Lessons Learned From the COVID-19 Pandemic: Occupational Therapy on the Front Line.

The pandemic caused by coronavirus disease 2019 (COVID-19) highlighted the insufficient public health policies and lack of a national pandemic response strategy. Rehabilitation departments faced barriers to providing care in the traditional manner and needed to consider protection of patients and staff, staffing and personal protective equipment shortages, and uncertainty about best practices to address a novel health condition. This article highlights the strategies implemented by acute care occupational therapy leaders to support their staff; facilitate efficient care provision; and pivot with constantly changing policies, procedures, and research during the COVID-19 crisis. Occupational therapy's distinct value in caring for this population and role in responding to the pandemic are shared to provide a guidepost for future health care crises.

Policy and Payment Changes Create New Opportunities for Occupational Therapy in Acute Care.

IMPORTANCE: Changes in health care policy and payment over the past decade have resulted in a greater emphasis on cost effectiveness, quality outcomes, and the health care consumer's experience. Payers' response to the new policies and their expectations have created expanded opportunities for occupational therapy practitioners in health care overall but particularly in acute care hospitals. OBJECTIVE: The objective of this article is to empower occupational therapy directors, practitioners, educators, and students to be proactive in a rapidly changing acute care setting. EVIDENCE REVIEW: Research on policy and payment changes since the passage of the Patient Protection and Affordable Care Act (Pub. L. 111-148) was synthesized with evidence related to occupational therapy practice and education. FINDINGS: Occupational therapy practitioners in acute care environments are experiencing expanded roles in optimizing patient readiness for safe community discharge, decreasing lengths of stay, and protecting them from hospital-acquired conditions. CONCLUSIONS AND RELEVANCE: Policy and payment initiatives reward health care organizations for the added value occupational therapy practitioners bring to acute care teams. WHAT THIS ARTICLE ADDS: This article details how occupational therapy practitioners can advance consumer satisfaction, outcomes, and efficiency in acute care, which can lead to increased recognition of the vital role that occupational therapy can play, thus leading to expanded opportunities.

Primary Care: A New Context for the Scholarship of Practice Model.

Interest in the emerging role for occupational therapy in the primary care practice setting has increased due to implementation of the Patient Protection and Affordable Care Act (ACA), which intends to expand health care coverage to uninsured Americans while improving coordination of care, health outcomes, and cost savings. Expanding occupational therapy to encompass promotion of wellness and prevention in a primary care context provides an opportunity for occupational therapy. The purpose of this article is to describe the role of occupational therapy in primary care and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary care.

Comparing and Using Occupation-Focused Models.

As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.

Establishing the measurement properties of the Residential Environment Impact Scale (Version 4.0).

BACKGROUND: Developed as an environment assessment informed by the Model of Human Occupation, the Residential Environment Impact Survey considered the physical, social and activity features of the environment, evaluating the impact of the environment on resident's quality of life. Clinicians reported that the Residential Environment Impact Survey was a useful tool; however, it had not been structured to be a measurement tool and did not have established psychometric properties. AIMS/OBJECTIVES: This study examines the psychometric properties of the restructured Residential Environment Impact Scale Version 4.0 (REIS), which measures the level of environment support provided to residents. MATERIAL AND METHODS: The REIS was completed across residential sites for people with complex mental health needs. A many facets Rasch analysis was conducted to establish the reliability and validity of the REIS. RESULTS: The REIS demonstrated reasonable psychometric properties, with items demonstrating internal scale validity and scale items following an expected pattern of increasingly challenging environment support. CONCLUSIONS AND SIGNIFICANCE: Initial evidence suggests that the REIS provides a valid and reliable measure of environment support, providing a detailed assessment of how physical, social and activity elements of the environment support or inhibit participation and can be applied across a range of living environments.

Developing the residential environment impact survey instruments through faculty-practitioner collaboration.

