering this field. Physiotherapy employers considered PT early graduates not yet ready for work injury management and prevention.

Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: a systematic review.

BACKGROUND/AIM: Occupational therapists and physiotherapists have established roles in work-related practice. However, there is limited information about the attributes required by these professions for competent practice in this field. The aim of this systematic review was to evaluate the research literature to determine the knowledge, skills and professional behaviours required by occupational therapists and physiotherapists, including new graduates, in work-related practice. METHODS: A systematic search was conducted of standard databases using keywords and phrases. All types of studies and reports were included from empirical research to descriptive reports. Included literature was appraised by standard critical appraisal tools by two reviewers. Words, phrases or themes related to the attributes required for work practice were manually extracted and a meta-synthesis conducted. RESULTS: Seven observational studies, six professional practice guidelines, one book chapter, one journal editorial and seven opinion pieces met the inclusion criteria. Observational studies and descriptive reports were low on the evidence hierarchy. Meta-synthesis determined that key attributes required by occupational therapists and physiotherapists in work-related practice were knowledge of injury prevention and management, skills in communication, and professional behaviours of self-reflection and evaluation. CONCLUSION: Findings from this systematic review provided credible evidence about attributes required by occupational therapists and physiotherapists but not including new graduates, in work-related practice. However, due to low evidence levels findings will need to be applied with caution. More rigorous research is needed to evaluate occupational therapy and physiotherapy workplace interventions to guide practice and to assist occupational therapists and physiotherapists promote the effectiveness of their services.

Knowledge, skills and professional behaviours needed for occupational therapists and physiotherapists new to work-related practice.

OBJECTIVES: The paper seeks to identify the key knowledge domains, skills and professional behaviours required to prepare occupational therapists and physiotherapists for employment in work related practice. PARTICIPANTS: Twelve experienced work related practitioners in one Australian state participated in face to face semi-structured interviews. PARTICIPANTS represented the majority of perspectives in the field and in addition to professional qualifications, a number of participants were employers or contractors of therapists. METHODS: The paper reviews existing evidence about knowledge, skills and professional behaviours in the field. The results of a study examining requisite knowledge, skills and professional behaviours for occupational therapists and physiotherapists follow. Interviews were analysed using the Leximancer™ text analysis program developed at The University of Queensland. RESULTS: A high level of congruence was evident in key areas of knowledge, skills and professional behaviours between all interviewees and the literature. Findings included the need for very good communication skills by both professions and the need for a sound grounding in specific disciplinary skills. Results identified that occupational therapists take a broad view of function and task analysis and that physiotherapists have good skills in anatomy, musculoskeletal assessment and movement analysis. CONCLUSIONS: These results are considered in relation to planning the clinical education of OT and PT students in preparation for work related practice.

Role of research in occupational therapy clinical practice: applying action learning and action research in pursuit of evidence-based practice.

BACKGROUND: In South Africa, as in many other countries, the development of research capacity in students and their early professional career is regarded as of major importance. Within the context of clinical education for occupational therapy students at the University of the Free State, a lecturer and her students embarked on a collaborative journey while fulfilling the requirements of their undergraduate curriculum. The outcome is a model promoting evidence-based practice (EBP) during service development on a dementia care ward. METHODS: The practical use of action learning, action research (ALAR) approach in the clinical context, was used to encourage student engagement in successive small-scale research projects while simulating EBP. The projects ranged from the development of therapeutic multi-sensory environments to compiling activity profiles for identified residents. At the same time, students had the opportunity to experience the value of a scientific approach to practice development, which stimulated their awareness of the importance of research. RESULTS: Reflection by the researcher contributed towards more effective ways for compiling project assignments and a formalised approach for assessing projects. Students described personal and professional gains because of participation in projects against the life-changing experience of rendering a service to elderly persons suffering from dementia. The formalised approach guiding thoughts and actions finally assisted in developing a practical process model that could support EBP. CONCLUSIONS: The ALAR model contributed towards a scholarship of practice where the students, clinical educator and residents of a dementia unit all experienced the value of research.

Development of roles for occupational therapists and physiotherapists in work related practice: An Australian perspective.

OBJECTIVE: This paper will explore the development of occupational therapists' and physiotherapists' roles in work related practice from an early focus on rehabilitation of injured workers, to one including prevention and health promotion. METHODS: A review of international evidence identified the roles, tasks and employment paths for occupational therapists and physiotherapists in work related practice. The relationship between government regulation and therapists' access to the workplace was also examined. RESULTS: Occupational therapists and physiotherapists hold valued positions in work related professional practice. Whilst initially their roles were based on injury management through occupational rehabilitation, both professions have demonstrated a clear vision of the importance of prevention of work related injury and disease. Social and workplace changes in the late 1970s in a number of western countries, commencing with the Robens' reforms in the United Kingdom, led to improved legislation and regulation for managing occupational health and safety. CONCLUSIONS: The approach of both disciplines to practice in this field reflects their individual professional education. However, some role overlaps exists in consultancy activities in the industrial environment. Implementation of modern OHS regulatory programs in other western countries, including Australia, has increased and broadened the opportunities for therapists, as governments, employers and insurers support early intervention to minimise the impact of workplace injuries and diseases.