Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013-2021.

PURPOSE: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. METHODS: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. RESULTS: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. CONCLUSIONS: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. CLINICAL RELEVANCE: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Diagnosis and management of suspected Lyme neuroborreliosis-related facial nerve palsy in children by paediatricians and general practitioners: a French survey.

The diagnosis and management of facial nerve palsy in children in Lyme borreliosis endemic area can be complex. The objective of this study was to evaluate the diagnosis and management of children with suspected Lyme neuroborreliosis (LNB)-related facial nerve palsy by general practitioners (GP) and paediatricians. We conducted a prospective national survey of clinical practice between September 2018 and January 2020. The questionnaire was intended for GPs and paediatricians. It is based on two distinct clinical situations (a 10-year-old child and a 5-year-old child) and contains questions about the diagnosis and management of facial nerve palsy in children with a recent tick bite. We obtained 598 responses (350/4125 paediatricians and 245/577 GPs). For a 10-year-old child with a facial nerve palsy in the context of a tick bite, more than half of GPs (52%) required a paediatric infectious consultation and 18% an admission to the hospital for lumbar puncture before the result of Lyme serology. The most prescribed antimicrobial therapies were amoxicillin (32%) and ceftriaxone (29%). For a 5-year-old child, there is no difference in the diagnosis of LNB and treatment except for doxycycline which was less prescribed. Concerning treatment, 18% of practitioners prescribed antibiotic therapy only (14% of GPs vs 21% of paediatricians, p = 0.09), and 17% prescribed antibiotic therapy combined with corticosteroids (14% of GPs vs 19% of paediatricians, p = 0.15). Finally, 93% of GPs and 75% of paediatricians reported to be uncomfortable with the diagnosis of LNB in children. CONCLUSION: Most participants were uncomfortable with the diagnosis of LNB. There was a limited difference in the management of LNB in children between GPs and paediatricians. WHAT IS KNOWN: • Lyme neuroborreliosis (LNB) is the second cause of facial nerve palsy in Europe, and its diagnosis is based on neurological symptoms and a lumbar puncture. However, no clinical criteria could be used to differentiate Bell's palsy and LNB. Moreover, data on the adjunctive corticosteroid treatment and outcome in patients with LNB-related facial nerve palsy are controversial. WHAT IS NEW: • Most participants were uncomfortable with the diagnosis of LNB. Its management was heterogeneous and most often not consistent with guidelines. Only 28% of participants requested a lumbar puncture in cases of suspected LNB, and 17% prescribed antibiotics with corticosteroids. • This study highlights the need for new specific guidelines in management (need for lumbar puncture and/or LB serology) and treatment (time to antibiotic initiation, probabilistic therapy, role of corticosteroids, doxycycline in children younger than 8 years) of LNB in children.

Minimizing unnecessary proBNP blood tests: an evaluation of a pop-up form implementation in general practice.

OBJECTIVE: To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark. DESIGN: A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention. SETTING AND SUBJECTS: From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients. MAIN OUTCOME MEASURE: The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention. RESULTS: Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p < 0.0001). CONCLUSIONS: This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines.

Evaluation of nurse practitioners' extended scope of practice in a regional hospital emergency department in tropical Australia.

OBJECTIVES: There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7-month period. METHODS: This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes. RESULTS: A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events. CONCLUSIONS: This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast-track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia.

Trauma Connect Clinic: Continuing the trauma case management model for patients affected by traumatic injuries: A quality improvement initiative.

BACKGROUND: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear. AIM: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care. METHODS: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications. RESULTS: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia. CONCLUSION: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients' physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.

Healthcare of patients with atopic dermatitis by general practitioners - a nationwide survey in Germany.

BACKGROUND AND OBJECTIVES: Epidemiological studies on the health care of patients with atopic dermatitis (AD) in dermatological treatment in Germany indicate no improvements within 10 years. In addition to dermatologists, general practitioners (GPs) are particularly involved in AD treatment. This study analyzed the health care situation of adult patients with AD by GPs. PATIENTS AND METHODS: The cross-sectional questionnaire survey "PsoADA" was conducted from 2019 to 2021 in general practices throughout Germany and the results were compared with previous data from dermatology care (AtopicHealth2, 2017-19). RESULTS: Among 150 patients (mean age: 40 years, 62.2% female), 39.2% received additional treatment by a dermatologist (GP+D). 20.7% of GP+D and 5.7% of patients in GP treatment only (GP only) had severe AD (p < 0.01, AtopicHealth2: 27.6%). Major limitations in quality of life were reported by 31.0% (GP+D) versus 3.4% (GP only) (p < 0.001, AtopicHealth2: 31.6%). Most patients received topicals, mainly glucocorticosteroids. Calcineurin inhibitors were currently administered by 2.7% (PsoADA total). Patient education was reported by 5.7% (PsoADA total). CONCLUSIONS: A considerable proportion of patients with AD in GP care shows poor outcomes, as has been observed in dermatological care - possibly due to the lack of use of modern systemic therapy.

