Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.

Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Clinical Radiology.

The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the "usual scope" of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.

Promoting professional behaviour in general practitioner training practices: The views of practice managers.

BACKGROUND AND OBJECTIVES: General practitioners (GPs) are required by the Australian professional colleges of general practice - The Royal Australian College of General Practitioners and The Australian College of Rural and Remote Medicine - to practise a high standard of professional behaviour. General practice registrars (GPRs) learn this in their training practices not only from their general practice supervisors, but also the practice managers (PMs). Little is known of PMs' views of the meaning of the term 'professional behaviour' and how they view their role in GPR education. METHOD: Nineteen semi-structured interviews with PMs were conducted. Saturation was reached and consensus achieved on the analysis. RESULTS: PMs held nuanced views on the meaning of the term 'professional behaviour' and actively promoted and modelled this to their staff, including GPRs. PMs believed they had a role in GPR education. DISCUSSION: Practice managers are well placed to model and teach professional behaviour, and their skills should be further used to educate GPRs.

Instrumentos de medición de los conocimientos sobre prevención de úlceras por presión: revisión de la literatura / Tools for measuring the knowledge on pressure ulcer prevention: a literature review

En la prevención de las úlceras por presión (UPP) intervienen diferentes factores: estructurales, organizativos y relacionados con los profesionales; entre ellos, el grado de conocimientos que los profesionales sanitarios tengan es un aspecto fundamental. Objetivo: Identificar los instrumentos de medición de conocimientos de los profesionales de enfermería sobre las UPP. Como objetivos específicos: a) resumir las propiedades psicométricas (validez y fiabilidad) de cada instrumento y b) sintetizar el nivel de conocimientos sobre prevención según los estudios seleccionados. Metodología: Revisión narrativa de la literatura sobre los conocimientos en prevención de UPP. Búsqueda de estudios en 10 bases de datos bibliográficas desde el inicio de indexación hasta julio de 2018. Se incluyeron estudios cuantitativos que utilizasen instrumentos, test o cuestionarios, que cuantificasen los conocimientos en profesionales o estudiantes de enfermería. Se realizó una síntesis descriptiva. Resultados: Se seleccionaron 90 artículos, a partir de los cuales se identificaron 7 instrumentos (o alguna variación del cuestionario original) que han sido utilizados en al menos dos estudios publicados y 31 investigaciones, los cuales han desarrollado instrumentos ad hoc. Los dos más utilizados son el cuestionario Pieper Pressure Ulcer Knowledge (PPKUT) y el cuestionario Pressure Ulcer Knowledge Assessment Tool (PUKAT). No todos los instrumentos publicados presentan datos de fiabilidad y validez psicométrica. Entre los 31 estudios que describen un instrumento desarrollado ad hoc para esa investigación, solo en 5 de ellos se presentan datos de fiabilidad y validez. Aunque se han encontrado estudios que utilizan como fuente para la redacción de los ítems guías de práctica clínica (GPC), son muchos otros los que se basan en revisiones de la literatura, parten de instrumentos previos o no indican la fuente original. Los conocimientos descritos, de forma general en los diferentes estudios, están por debajo del punto de corte establecido por los autores. Conclusión: La medición del nivel de conocimientos sobre prevención de las UPP que tienen los profesionales de salud es importante como primer paso dentro de los programas de prevención de estas lesiones. Se han encontrado un elevado número de cuestionarios sin ninguna prueba de fiabilidad ni de validez, pero que han sido usados en estudios, lo cual contribuyen a generar datos poco relevantes y un grado de confusión. Es fundamental que los investigadores utilicen alguno de los cuestionarios que cuentan con evaluación psicométrica y que determinen dichas propiedades en la muestra utilizada en la investigación