The Residential Environment Impact Survey (REIS) and the REIS-Short Form (REIS-SF), based on the Model of Human Occupation, are non-standardized, semi-structured assessments aimed at evaluating how a home influences the quality of life of the resident(s). Occupational therapy practitioners have used these instruments as consulting tools to formulate and implement recommendations to improve residents' occupational functioning. Using a faculty-practitioner collaboration framework, international REIS and REIS-SF users were surveyed to elicit feedback regarding how these tools are being used, and how they can be improved. Survey results were analyzed and will be used to further develop these instruments to better meet the needs of practitioners.

Theory use in practice: a national survey of therapists who use the Model of Human Occupation.

OBJECTIVE: This study describes how occupational therapists who reported using the Model of Human Occupation (MOHO) actually use the concepts and tools of this model in everyday practice as well as identifies supports and barriers to its use. METHOD: A systematic random sample of 1,000 occupational therapists was surveyed as to what theories they used in their practice. Those using MOHO (430) were sent a detailed questionnaire; 259 therapists (60.2%) responded to the survey questionnaire. RESULTS: More than 80% of respondents indicated that they used MOHO in their practice at least some of the time. Therapists reported that MOHO supports holistic, occupation-focused, client-centered, and evidence-based practice. They reported finding MOHO concepts useful for treatment planning and intervention. Most saw the major barrier to using MOHO as their own lack of knowledge. CONCLUSION: Making resources more readily available and accessible to therapists might enhance the extent to which they use conceptual models such as MOHO.

Suicide Postvention in the Department of Defense: Evidence, Policies and Procedures, and Perspectives of Loss Survivors.

The U.S. Department of Defense (DoD) has been struggling with increasing rates of suicide among military personnel for the past decade. As DoD continues to implement new programs and examine its policies in an effort to prevent military personnel from taking their own lives, it is important to assess its current responses to suicide and to identify opportunities to enhance these programs and policies. Unfortunately, there is little scientific evidence on how best to respond to suicides, how to ensure that surveillance activities are managed appropriately and that loss survivors are given sufficient support to grieve, how additional suicides can be prevented, and how to honor and respect the decedent and his or her loved ones. At the same time, there are many resource guides intended to provide recommendations for organizations (mostly schools) in responding to suicides. A review of the existing scientific evidence on postvention (responses to prevent additional suicides in the aftermath of a suicide) and guidance for other types of organizations provides potential insights for DoD, however. Complemented by the perspectives of those most intimately touched by military suicide-the family and friends of those who have died-these sources may help DoD formulate its guidance in a practical and sensitive way.

Toward Integrated DoD Biosurveillance: Assessment and Opportunities.

In the context of the 2012 National Strategy for Biosurveillance, the Office of Management and Budget (OMB) asked the Department of Defense (DoD) to review its biosurveillance programs, prioritize missions and desired outcomes, evaluate how DoD programs contribute to these, and assess the appropriateness and stability of the department's funding system for biosurveillance. DoD sought external analytic support through the RAND Arroyo Center. In response to the questions posed by OMB request, this study finds the following: (1) Current DoD biosurveillance supports three strategic missions. Based mostly on existing statute, the highest-priority mission is force health protection, followed by biological weapons defense and global health security. (2) Guidance issued by the White House on June 27, 2013, specified priorities for planning fiscal year 2015 budgets; it includes an explicit global health security priority, which strengthens the case for this as a key DoD biosurveillance strategic mission. (3) DoD biosurveillance also supports four desired outcomes: early warning and early detection, situational awareness, better decision making at all levels, and forecast of impacts. (4) Programs and measures that address priority missions-force health protection in particular-and desired outcomes should be prioritized over those that do not do so. (5) More near-real-time analysis and better internal and external integration could enhance the performance and value of the biosurveillance enterprise. (6) Improvements are needed in key enablers, including explicit doctrine/policy, efficient organization and governance, and increased staffing and improved facilities for the Armed Forces Health Surveillance Center (AFHSC). (7) AFHSC has requested additional funding to fully implement its current responsibilities under the 2012 Memorandum of Understanding between the Assistant Secretaries of Defense for Health Affairs and for Nuclear, Chemical, and Biological Defense Programs. Additional responsibilities for coordinating the entire DoD biosurveillance enterprise would need concomitant resourcing. (8) There is not a single, unified funding system for the DoD biosurveillance enterprise; the multiple current funding systems would likely benefit from an organizing mechanism with the authority to manage and control funds to meet enterprise goals. Interim guidance issued by the Deputy Secretary of Defense on June 13, 2013, is significant because it is the first policy to explicitly address biosurveillance; it adopts the definition from the National Strategy for Biosurveillance, calls for development of a DoD Directive for biosurveillance, and specifies tasks for DoD's implementation of the Strategy.