Emergency care via video consultation: interviews on patient experiences from rural community hospitals in northern Sweden.

BACKGROUND: Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and patients have a significant impact on the patient's experience of safety and inclusion. Understanding the patient perspective is crucial to developing good quality healthcare, but little is known about patient experiences of emergency care via VC in a rural context. The aim of this study was to explore patient experiences of emergency care via VC in northern rural Sweden. METHODS: Using a qualitative approach, semi- structured interviews (n = 12) were conducted with individuals aged 18-89 who had received emergency care with a registered nurse (RN) on site and VC with a general practitioner (GP). The interviews were conducted between October 2021 and March 2023 at community hospitals (n = 7) in Västerbotten County, Sweden. Interviews were analysed with content analysis. RESULTS: The analysis resulted in main categories (n = 2), categories (n = 5) and subcategories (n = 20). In the main category, "We were a team of three", patients described a sense of inclusion and ability to contribute. The patients perceived the interaction between the GP and RN to function well despite being geographically dispersed. Patients highly valued the opportunity to speak directly to the GP. In the main category, "VC was a two-sided coin", some experienced the emergency care through VC to be effective and smooth, while some felt that they received a lower quality of care and preferred face-to-face consultation with the GP. The quality of the VC was highly dependent on the RN's ability to function as the hub in the emergency room. CONCLUSION: Patients in rural areas perceived being included in 'the team' during VC, however they experienced disadvantages with the system on individual basis. The nursing profession plays an important role, and a proper educational background is crucial to support RNs in their role as the hub of the visit. The GP's presence via VC was seen as important, but to fully enable them to fulfil their commitments as medical professionals, VC needs to be further improved with education and support from technical devices.

Comparing independent prescribing to patient group direction use in a general practitioner out-of-hours service: a retrospective cross-sectional service evaluation.

Introduction: Global demand for healthcare is escalating, prompting exploration of innovative strategies to augment service capacity. Independent prescribing (IP) helps to address this challenge, allowing non-medical professionals to prescribe medication. Paramedics in the UK were granted prescribing privileges in 2018, yet uptake remains low. Despite qualitative evidence indicating that paramedic prescribing is beneficial, quantitative comparisons of medication provision between prescribers and non-prescribers are lacking. Paramedics provide patients with non-emergency medication by three different routes: IP, using a patient group direction (PGD) or with prescriber support.Advanced paramedic practitioners who are not qualified as independent prescribers, rotating through ambulance and general practitioner out-of-hours services, offered an opportunity to quantitatively compare medication supply. Methods: This study compares medication supply by three advanced paramedic practitioners using PGDs with three prescribing nurses in a Welsh general practitioner out-of-hours service. A cross-sectional design was employed to retrospectively review electronic patient clinical records between 1 December 2019 and 30 November 2020, including patients presenting with one of five generalised clinical conditions (urinary, soft tissue, respiratory, abdominal pain, ear). Descriptive analysis and non-parametric tests compared medications prescribed or supplied, how patients received medication and reasons for seeking prescriber support. Results: A total of 397 patient records were analysed. Paramedics supplied medications more frequently with prescriber support (68.2%) than via PGD (27.9%). Nurses predominantly prescribed medication independently (99.3%). Medication provision was comparable when paramedics had prescriber support. Reasons for paramedic support-seeking included having no PGD available (34.1%) and PGD being excluded from use (28.4%). Conclusions: Advanced paramedic practitioner medication supply using PGDs and prescriber support was comparable to that of prescribing nurse colleagues. However, autonomy restrictions highlight the need for paramedic prescribing in services where prescriber availability is limited. Further research evaluating the efficiency and cost-effectiveness of PGD use versus IP is necessary. Additionally, the qualitative benefits of IP, such as improved patient care and satisfaction, warrant due consideration when implementing future healthcare strategies.

Advanced Practice Providers in the Medical Genetics Workforce: A Nationwide Survey.

