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1.
Work ; 63(4): 623-633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282455

RESUMO

BACKGROUND: The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance. OBJECTIVE: Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates. METHODS: A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups. RESULTS: Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power. CONCLUSIONS: Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Avaliação de Desempenho Profissional/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Aptidão Física , Treinamento de Resistência/métodos , Adulto , Pessoal Técnico de Saúde/normas , Avaliação de Desempenho Profissional/normas , Emprego/normas , Feminino , Humanos , Masculino , Ontário , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
2.
Work ; 63(4): 603-613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282457

RESUMO

BACKGROUND: Physical employment standards (PES) ensure that candidates can demonstrate the physical capacity required to perform duties of work. However, movement competency, or an individual's movement strategy, can relate to injury risk and safety, and therefore should be considered in PES. OBJECTIVE: Demonstrate the utility of using artificial intelligence (AI) to detect risk-potential of different movement strategies within PES. METHODS: Biomechanical analysis was used to calculate peak flexion angles and peak extensor moment about the lumbar spine during participants' performance of a backboard lifting task. Lifts performed with relatively lower and higher exposure to postural and moment loading on the spine were characterized as "low" or "high" exposure, respectively. An AI model including principal component and linear discriminant analyses was then trained to detect and classify backboard lifts as "low" or "high". RESULTS: The AI model accurately classified over 85% of lifts as "low" or "high" exposure using only motion data as an input. CONCLUSIONS: This proof-of-principle demonstrates that movement competency can be assessed in PES using AI. Similar classification approaches could be used to improve the utility of PES as a musculoskeletal disorders (MSD) prevention tool by proactively identifying candidates at higher risk of MSD based on movement competency.


Assuntos
Emprego/normas , Movimento/fisiologia , Traumatismos Ocupacionais/prevenção & controle , Exame Físico/métodos , Aptidão Física/fisiologia , Adulto , Pessoal Técnico de Saúde/normas , Inteligência Artificial , Fenômenos Biomecânicos/fisiologia , Avaliação de Desempenho Profissional/métodos , Avaliação de Desempenho Profissional/normas , Estudos de Viabilidade , Feminino , Humanos , Vértebras Lombares/fisiologia , Masculino , Exame Físico/normas , Estudo de Prova de Conceito , Amplitude de Movimento Articular/fisiologia , Medição de Risco/métodos , Adulto Jovem
4.
Ergonomics ; 62(8): 1033-1042, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31092138

RESUMO

The Ottawa Paramedic Physical Ability Test (OPPAT) is a physical employment standard (PES) that candidates must pass as a pre-hire requirement and that incumbents may have to pass prior to returning to work after absence, to demonstrate their physical capabilities as required to safely meet the demands of paramedic work. Consistent with best practice guidelines for PES development, it is important to establish reliability and to investigate sex-based performance differences. Active duty paramedics completed the OPPAT twice while candidates completed the OPPAT six times. Across all participants, a median improvement of 76.0 s was observed in OPPAT performance (922.0-846.0 s) between trial 1 and trial 2. Among candidates, OPPAT performance stabilised by the fourth trial confirming reliability. Sex-based analyses revealed median differences in OPPAT performance time of 39.0 and 63.0 s between males and females during the first and second trials respectively. Practitioner summary: Active duty paramedics and candidates performed the Ottawa Paramedic Physical Ability Test (OPPAT) faster following familiarisation. Among candidates, performance time stabilised by the fourth trial. Performance time was slower among females, but this had less impact on females' ability to meet the OPPAT standard.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Seleção de Pessoal/normas , Fatores Sexuais , Avaliação da Capacidade de Trabalho , Desempenho Profissional/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/normas , Emprego/normas , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas
6.
BMC Med Educ ; 19(1): 65, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819159