Different factors (structural, organizational and related with professionals) intervene in the prevention of pressure ulcers (PU); the degree of knowledge of health professionals is one of the main aspects. Aim: To identify the instruments for measuring the knowledge of nursing professionals about pus. The specific objectives are: a) to summarize the psychometric properties (validity and reliability) of each instrument and b) to synthesize the knowledge on prevention according to the selected studies. Methodology: Narrative review on knowledge about PU prevention. Search in 10 bibliographic databases from the beginning of indexation until July 2018. The studies included were quantitative studies that used instruments, tests or questionnaires, which quantified the knowledge of professionals or nursing students. A descriptive synthesis was carried out. Results: 90 articles were selected, from which 7 instruments were identified (or some variation of the original questionnaire) that have been used in at least 2 published studies and 31 investigations, which have developed ad hoc instruments. The 2 most used tools are the Pieper Pressure Ulcer Knowledge (PPKUT) questionnaire and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) questionnaire. Not all published instruments show data on psychometric reliability and validity. Among the 31 studies that describe an ad hoc instrument, only in 5 of them reliability and validity data are shown. Although some studies used Clinical Practice Guidelines as a source for item elaboration, there are many others that are based only in literature review; modified some previous instruments or did not indicate the original source. The knowledge described in the different studies, in general, are below the cut-off point established by the authors. Conclusions: Measuring the knowledge on PU prevention of health professionals is important as a first step in injury prevention programs. A large number of the questionnaires found have any proof of reliability or validity; nevertheless they have been used in studies, which contribute to the generation of irrelevant data and to create confusion. It is essential that researchers use questionnaires with good psychometric properties and these properties should be evaluated again in the sample used in the research

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota.

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: At the 2017 annual meeting of the American Association of Hip and Knee Surgeons (AAHKS), a survey was conducted to assess current practice management strategies by AAHKS members. METHODS: During the annual AAHKS meeting, a survey was conducted using an audience response system. The moderator queried AAHKS members with respect to a variety of practice management issues. The survey included both multiple choice and yes or no questions. The answers were collected in a central database and provided to the audience in real time. RESULTS: The survey responses provided valuable information with respect to the practice activity of AAHKS members. A total of 47% of AAHKS members are in private practice, and fee for service remains the major form of compensation for 39% of the membership. Participation in bundled-payment programs was 46%. A minority (22%) had performed a total joint arthroplasty in an outpatient surgery center. CONCLUSION: This survey of AAHKS members' practice patterns provided interesting data. Future surveys should determine potential changes in practice activity related to private practice, fee for service compensation, the use of outpatient surgery centers for total joint arthroplasty, and surgeon participation in bundled-payment programs.

Infrastructures for healthcare: From synergy to reverse synergy.

The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada.

OBJECTIVE: In the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). METHODS: Data regarding speciality surgeons' adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. RESULTS: Compared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: "no suitable product for my practice" (p = 0.01), "too costly" (p = 0.0006), "too time consuming" (p < 0.0001), and "planning to retire soon" (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. CONCLUSIONS: The barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.

The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

BACKGROUND: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. METHODS: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. CONCLUSIONS: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.

The Current Situation on Major Depressive Disorder in China: Research on Mechanisms and Clinical Practice.

Depression is the most disabling disorder worldwide that accounts for the highest proportion of global burden attributable to mental disorders. Major depressive disorder (MDD) is characterized by deep sadness, reduced energy, vegetative nervous system dysregulation, cognitive dysfunction, and even a high suicidal tendency. Although other treatment choices are available, antidepressant medication is the front-line treatment option for MDD. Regarding clinical efficacy, only ~50% of patients respond to frontline antidepressants, and <33% obtain remission. Currently, objective indexes to guide clinical decisions are still lacking. Furthermore, knowledge about the neurobiological mechanisms underlying discrepant antidepressant outcomes is still also fragmentary. In the present review, we discuss the current research progress and clinical opinions on MDD in China.

