Enabling Access to Rehabilitation in Acute Care: Exploring Physiotherapists' and Occupational Therapists' Perspectives on Patient Care When Assistants Become the Primary Therapy Providers.

Purpose: The aim of this study was to explore physiotherapists' and occupational therapists' perspectives on how the implementation of a new model of care in the acute medicine setting has affected their practice and patient care outcomes. Method: A qualitative case study was used to gain an in-depth understanding of therapists' experiences. Semi-structured, in-person interviews (45-60 min long) were conducted with eight clinicians (four occupational therapists and four physiotherapists). We used an iterative process of discussion and questioning to interpret the themes emerging from the data. Results: The findings are grouped into four categories - change in the therapist-patient relationship, change in therapists' access to first-hand patient information, developing processes to enhance information exchange, and developing processes to support patient care delivery - and two themes - therapists' expectations of patient care outcomes and redefining the value of the occupational therapists' and physiotherapists' role in contributing to patient care. Conclusions: Participants described the process of adapting their professional skills and behaviours as they evolved into the role of manager of therapy care. Occupational therapists and physiotherapists recognized the potential for occupational therapist assistants (OTAs) and physiotherapist assistants (PTAs) to provide more frequent and consistent care. The therapists highlighted the necessity of ensuring that effective working processes and interactions between the therapist and the OTAs and PTAs were in place to ensure high-quality patient care.

Objectif : explorer les points de vue des physiothérapeutes et des ergothérapeutes sur la mise sur pied d'un nouveau modèle de soins aigus qui a eu une incidence sur leur pratique et les résultats des soins aux patients. Méthodologie : les chercheurs ont privilégié une étude de cas qualitative pour tâcher de mieux comprendre les expériences des thérapeutes. Ils ont réalisé des entrevues individuelles semi-structurées (de 45 à 60 minutes) auprès de huit cliniciens (quatre ergothérapeutes et quatre physiothérapeutes). Ils ont privilégié un processus itératif de discussion et de questions pour interpréter les thèmes qui se sont dégagés. Résultats : les résultats sont divisés en quatre catégories (changement à la relation entre le thérapeute et le patient, changement à l'accès à l'information directe sur le patient, élaboration de processus pour améliorer l'échange d'information et élaboration de processus pour soutenir la prestation des soins aux patients) et en deux thèmes (attentes des thérapeutes quant aux résultats des soins au patient et redéfinition de la valeur du rôle de l'ergothérapeute et du physiothérapeute dans les soins au patient). Conclusion : les participants ont décrit le processus d'adaptation de leurs compétences et comportements professionnels dans l'évolution de leur rôle vers celui de gestionnaires des soins thérapeutiques. Les ergothérapeutes et les physiothérapeutes ont convenu de la possibilité que des soins plus fréquents et plus réguliers soient fournis par les assistants-ergothérapeutes et les assistants-physiothérapeutes. Les thérapeutes ont souligné la nécessité de s'assurer de la mise en place de processus de travail et d'interactions efficaces entre les assistants-ergothérapeutes, les assistants-physiothérapeutes et les autres thérapeutes pour garantir des soins de qualité aux patients.

Introducing Primary Care Telephone Visits: An Urban Safety-Net Community Clinic Experience.

BACKGROUND: Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. MEASURES: Patient and physician surveys, and physician focus groups. RESULTS: Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. CONCLUSIONS: Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

Physical conditioning to enhance +Gz tolerance: issues and current understanding.

INTRODUCTION: Although Canadian Forces (CF) efforts directed at developing new G-protection strategies have often raised the question of potential benefits of physical conditioning (PC) on G tolerance (GT), a fatality in a CF fighter aircraft accident, in which it was suggested the pilot may have had 'sub-optimal GT,' sparked renewed interest in this topic. METHODS: A two-part review was conducted: 1) a survey of the literature on the effects of PC on GT; and 2) a determination of further research required to resolve uncertainties on the subject. RESULTS: Five key themes surfaced: 1) GT as a concept is complex, and has different connotations for different users; 2) the term 'PC' likewise has a variety of meanings, and precise definitions are necessary to compare research results; 3) in examining the relationship between PC and GT, the roles of strength training, muscle fatigue, and aerobic fitness are not as clear as some studies seem to suggest; 4) in designing PC programs to enhance GT, issues such as palatability, efficacy, and intended target population must be addressed for the program to be operationally useful; and 5) there is a requirement for investigations that have controlled important influences such as intercurrent +Gz-stress exposure, proficiency in performing the anti-G straining maneuver, and the wide inter- and intra-individual variation for PC and GT measurements. DISCUSSION: The effects of PC on GT are not well established. Further research with more robust experimental designs and/or analyses than those used to date must be conducted (on new or existing data) to clarify this relationship. Conducting such work with sound experimental design and controls is more complex and time-consuming than some may appreciate.

Focus group study assessing self-management skills of Chinese Americans with type 2 diabetes mellitus.

Despite a rapid growth of Type 2 diabetes mellitus in Chinese Americans, the management of diabetes in this population is yet understudied. This pilot study attempts a first step in seeking solutions to decrease demand for health services in this population by improving patients' self-care. Focus groups were conducted in well-controlled (HbA1c < 7) and poorly-controlled (HbA1c > 8) Chinese Americans with Type 2 DM who were asked about their knowledge and self-care skills of diabetes as well as experience of living with the disease. Well-controlled had more insights in their illness and were more inquisitive, while poorly-controlled were more fixated on symptoms and side effects of treatments. Common themes for both groups included interest in diet and Traditional Chinese Medicine. The findings provide valuable information to design a survey instrument to more definitively assess self-care skills differentiating levels of control, suggest that changing attitudes and behaviors need to be a stronger focus in care and identify needs to provide more culturally appropriate materials to care for this population.

Uncertainties and constraints on breaching and their implications for flood loss estimation.

Around the coasts of the southern North Sea, flood risk is mediated everywhere by the performance of natural and man-made flood defences. Under the conditions of extreme surge with tide water levels, the performance of the defences determines the extent of inland flooding. Sensitivity tests reveal the enormous increase in the volume of water that can pass through a defence once breaching is initiated, with a 1m reduction in sill elevation doubling the loss. Empirical observations of defence performance in major storm surges around the North Sea reveal some of the principal controls on breaching. For the same defence type, the maximum size and depth of a breach is a function of the integral of the hydraulic gradient across the defence, which is in turn determined by the elevation of the floodplain and the degree to which water can continue to flow inland away from the breach. The most extensive and lowest floodplains thereby "generate" the largest breaches. For surges that approach the crest height, the weaker the protection of the defence, the greater the number of breaches. Defence reinforcement reduces both the number and size of the breaches.