RESUMO

BACKGROUND: The purpose of this study was to test the sensitivity and specificity of eight undergraduate volunteer examiners conducting vision screening tests in a community setting, in order to determine if non-eye care professionals were able to be trained to an appropriate level of skill. METHODS: Eight undergraduate volunteer examiners were trained to conduct vision screening tests to address a gap in pediatric community eye care. Phase I of the study was implemented in the pediatric ophthalmology clinic, and phase II was conducted in nine local schools. Phase I consisted of 40 h of training for each volunteer regarding specific vision tests. Phase II consisted of screening children at nine local schools. RESULTS: A total of 690 children from nine local schools were screened by both the volunteer examiners and the optometrist during the course of this study. Volunteer examiners had a screening sensitivity of 0.80 (95%CI 0.66-0.90) and screening specificity of 0.75 (95%CI 0.71-0.78) when compared to the study optometrist. The overall accuracy of volunteer examiners was 75%. The resulting positive likelihood ratio was 3.24 (95%CI 2.6-3.9), indicating that a child with vision impairment was 3.2 times more likely to fail the vision test performed by the volunteer examiners compared to a child with no vision impairment. CONCLUSIONS: Non-healthcare professionals can be trained to an acceptable degree of accuracy to perform vision screening tests on children, which may assist in mitigating existing gaps in paediatric eye care.


Assuntos
Pessoal Técnico de Saúde/educação , Optometria/educação , Pediatria , Serviços de Saúde Escolar , Estudantes , Transtornos da Visão/diagnóstico , Seleção Visual/organização & administração , Voluntários/educação , Adolescente , Pessoal Técnico de Saúde/normas , Criança , Pré-Escolar , Competência Clínica , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pediatria/educação , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Serviços de Saúde Escolar/organização & administração , Sensibilidade e Especificidade , Seleção Visual/normas , Acuidade Visual
7.
Support Care Cancer ; 27(2): 649-657, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30051203

RESUMO

PURPOSE: Low health literacy leads to poor knowledge and understanding of health information, delayed diagnosis, lower use of preventative medicines/health services, increased likelihood of hospitalisation, and increased patient anxiety. Effective communication facilitates patient understanding and helps patients to manage the adverse side-effects associated with treatment. It is not yet known whether radiation therapists in Ireland tailor their communication to match a patient's health literacy level. The purpose of this research was to investigate radiation therapists' knowledge and awareness of health literacy and perceptions of their role in supporting patients with low health literacy. METHODS: Semi-structured interviews were conducted with sixteen radiation therapists working in four radiotherapy departments in Ireland. Data were analysed using the framework approach. RESULTS: Through discussions with participants, it was apparent that radiation therapists had limited knowledge of the concept of health literacy. Common themes arose from the interviews with four key themes identified: 1. Strategies used to identify patients' health literacy 2. Perceived effect of low health literacy 3. Obstacles faced when addressing low health literacy 4. Recommendations to support lower health literacy groups CONCLUSION: Currently, radiation therapists show some knowledge and awareness of health literacy, but an increased awareness of the prevalence of low health literacy and a structured approach to supporting patients would allow radiation therapists to more effectively communicate with patients, thus improving their treatment experience and reducing the risk of adverse outcomes.


Assuntos
Pessoal Técnico de Saúde/normas , Alfabetização em Saúde/métodos , Radioterapia/normas , Feminino , Humanos , Masculino , Pesquisa Qualitativa
8.
Int J Qual Health Care ; 31(2): 103-109, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912467

RESUMO

OBJECTIVE: To explore cost-efficiency, safety and acceptability of trans-disciplinary advanced allied health (AH) practitioners for acute adult general medicine inpatients. DESIGN: Quasi-experimental feasibility study. SETTING: Three acute general medical units in an Australian urban hospital. PARTICIPANTS: Two hundred and fifty-six acute hospital inpatients. MAIN OUTCOME MEASURES: Cost-efficiency measures included AH service utilization and length of stay (LOS). Patient outcomes were functional independence, discharge destination, adverse events, unplanned admissions within 28 days, patient satisfaction and quality of life data on admission, and 30 days post-discharge. Ward staff were surveyed regarding satisfaction with the service model, and advanced health practitioners (AHPs) rated their confidence in their own ability to meet the performance standards of the role. RESULTS: Patients allocated to AHPs (n = 172) received 0.91 less hours of AH intervention (adjusted for LOS) (95% confidence intervals (CI): -1.68 to -0.14; P = 0.02) and had 1.76 days shorter LOS relative to expected (95%CI: 0.18-3.34; P = 0.03) compared with patients receiving standard AH (n = 84). There were no differences in patient outcomes or satisfaction. AHPs demonstrated growth in job satisfaction and skill confidence. CONCLUSIONS: Trans-disciplinary advanced AH roles may be feasible and cost-efficient compared with traditional roles for acute general medical inpatients. Further development of competency frameworks is recommended.