PURPOSE: This study characterizes the current landscape of genetics advanced practice providers (APPs) in the United States. METHODS: A 35-question survey was emailed to the Genetics APP Listserv in the fall of 2023. Questions represented five domains: demographics, practice, onboarding, compensation, and perceptions. RESULTS: A total of 105 genetics APPs (93%) completed the survey. Genetics APPs evaluate various patient types and populations in multiple settings, working an average of 41.3 hours and seeing 15 patients weekly. Nearly all see new (96%) and follow-up (98%) patients and utilize telemedicine (93%). Half (51%) have only worked in the genetics specialty during their career. Overall, APPs are generally satisfied with their career as a genetics APP (98%) and work-life balance (86%), and most (86%) feel they function at the top of their scope. CONCLUSION: Study findings elucidate the current state of genetics APPs. Results define the characteristics and role of an APP in the genetics specialty and will guide employers and genetics organizations to utilize APPs at the top of their scope and recruit new APPs to this exciting field. A collaborative effort is needed to increase the overall genetics workforce, decrease patient wait times, and increase access to genetics care.

Comparison of clinical pharmacist practitioners' headache care roles across clinical contexts within the Veterans Health Administration: Optimizing pharmacist integration.

BACKGROUND: Studies show interdisciplinary treatment is highly effective for addressing chronic pain syndromes, including headache disorders. Increasingly, advanced practice pharmacists work collaboratively with physicians to apply their unique skills to enhance patient outcomes. OBJECTIVE: This qualitative study aimed to elucidate the potential in the Veterans Health Administration (VHA) for increased roles of clinical pharmacist practitioners (CPPs)-advanced practice pharmacists with a scope of practice-in collaborative, interdisciplinary headache care teams. Our research question was: How do CPPs integrate with interdisciplinary headache care teams in Headache Centers of Excellence (HCoE) and non-HCoE VHA facilities, and how can their roles be configured to optimize headache specialty care services? METHODS: This cross-sectional qualitative study used purposive sampling to recruit CPPs providing headache care within HCoEs and in non-HCoE VHA facilities for virtual, recorded, individual interviews. Multi-stage qualitative data analysis entailed: team discussions; immersion/crystallization for close reading of transcripts to identify emerging patterns of HCoE/non-HCoE comparison of CPPs' experiences; team data sorting using spreadsheets; and further immersion into sorted data for final identification of comparisons and interpretation of the data. RESULTS: A total of 15 CPPs involved in headache care were interviewed, with about half working in HCoEs and half in non-HCoE VHA facilities across the United States. CPPs' roles within and outside HCoEs have considerable overlap as both groups co-manage patients with headache with physicians. CPPs have independent and collaborative responsibilities as they extend headache specialists' services by providing direct patient care and referring to additional providers for headache treatment. When their roles differ within and outside HCoEs it is largely due to level of integration on interdisciplinary headache or pain teams. CPPs in HCoEs collaborate with headache neurologists and interdisciplinary teams; some outside HCoEs do as well, while others work with primary care. CPPs' weekly time dedicated specifically to headache tends to be greater in HCoEs. Nevertheless, most interviewees in both groups stated patient need exceeds CPP availability at their facilities for conducting detailed chart reviews, initial visits to understand the context of patients' headache, and scheduled follow-ups over time to monitor and adjust treatment. CPPs also consult with and educate physicians on headache pharmacy, particularly regarding appropriate use of non-formulary medications. CONCLUSION: Findings from this study suggest that CPPs' roles in headache care are valuable to clinical colleagues and their patients and should be leveraged and expanded within HCoEs and non-HCoE VHA facilities. When substantively integrated into interdisciplinary headache care teams, CPPs offer unique knowledge, headache management and patient behavior change skills, extend headache specialists' services, and provide both patient and physician education. These combined responsibilities contribute to enhancing patient outcomes and facilitating ongoing access to high quality, evidence-based headache care.

Adapting the Nurse Practitioner Primary Care Organizational Climate Questionnaire for Acute Care Nurse Practitioners.

Background and Purpose: This study adapted the Nurse Practitioner Primary Care Organizational Climate Questionnaire to measure the organizational climate of nurse practitioners in acute care settings and validated the Nurse Practitioner Acute Care Organizational Climate Questionnaire (NP-ACOCQ). Methods: We used a three-phase instrument adaptation design. In phase 1, experts assessed face and content validity. In phase 2, pilot testing enabled item analysis and preliminary reliability testing. In phase 3, field testing supported exploratory factor analysis. Results: The NP-ACOCQ had a three-factor structure representing subscales. The subscales had Cronbach's alphas of 0.87, 0.90, and 0.94. The subscales, Institutional Visibility, Interprofessional Relationships, and Organizational Autonomy each had between 5 and 13 items. Conclusions: The NP-ACOCQ is a valid and reliable measure to assess organizational factors determining the acute care nurse practitioner work environment.

Willingness to use clinical scales for menopause management among general practitioners.