A general method for the separation of triphenylphosphine oxide and reaction products using high performance countercurrent chromatography.

A standardised separation methodology was developed for the purification of crude reaction mixtures containing triphenylphosphine oxide (TPPO) using high performance countercurrent chromatography (HPCCC). A solvent system consisting of hexane/ethyl acetate/methanol/water (5:6:5:6) was used in 1 column volume elution-extrusion mode. The HPCCC methodology was compared with classical RP HPLC purification using a set of 12 representative Mitsunobu reaction mixtures. HPCCC was seen to yield a 65% increase in the average recovery of the target component whilst providing similar final target purities to those obtained by HPLC. By eliminating the need for method development for individual samples, the HPCCC methodology described within provides a simple and efficient means for the purification of the entire family of TPPO-containing reaction products.

Implications of the Affordable Care Act for occupational therapy practitioners providing services to Medicare recipients.

The passage of the Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111-148) represents the largest expansion in government funding of health care since Medicare and Medicaid were established in 1965 (Curfman, Abel, & Landers, 2012). Although the health insurance mandate and Medicaid expansion have received the most attention as a result of legal challenges and the July 2012 Supreme Court ruling on the legality of the ACA (Henry J. Kaiser Family Foundation, 2012), other ACA initiatives may have even greater implications for occupational therapy. The ACA includes sections on improving quality and health systems performance for Medicare recipients, with some sections also applying to Medicaid recipients. Insurance companies commonly follow Medicare rules; therefore, the Medicare reforms are likely to spread across all payers, health care settings, and care recipients.

A practical drug discovery project at the undergraduate level.

In this article, we describe a practical drug discovery project for third-year undergraduates. No previous knowledge of medicinal chemistry is assumed. Initial lecture workshops cover the basic principles; then students, in teams, seek to improve the profile of a weakly potent, insoluble phosphatidylinositide 3-kinase delta (PI3Kδ) inhibitor (1) through compound array design, molecular modelling, screening data analysis and the synthesis of target compounds in the laboratory. The project benefits from significant industrial support, including lectures, student mentoring and consumables. The aim is to make the learning experience as close as possible to real-life industrial situations. In total, 48 target compounds were prepared, the best of which (5b, 5j, 6b and 6ap) improved the potency and aqueous solubility of the lead compound (1) by 100-1000 fold and ≥tenfold, respectively.

Harnessing Full Value from the DoD Serum Repository and the Defense Medical Surveillance System.

The Army manages the Department of Defense Serum Repository (DoDSR) of over 43 million serum samples and the associated Defense Medical Surveillance System (DMSS) database that links individual service member characteristics to these biological samples. The main mission and use of these resources has been for military health surveillance. The Army turned to RAND Arroyo Center to systematically examine current requirements and capabilities of the DoDSR and DMSS, identify gaps, and suggest strategies to improve their ability to meet current and potential future military health needs, including surveillance, outbreak investigation, research, and clinical support, particularly as these relate to influenza and other infectious disease threats. The research drew information from written documents and interviews with military and civilian experts. The study identified a number of opportunities to improve the management, content, and use of the serum repository and associated database. There were six main recommendations: (1) clarify and communicate the missions of the DoDSR and DMSS both within and beyond the Department of Defense; (2) empower, structure, and resource the organizational oversight of DoDSR and DMSS so that they can fulfill the full range of their missions; (3) create an integrative data plan for comprehensive health surveillance; (4) enhance the utility of specimens; (5) plan for the next repository facility; and (6) raise awareness of and expand access to DoDSR and DMSS.

Association between increased number of US pharmacy graduates and pharmacist counts by state from 2000-2009.