Assuntos
Pessoal Técnico de Saúde/normas , Análise Custo-Benefício , Equipe de Assistência ao Paciente/organização & administração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde/educação , Estudos de Viabilidade , Feminino , Humanos , Pacientes Internados/psicologia , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida , Vitória
9.
Ir J Med Sci ; 188(2): 683-688, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30112623

RESUMO

BACKGROUND: Paediatric airway management is of fundamental importance in the critically unwell child. Pre-hospital paediatric airway management especially endotracheal intubation is however controversial. AIM: To explore Irish Advanced Paramedics (APs) training, experience and clinical practice in paediatric airway management as well as to examine clinician attitudes toward this topic. METHODS: An anonymous online survey of all graduates of the University College Dublin AP training program (N = 453). RESULTS: With duplicates and failed email deliveries excluded a valid sample of 382 individuals was obtained from whom a response rate of 185/382 (48.4%) was achieved. Three quarters of responding APs worked in urban or mixed practice with the remaining minority operating primarily in rural areas. One quarter of responding APs reported formal training in paediatric intubation. Almost 70% of APs had encountered a child requiring significant airway management in the preceding year. However, this was a rare exposure in terms of overall workload. Basic airway adjuncts were used frequently in such circumstances, with endotracheal intubation having been attempted by only a small minority of APs. Lack of practice was identified by many responding APs as a key issue causing concern in terms of paediatric intubation. CONCLUSION: Paediatric airway management has key relevance for pre-hospital care in Ireland. The overall frequency of exposure to children who may benefit from definitive airway management is however likely to represent a significant barrier to the acquisition and maintenance of competency. The ongoing practice of pre-hospital paediatric intubation by APs may not justify its risks.


Assuntos
Manuseio das Vias Aéreas/métodos , Pessoal Técnico de Saúde/normas , Serviços Médicos de Emergência/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
10.
Disabil Rehabil ; 41(1): 53-65, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28877650

RESUMO

PURPOSE: Evidence-based assessments for children with cerebral palsy are not widely used by healthcare professionals in day-to-day practice. This study aimed to examine allied health practitioner experiences, perceptions, and use of assessments for children with cerebral palsy. METHOD: A mixed methods study was conducted in two rehabilitation organisations. Three focus group interviews explored therapists' assessment experiences with data analysed using interpretive description. Assessment practices of therapists (n = 55) were assessed through self-report questionnaire and case-file audit of children with cerebral palsy (n = 44). RESULTS: Emergent themes described therapists' motivation to use evidence-based assessments on a behavioural continuum - I don't; I can't; I try; I do; We do; influenced by assessment satisfaction, child and family collaboration, organisational expectation, research fit, and time dedication. Only two of fifteen audited assessments were documented in more than 50% of files. Use was higher where assessments positively connected therapists, children and parents, and use was organisationally endorsed. The Cultural Cone for evidence-based assessment behaviour was conceptualised. CONCLUSIONS: "Engagement in" assessment appears to require a conceptual shift by therapists and organisations to understanding assessment as part of, not an adjunct to, therapy. The Cultural Cone framework may assist therapists and services in designing strategies to promote evidence-based assessment behaviours. Implications for rehabilitation Therapists' can reflect on where they are positioned on the "use continuum" in the Cultural Cone framework, and consider the contextual influences contained in this framework to understand their motivation to use evidence-based assessments. Routine use of evidenced-based assessments for children with cerebral palsy by allied health practitioners remains generally low and therapists and service organisations need to consider ways to increase use. Where possible, therapists' should choose assessment tools that fully engage children and families and themselves in the assessment process. The Cultural Cone framework may be used to assist therapists and organisations identify and design site specific strategies to increase evidence-based assessment use in day-to-day practice.