OBJECTIVES: The use of digital healthcare technologies to enhance healthcare delivery has seen significant growth. However, a notable a notable research gap exists in the application of clinical scales for menopause management by general practitioners (GPs). This study aims to investigate willingness of GPs to use specific menopausal scale tools in the care of females for menopause management. METHOD: An anonymous online survey was developed, which received responses from 348 French GPs in 2023. Multiple backward logistic regression was performed to identify the factors influencing the willingness to use a practical menopause management scale. RESULTS: In total, 87.93% of GPs are not familiar with the Greene Climacteric Scale and 90.52% are not familiar with the Menopause Quick 6 scale. In contrast, 90.52% would be interested in having access to such scales. The willingness to use a menopause management scale is associated with caring for menopausal females (odds ratio [OR] = 6.13, 95% confidence interval [CI] [2.08-18.08], p = 0.001), less experience (OR = 7.10, 95% CI [2.05-25.22], p = 0.002), the importance of health prevention in daily practice (comparing 'very important' to 'not', OR = 12.98, 95% CI [1.68-97.60], p = 0.004) and the use of a digital scale in daily practice for menopausal management (OR = 2.13, 95% CI [1.04-5.83], p = 0.014). CONCLUSION: Future research is essential in representative population to confirm these findings in menopause management.

Effective Engagement Techniques Across the Agricultural Conservation Practice Adoption Process.

Encouraging agricultural landowners to adopt conservation practices is crucial to enhancing ecosystem services in privately-owned farm landscapes. To improve engagement with landowners and increase adoption rates, much research has been dedicated to investigating how different psychological, social, economic, and political factors correlate with adoption. However, these studies largely measure adoption as a discrete, binary event. Doing so obscures sequences of landowner decisions and engagement techniques that conservation practitioners use to encourage landowners' progression through the adoption process. We report on two studies that contribute to the emerging literature on the agricultural conservation practice adoption process and the varying effectiveness of engagement techniques throughout. First, interviews with conservation practitioners in the Chesapeake Bay watershed, USA, yielded a preliminary model of the different stages in the adoption process and what techniques practitioners find effective at each stage. Second, an online experiment examined the effectiveness of a visualization intervention across two sequential outcomes in the adoption process, seeking further information and contacting a practitioner. Our results suggested that practitioners use a wide variety of engagement techniques, most of which are unique to a single stage in the adoption process, and that the effectiveness of the visualization technique varies substantially between different stages. Together these studies outline a suite of techniques that other practitioners may find effective at different stages of the adoption process, and suggest that research can better inform practice by accounting for variation in the effectiveness of different techniques across stages of adoption.

Impact of the Swine flu pandemic on General Practitioner (GP) visits in Finland: sex and age differences.

BACKGROUND: Swine flu might serve as a model for challenges that primary care faces during pandemics. This study examined changes in the numbers and diagnoses of general practitioner (GP) visits during and after the Swine flu pandemic in Vantaa, a Finnish city, and how GP activities recovered after the pandemic. Putative sex and age group differences were also evaluated. METHODS: The study was an observational retrospective study. The monthly number of patient visits to primary care GPs by women and men in age groups 0-19, 20-64 and 65 + years was recorded before, during and two years after the Swine flu pandemic. The recorded diagnoses were also examined. The investigation period was from 2008 to 2012. RESULTS: The numbers of monthly visits to primary care decreased from 12 324 (mean) to 10 817 in women and from 8563 to 7612 in men during the first six months of the Swine flu, returning to the original level afterwards. This decrease was thus slightly more prominent in women. However, as the size of the population increased during the follow-up period, the actual number of GP visits adjusted for the size of population remained at a decreased level for two years after the Swine flu. This decrease was observed especially in office-hours visits of men (from 3692 to 3260) and women (from 6301 to 5428) of 20-64 years. Swine flu did not alter the number of visits to the primary care Emergency Department. The proportion of visits with diagnostic recordings of common infectious diseases mostly decreased during the Swine flu. Only a minor impact on the distribution of recordings of chronic diagnoses was found. CONCLUSION: A pandemic, such as Swine flu, may decrease office-hours visits to primary care GPs. This in turn may lead to activities of primary care being adjusted downward for a long time following the pandemic. Especially the age group 20-64 years may be affected. This risk should be considered when recovery from the COVID-19 pandemic begins. Swine flu did not affect the proportion of consultations of chronic diseases, but the number of diagnoses of common infectious diseases had diminished.

Cooperation across healthcare service levels for medication reviews in older people with polypharmacy admitted to a municipal in-patient acute care unit (The COOP II Study): study protocol for a randomized controlled trial.