OBJECTIVE: To determine whether growth in the number of pharmacy graduates and newly accredited schools from 2000 to 2009 were larger in states with fewer pharmacists per population age ≥ 65 years. METHODS: States were aggregated into quartiles based on rank-ordered ratios of in-state pharmacists per 100,000 population aged ≥ 65 years. Quartiles were then compared with respect to the number of new graduates. RESULTS: The mean cumulative number of graduates was highest in the first quartile of states (those with the greatest need for pharmacists) and lowest in the fourth quartile of states. States with the greatest need for pharmacists had the lowest positive growth in number of pharmacists per population ≥ 65 years. The majority of new schools in 2009 were located in states with relatively low numbers of pharmacists. CONCLUSION: The growth in new pharmacy graduates created by expansion in schools as well as in graduates per school helped states meet demand between 2000 and 2009. However, tremendous variation remains in the number of graduates as well as the number of pharmacists across states. The quartile framework is useful for assessing the number of new pharmacy graduates based on pharmacists per population ratios. Based on current dynamics in the supply and demand of pharmacists, frequent monitoring is recommended.

Synthesizing research, education, and practice according to the scholarship of practice model: two faculty examples.

SUMMARY The Scholarship of Practice involves an ongoing, reflective discourse among the theoretical concepts of occupational therapy, the empirical verification of those concepts through research, and the application of those concepts in real-world clinical practice. This article illustrates how the Scholarship of Practice framework is applied by occupational therapy faculty members as a key aspect of their scholarly and teaching roles. Two distinct perspectives are provided-one describes the scholarship and teaching of a clinical-track faculty member and the other describes that of a research-track faculty member. Both examples illustrate how each faculty member's work involves an integration of teaching and advising, scholarship (i.e., developing occupational therapy theory and conducting research), and practice. In both cases, the faculty member uses the Scholarship of Practice approach to better understand the kinds of problems and needs of clients and the ways in which practitioners can use knowledge generated by theory and research to most effectively address them. In turn, each faculty member relies heavily on the feedback from students and practitioners regarding the outcomes of the practical application of the concepts offered by theory and research. This feedback is then utilized to revise and refine existing theory, generate new research questions, and ultimately inform best occupational therapy practice. Finally the process serves as an ideal context for teaching and advising.

Administration and application of the Worker Role Interview: looking beyond functional capacity.

Assessing factors beyond the functional capacity of the injured worker is challenging, yet essential for deriving a more complete understanding of the worker. Insight into a worker's perceptions of abilities and limitations, commitment to the worker role, perception of the impact of the injury on non-work roles, ability to adjust habits and routines, and perception of the work environment allows the therapist to identify and address barriers to return-to-work. The Worker Role Interview (WRI), based on the Model of Human Occupation, is designed to assist the therapist in obtaining this information. The therapist's ratings on a four-point scale provide a picture of the factors which support and interfere with successful return-to-work. This paper describes the WRI and discusses its clinical application. A case example illustrates how the information gained from the WRI can be used for treatment planning.

Developing and maintaining community partnerships within "a scholarship of practice".

SUMMARY This article describes the application of a model developed and adopted by the occupational therapy faculty at the University of Illinois at Chicago to utilize partnerships with community-based organizations to meet a tripartite mission of education, research, and service delivery. The model (A Scholarship of Practice) was developed and adopted in response to contextual influences occurring at multiple levels. These influences are identified and the actions taken by the faculty are described. "A Scholarship of Practice" is briefly described and the principles that have guided development and maintenance of successful partnerships with community-based organizations are discussed. Finally, the outcomes and benefits of partnering with community-based organizations are identified.

The model of human occupation: understanding the worker who is injured or disabled.

This paper discusses application of the model of human occupation to the worker with an injury or disability. Concepts from the model of human occupation (MOHO) are used to frame potential work-related strengths and weaknesses. Using MOHO as a framework to understand the worker with an injury or disability provides a more complete and holistic understanding of the many factors which can affect a worker. In particular, the model illuminates how factors of capacity, motivation, lifestyle, and environment inter-relate in determining a worker's success or failure. Implications for using the model to achieve a more effective work-related practice are discussed.