Assuntos
Pessoal Técnico de Saúde , Paralisia Cerebral , Avaliação da Deficiência , Competência Profissional/normas , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/normas , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/reabilitação , Criança , Prática Clínica Baseada em Evidências/métodos , Feminino , Grupos Focais , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pais/psicologia , Inquéritos e Questionários , Pesquisa Médica Translacional
12.
J Med Internet Res ; 20(12): e12091, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30559094

RESUMO

BACKGROUND: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. OBJECTIVES: This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD. METHODS: A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants' points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment. RESULTS: A significant reduction in symptom of obsession-compulsion (Y-BOCS=-6.2; Cohen d=0.74; 95% CI -9.4 to -3.0, P=.002), panic (PDSS=-5.6; Cohen d=0.89; 95% CI -9.83 to -1.37; P=.02), social anxiety (LSAS=-33.6; Cohen d=1.10; 95% CI -59.62 to -7.49, P=.02) were observed. In addition, depression (PHQ-9=-1.72; Cohen d=0.27; 95% CI -3.26 to -0.19; P=.03) and general anxiety (GAD-7=-3.03; Cohen d=0.61; 95% CI -4.57 to -1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI -0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30). CONCLUSIONS: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable.


Assuntos
Pessoal Técnico de Saúde/normas , Transtornos de Ansiedade/psicologia , Terapia Cognitivo-Comportamental/métodos , Internet/normas , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno de Pânico/psicologia , Videoconferência/normas , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Qualidade de Vida/psicologia
13.
BMC Health Serv Res ; 18(1): 965, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547793

RESUMO

BACKGROUND: Clinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified. METHODS: We used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions. RESULTS: Participants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency. CONCLUSIONS: South African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Motivação , Guias de Prática Clínica como Assunto , Enfermagem de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/normas , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/normas , Assistência à Saúde/normas , Grupos Focais , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Enfermagem de Atenção Primária/psicologia , Enfermagem de Atenção Primária/normas , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/normas , Pesquisa Qualitativa , Melhoria de Qualidade , Saúde da População Rural , África do Sul
14.
PLoS One ; 13(10): e0203420, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30335752

RESUMO

BACKGROUND: Microscopic diagnosis of Giemsa stained thick and thin blood films by skilled microscopists has remained the gold standard laboratory method for the diagnosis of malaria. However, there is a scarcity of qualified laboratory professionals for correctly diagnosing malaria using microscopy. The aim of this study was to evaluate the performance of laboratory professionals on malaria microscopy at health facilities in Bahir Dar city administration, Northwest Ethiopia. METHODS: A cross-sectional study was conducted from January to March 2017 in Bahir Dar City. A total of 87 laboratory professionals participated in the selected health facilities, with a response rate of (100%). Standardized pre-validated slide panels and questionnaire were distributed to laboratory professionals by the principal investigator. The panel slides were comprised of 5 positives and 3 negative blood films. The laboratory professionals were requested to report the parasite density using semi-quantitative (+) and per micro-liter methods. Their performances of slide readings were compared with the experts' readings. Agreement in detecting malaria parasites between laboratory professionals and expert was estimated using the kappa score. RESULTS: The overall sensitivity and specificity of the laboratory professionals in detecting malaria parasites were 83% and 97%, respectively. Similarly, positive predictive values of 98.1% and negative predictive values of 77.7% were reported. The percent agreement between laboratory professionals and expert microscopist in the detection of malaria parasites was 88.5% with a Kappa index of 0.78. Percent agreement in species identification and reporting of Pf/Pv mixed infections were 27.2% and 22.4%, respectively. About 62.2% of the laboratory professionals reported parasite density using semi-quantitative method. While none of them reported per micro-liter method. CONCLUSIONS: The current study showed that laboratory professionals had good performance in parasite detection. However, poor performance was seen in both species identification and reporting of Pf/Pv mixed infections.


Assuntos
Pessoal Técnico de Saúde/normas , Instalações de Saúde/normas , Malária/diagnóstico , Plasmodium/isolamento & purificação , Adulto , Estudos Transversais , Ética Médica , Etiópia/epidemiologia , Feminino , Humanos , Laboratórios/normas , Malária/epidemiologia , Malária/parasitologia , Masculino , Plasmodium/patogenicidade , Controle de Qualidade
15.
BMJ Open ; 8(9): e024161, 2018 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-30232116

RESUMO

OBJECTIVE: To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. DESIGN: Classic e-Delphi survey. SETTING: National study in Wales. PARTICIPANTS: Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. RESULTS: A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. CONCLUSION: Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.