Conhecimento e práticas em saúde bucal nas escolas de ensino fundamental de um município de pequeno porte do sertão paraibano / Knowledge and practices in oral health of elementary school teachers from a small city in the savanna region of the state of Paraíba, Brazil

Objetivo: Este estudo objetivou avaliar o conhecimento dos professores e práticas de saúde bucal nas escolas de ensino fundamental em um município de pequeno porte pertencente ao Sertão Paraibano. Materiais e Métodos: Utilizou-se um questionário composto por questões relativas às condições sociodemográficas, ao conhecimento das principais medidas preventivas e agravos de saúde bucal, como também questões relacionadas à existência de atividades educativas em saúde bucal nas unidades públicas de ensino. A amostra correspondeu ao censo de professores cadastrados na rede de ensino fundamental de Desterro-PB, totalizando 61 educadores. Os dados foram analisados por meio da estatística descritiva. Resultados: Comprovou-sepercentual considerado de professores graduados ou pós-graduados (81,9%). Quando avaliados a respeito dosprincipais agravos de saúde bucal; 54,3% dos entrevistados mencionaram cárie dentária como uma patologiae apresentam conhecimento satisfatório em relação à etiologia da doença. Ao serem questionados em relaçãoàs medidas preventivas em saúde bucal; 95,1% dos educadores afirmaram que a técnica utilizada é o fatormais importante durante a escovação dentária, porém, apenas 16,4% relataram inserir a quantidade correta de dentifrício na escova. Um percentual expressivo da amostra já recebeu informações a respeito dos cuidadosem saúde bucal (95,1%). Porém, do total de pesquisados, um pouco mais da metade afirmou transmitir essasinformações aos alunos. Entre aqueles que relataram não realizar tal tarefa, 41% mencionaram a falta de materialde apoio como maior obstáculo para abordar os conteúdos dentro das instituições de ensino. A existência deatividades educativas em saúde bucal, realizada por odontólogos, foi presenciada por 85,2 % dos educadores.Conclusão: Embora existam práticas preventivas nas escolas pesquisadas, há necessidade da implementaçãode programas de educação continuada sobre saúde bucal...

Characteristics of primary care practices associated with high quality of care.

BACKGROUND: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. METHODS: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. RESULTS: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. INTERPRETATION: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

Modelo de gestión de casos e investigación / Management of cases and research model

El modelo de gestión de casos es una forma de avanzar y mejorar la atención integrada, coordinada y continuada, centrado en la responsabilidad compartida de coordinar los cuidados, recursos, servicios y profesionales. La enfermera es líder de este proyecto por tener una visión integral orientada a cubrir necesidades y fomentar el auto-cuidado. Significa un agente de cambio en este nuevo escenario de gestión y liderazgo dentro del sistema sanitario. El objetivo del trabajo es hacer una reflexión sobre posibles líneas de investigación en cuidados de enfermería, aplicadas a la gestión de casos. Los lenguajes NANDA-NIC-NOC constituyen un proyecto original para proporcionar un panorama general de pensamiento enfermero, una estructura y un contenido para planificar cuidados y tomar decisiones clínicas. La enfermería basada en la evidencia establece un medio útil que interconecta teoría y práctica dando instrumentos para implementar los resultados de investigación entre las enfermeras clínicas evitando la variabilidad en la práctica. El uso de la investigación enfermera enfocada a medir resultados, orientará la organización de los servicios de salud. Las enfermeras gestoras de casos han demostrado resultados de efectividad en disminución de la mortalidad y los reingresos pero es necesario construir preguntas de investigación empleando términos y elementos del marco conceptual enfermero que aporten resultados sólidos y eviten variabilidad en la clínica (AU)

Management of cases is a way of advancing and improving integrated, coordinates ans continuous attention, with the focus on shared responsibility in coordinating care, resourcesm services and professionals. The nurse is the leader of the project since he/she has an overall view aimed at covering needs and fostering self-care. The nurse is an agent of change in this new management and leadership scenario in the health system. The aim of this study is to offer a refection on possible research lines on nursing cares applied to management of cases. The NANDA-NIC-NOC languages comprise an original project to provide an overview of nursing thought, a structure and content to plan care and to take clinical decisions. Evidence-based nursing establishes a useful means to interconnect theory and practice, by providing tools to implement the results from research in nursing clinics and so avoid variations of practice. The use of nursing research focused on measuring results can direct and guide the organization of health services. Case manager nurses have reported results that are effective in reducing mortality and readmissions but it is necessary to develop research questions using terms and elements from the nursing conceptual framework that provide sound results and avoid variations in the clinic (AU)