BACKGROUND: Polypharmacy and inappropriate drug use are associated with adverse health outcomes in older people. Collaborative interventions between geriatricians and general practitioners have demonstrated effectiveness in improving clinical outcomes for complex medication regimens in home-dwelling patients. Since 2012, Norwegian municipalities have established municipal in-patient acute care (MipAC) units, designed to contribute towards reducing the number of hospital admissions. These units predominantly serve older people who typically benefit from multidisciplinary approaches. The primary objective of this study is to evaluate the effect of cooperative medication reviews conducted by MipAC physicians, supervised by geriatricians, and in collaboration with general practitioners, on health-related quality of life and clinical outcomes in MipAC patients ≥ 70 years with polypharmacy. Additionally, the study aims to assess the carbon footprint of the intervention. METHODS: This is a randomized, single-blind, controlled superiority trial with 16 weeks follow-up. Participants will be randomly assigned to either the control group, receiving usual care at the MipAC unit, or to the intervention group which in addition receive clinical medication reviews that go beyond what is considered usual care. The medication reviews will evaluate medication appropriateness using a structured but individualized framework, and the physicians will receive supervision from geriatricians. Following the clinical medication reviews, the MipAC physicians will arrange telephone meetings with the participants' general practitioners to combine their assessments in a joint medication review. The primary outcome is health-related quality of life as measured by the 15D instrument. Secondary outcomes include physical and cognitive functioning, oral health, falls, admissions to healthcare facilities, and mortality. DISCUSSION: This study aims to identify potential clinical benefits of collaborative, clinical medication reviews within community-level MipAC units for older patients with polypharmacy. The results may offer valuable insights into optimizing patient care in comparable municipal healthcare settings. TRIAL REGISTRATION: The study was registered prospectively on ClinicalTrials.gov 30.08.2023 with identifier NCT06020391.

Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations.

Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development.

Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control.

Longstanding inequities in cancer prevention and control require novel approaches to improve evidence-based intervention implementation. Exploring and elevating the perspectives of cancer prevention and control practitioners working to advance health equity and equitably implement evidence-based interventions is an important yet underutilized step among researchers working in this space. The purpose of this study was to explore practitioners' perspectives of how health equity is defined and integrated into their work, challenges of advancing health equity for implementation in local settings, and associated strategies. We conducted virtual key informant interviews and focus groups with 16 US practitioners (e.g. clinicians, health administrators, public health professionals) in 2021-2022. Interviews and focus groups were audio recorded and transcribed. Data were coded using inductive content analysis and summarized into themes. Four major themes emerged: (i) how health equity is conceptualized as a process and outcome; (ii) need to shift equity mindsets; (iii) importance of community partnerships; (iv) organizational policies and strategies for fostering equity in implementation. Respondents noted the need for research and medical communities to learn about the importance and benefits of allowing communities to shape implementation to advance equity in the delivery of evidence-based interventions and outcomes. Additionally, respondents emphasized that institutional leaders should initiate changes regarding equitable implementation at the organizational- and system-levels. Respondents endorsed the need to address equity issues related to the implementation of cancer prevention and control programs, practices, and policies. Many findings can be applied beyond cancer prevention and control to support equitable implementation and outcomes more generally.

We need practitioners' input to improve how interventions can help those who need them most. In cancer prevention and control, we asked practitioners what they think about health equity in their work and problems they face. Our findings show how practitioners build strong community partnerships and make changes in health care and public health to improve health equity. These findings can be used in other health areas.

Perspectives on improving wound care for Aboriginal health workers in rural and remote communities in Queensland, Australia.

BACKGROUND: The care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians' Health Program's objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia. METHODS: Yarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia. RESULTS: Two themes were developed through rigorous data analysis of yarning information and responses: participants' experiences of managing wounds and barriers and enablers to effective wound care. CONCLUSIONS: This study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.

[Clinical and transversal competencies of advanced practice nurses (APNs) within a cellular therapy team (SFGM-TC)]. / Compétences cliniques et transversales des infirmier(e)s en pratique avancée (IPA) au sein d'une équipe de thérapie cellulaire (SFGM-TC).

The advanced practice nurse (APN) has been introduced in France, following the 2016 health law and implementing decrees published in 2018. In this context, the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has already issued guidelines regarding the allocation of APNs' new clinical competences and their collaboration with physicians. It is now providing new recommendations on the transversal activities that can be fulfilled by APNs, such as research, leadership, training and teaching. Additionally, the guidelines outline how APNs can cooperate with other professionals in departments of haematology and cellular therapy, including nurses, coordinators and health managers.

Collaborative nursing education between advanced practice registered nurses.

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.