Assuntos
Pessoal Técnico de Saúde , Prescrições de Medicamentos , Administração de Serviços de Saúde/normas , Enfermeiras e Enfermeiros , Farmacêuticos , Gestão da Segurança , Pessoal Técnico de Saúde/normas , Pessoal Técnico de Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , Consenso , Técnica Delfos , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Cultura Organizacional , Farmacêuticos/normas , Farmacêuticos/estatística & dados numéricos , Autonomia Profissional , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , País de Gales
16.
Educ Prim Care ; 29(6): 376-380, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30239273

RESUMO

Despite the need to develop a non-medical out-of-hours (OOHs) workforce to address increasing healthcare demands and to support a strained GP workforce, there is no consensus on the required training and clinical competencies needed for nurses and paramedics to be developed as safe OOH practitioners. This paper presents the development and evaluation of one programme delivered in 2017 to paramedics seeking to work in OOHs services. Details of the course delivery are outlined and the mixed-methods evaluation presented. Following successful university ethical approval, student and staff experiences were reviewed through interviews, questionnaires and graded feedback of completed electronic patient case records. The findings provided useful learning that can be transferred to other organisations seeking to develop such training. In particular, the findings suggest the course was able to provide the students with the skills, knowledge and confidence to become safe practitioners in the OOHs service. Challenges in course delivery were highlighted. It was suggested that course organisation, duration and scope require careful consideration to enable students to complete and practise successfully.


Assuntos
Plantão Médico/organização & administração , Pessoal Técnico de Saúde/educação , Medicina Geral/organização & administração , Profissionais de Enfermagem/educação , Assistentes Médicos/educação , Plantão Médico/normas , Pessoal Técnico de Saúde/normas , Competência Clínica , Medicina Geral/normas , Humanos , Profissionais de Enfermagem/normas , Assistentes Médicos/normas , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Critérios de Admissão Escolar
17.
BMC Health Serv Res ; 18(1): 716, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30219065

RESUMO

BACKGROUND: Building the capacity of allied health professionals to engage in research has been recognised as a priority due to the many benefits it brings for patients, healthcare professionals, healthcare organisations and society more broadly. There is increasing recognition of the need for a coordinated multi-strategy approach to building research capacity. The aim of this systematic review was to identify existing integrated models and frameworks which guide research capacity building for allied health professionals working in publicly funded secondary and tertiary healthcare organisations. METHODS: A systematic review was undertaken searching five databases (Medline, CINAHL, Embase, AustHealth and Web of Science) using English language restrictions. Two authors independently screened and reviewed studies, extracted data and performed quality assessments using the Mixed Methods Appraisal Tool. Content and thematic analysis methods were used to code and categorise the data. RESULTS: A total of 8492 unique records were screened by title and abstract, of which 20 were reviewed in full-text. One quantitative study and five qualitative studies were included, each of which describing a research capacity building framework. Three interconnected and interdependent themes were identified as being essential for research capacity building, including 'supporting clinicians in research', 'working together' and 'valuing research for excellence'. CONCLUSIONS: The findings of this systematic review have been synthesised to develop a succinct and integrated framework for research capacity building which is relevant for allied health professionals working in publicly funded secondary and tertiary healthcare organisations. This framework provides further evidence to suggest that research capacity building strategies are interlinked and interdependent and should be implemented as part of an integrated 'whole of system' approach, with commitment and support from all levels of leadership and management. Future directions for research include using behaviour change and knowledge translation theories to guide the implementation and evaluation of this new framework. TRIAL REGISTRATION: The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018087476 .


Assuntos
Pessoal Técnico de Saúde/normas , Fortalecimento Institucional , Pesquisa sobre Serviços de Saúde/normas , Humanos , Liderança , Prática Profissional/normas , Pesquisa Qualitativa
18.
J Allied Health ; 47(3): 228-233, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30194831

RESUMO

Following development of a framework to establish the scope of advanced practice for radiation therapists (APRTs), a Canadian certification process was built. This involved three independently-assessed phases: professional portfolio, case submission, and oral examination. The oral examination was to test the candidate's knowledge and capacity for decision-making. Development and piloting involved 3 elements: 1) content development, including relevant case selection, with accompanying high-fidelity imaging and resources; 2) harnessing of technology and ensuing logistics, given the desire to offer the examination online, maximizing accessibility and minimizing resources; and 3) examiner recruitment and preparation, involving a national call for interprofessional examiners, to assess across the spectrum of competencies. Each element was approached systematically, with modifications made iteratively. Three overarching challenges required ongoing attention and consideration: resource-intensiveness of building and validating cases, ensuring applicability and relevance of case content and "answers" across practice environments, and preparation of non-radiation therapist (oncologist and physicist) examiners regarding APRT standards. The resultant examination model is thought to be a robust assessment tool, well-regarded by candidates and examiners as fair and transparent, and complementary to the other certification phases. A consultatory pilot process supported establishment of a robust framework that is believed to be defensible and preliminarily valid.


Assuntos
Pessoal Técnico de Saúde/normas , Certificação/métodos , Competência Clínica/normas , Avaliação Educacional/métodos , Radioterapia/normas , Canadá , Humanos , Liderança , Variações Dependentes do Observador , Competência Profissional , Reprodutibilidade dos Testes
19.
BMC Health Serv Res ; 18(1): 509, 2018 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970079

RESUMO

BACKGROUND: Inadequate non-technical skills (NTSs) among employees in the Norwegian prehospital emergency medical services (EMSs) are a risk for patient and operational safety. Simulation-based training and assessment is promising with respect to improving NTSs. The frequency of simulation-based training in and assessment of NTSs among crewmembers in the Norwegian helicopter emergency medical service (HEMS) has gained increased attention over recent years, whereas there has been much less focus on the Norwegian ground emergency medical service (GEMS). The aim of the study was to compare and document the frequencies of simulation-based training in and assessment of seven NTSs between the Norwegian HEMS and GEMS, conditional on workplace and occupation. METHOD: A comparative study of the results from cross-sectional questionnaires responded to by employees in the Norwegian prehospital EMSs in 2016 regarding training in and assessment of NTSs during 2015, with a focus on the Norwegian GEMS and HEMS. Professional groups of interest are: pilots, HEMS crew members (HCMs), physicians, paramedics, emergency medical technicians (EMTs), EMT apprentices, nurses and nurses with an EMT licence. RESULTS: The frequency of simulation-based training in and assessment of seven generic NTSs was statistically significantly greater for HEMS than for GEMS during 2015. Compared with pilots and HCMs, other health care providers in GEMS and HEMS undergo statistically significantly less frequent simulation-based training in and assessment of NTSs. Physicians working in the HEMS appear to be undergoing training and assessment more frequently than the rest of the health trust employees. The study indicates a tendency for lesser focus on the assessment of NTSs compared to simulation-based training. CONCLUSION: HEMS has become superior to GEMS, in terms of frequency of training in and assessment of NTSs. The low frequency of training in and assessment of NTSs in GEMS suggests that there is a great potential to learn from HEMS and to strengthen the focus on NTSs. Increased frequency of assessment of NTSs in both HEMS and GEMS is called for.


Assuntos
Resgate Aéreo , Ambulâncias , Auxiliares de Emergência/educação , Capacitação em Serviço/métodos , Competência Profissional/normas , Treinamento por Simulação/métodos , Aeronaves , Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/normas , Estudos Transversais , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência/normas , Enfermagem em Emergência/normas , Humanos , Noruega , Médicos/normas , Pilotos/educação , Pilotos/normas , Segurança , Inquéritos e Questionários
20.
J Allied Health ; 47(2): 126-132, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29868698

RESUMO

OBJECTIVE: Clinical supervision (CS) is widely used by allied health (AH) professionals, although with limited supporting research evidence. The aim of this study was to evaluate the effectiveness of CS for AH professionals in a regional health setting and to investigate differences in CS perceptions between AH disciplines. METHODS: Within a participatory action research project, a quantitative cross-sectional survey was distributed to AH professionals at a regional Australian health service. Data were collected using the Manchester Clinical Supervision Scale (MCSS-26), and differences between disciplines were analysed with independent-samples t-tests and one-way between-groups ANOVA. Of a possible 258 participants, 106 responded to the survey (response rate 41%). The action research group assisted with the interpretation of findings. RESULTS: The total mean for MCSS-26 scores across AH was 78.5 ± 13.9 (SD), which is above the recommended threshold score for effective CS (73). There were statistically significant differences in total scores between occupational therapy (82.8 ± 14.4) and physiotherapy (70.9 ± 11.3) and in the formative and restorative domains. CONCLUSIONS: While CS was perceived to be effective, there were significant differences between some disciplines. The findings demonstrate that CS is effective when it is practised within a structured framework; however, flexible models of CS across disciplines need to be explored.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Mentores , Adulto , Pessoal Técnico de Saúde/normas , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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