Physiotherapy private practitioners' opinions regarding interprofessional collaborative practice: A qualitative study.

Physiotherapy private practitioners comprise a growing proportion of Australia's primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners' opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists' perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.

A Survey of Parents' and Carers' Perceptions of Parenting a Child With Developmental Dysplasia of the Hip.

PURPOSE: To explore parents' and carers' perceptions of parenting a child with developmental dysplasia of the hip (DDH). METHODS: A retrospective analysis of a questionnaire of parents and carers of children with hip dysplasia. Data analysis was guided by qualitative content analysis. RESULTS: There were 753 responses describing a range of parenting experiences. Three themes emerged: arduous parenting , detailed the parenting challenges, both practical and emotional posed by the management of DDH; insufficient understanding , described the social disconnection experienced by the respondents due to a lack of empathy from others; inconsistent guidance , encompassed respondents' reliance on health professionals for information and support, yet frustration at variability in the management of DDH. CONCLUSIONS: Overall, having to care for a child with DDH has a negative effect on the practice of parenting. Health professionals can support parenting and provide consistent education to assist parents' understanding of the complex nature of DDH management. What this study adds to the evidence: Despite a good prognosis, the diagnosis of hip dysplasia has a negative effect on of parenting. Parents and carers of children with hip dysplasia rely on the support of health professionals but find the associated loss of parenting autonomy distressing.

Allied health professionals' perceptions of interprofessional collaboration in primary health care: an integrative review.

This integrative review synthesizes research studies in order to explore the perceptions of allied health professionals regarding interprofessional collaboration in primary health care. A comprehensive literature search was conducted using three electronic databases and a manual search of the Journal of Interprofessional Care. The Crowe Critical Appraisal Tool was used to assess the quality of included papers. Study findings were extracted, critically examined and grouped into themes. Twelve studies conducted in six different countries met the inclusion criteria. Thematic analysis revealed five themes: (1) shared philosophy; (2) communication and clinical interaction; (3) physical environment; (4) power and hierarchy; and (5) financial considerations. This review has identified diverse key elements related to interprofessional collaboration in primary health care, as perceived by allied health professionals. Opportunity for frequent, informal communication appeared essential for interprofessional collaboration to occur. Allied health professionals working in close proximity to health practitioners from other professions had more regular interprofessional interactions than those who were geographically separated. Co-location of multiple primary health care services within the same physical space may offer increased opportunities for interprofessional collaboration. Future research should avoid reporting on allied health professionals in primary health care collectively, and isolate data to the individual professions. Direct observational methods are warranted to investigate whether allied health professionals' perceptions of interprofessional collaboration align with their actual clinical interactions in primary health care settings.

Exploring the Lived Experience of Parenting a Child with Developmental Dysplasia of the Hip.

Aim: Parenting a child with a health issue such as hip dysplasia (DDH) can be complicated and stressful. We aimed to explore in depth, the lived experience of parenting a child with DDH.Methods: Guided by phenomenology of practice, six mothers and one father of children with DDH were engaged in semi-structured interviews about their parenting experiences. Data were audio-recorded, transcribed verbatim and analyzed thematically.Results: Two themes emerged. Surrendering the parenting prerogative, which described participants' accounts of losing parenting autonomy while needing to rely on others to meet the needs of their child. The second theme; Struggling to adjust day-to-day, described the impact that DDH had on parenting and how participants struggled daily to meet the needs of their child.Conclusion: The management of DDH impacted both the emotional and practical aspects of parenting. Health professionals are ideally placed to support the parenting of children with DDH, but need to understand the parents' particular needs to provide this support empathetically.

Delivering introductory physiotherapy clinical placements incorporating simulated learning experiences in rural settings.

OBJECTIVE: To investigate the delivery, in rural settings, of introductory physiotherapy clinical placements incorporating simulation and describe the impact of these placements on the uptake of longer-term rural immersion opportunities. DESIGN: Retrospective cohort design. SETTING: The University of Newcastle and the University of Newcastle Department of Rural Health (UONDRH), New South Wales, Australia. PARTICIPANTS: Data from undergraduate physiotherapy students were included. INTERVENTION: Second-year University of Newcastle physiotherapy students undertake an introductory placement which includes one week of simulated learning followed by a two-week traditional health care placement. Supervisor training and active promotion of placements were undertaken to increase the capacity of rural sites to deliver these placements, including both simulation and immersion components. MAIN OUTCOME MEASURE(S): Data relating to numbers of students undertaking introductory placements and final-year rural immersion experiences in the UONDRH between 2012 and 2020 were described. A simple review of the placement strategy was also undertaken. RESULTS: Introductory placements incorporating simulation were successfully implemented in the UONDRH settings and have continued annually. Physiotherapy staff in the UONDRH have been upskilled and have supported local clinicians to increase their supervisory capacity. The proportion of students undertaking introductory placements supported by the UONDRH has increased considerably as has the number of students completing full-year rural immersion experiences in the UONDRH. CONCLUSIONS: Delivering introductory physiotherapy placements incorporating simulation in rural settings was feasible and this strategy leads to increased placement capacity. Early rural clinical placement opportunities can increase students' uptake of longer-term rural immersion experiences which, in turn, can positively influence rural practice intentions.

The changing landscape of physiotherapy student clinical placements: An exploration of geographical distribution and student performance across settings.

OBJECTIVE: To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students. DESIGN: A retrospective cohort design was used for this study. SETTING: The University of Newcastle, New South Wales. PARTICIPANTS: Data from entry-level Bachelor of Physiotherapy student clinical placements. MAIN OUTCOME MEASURE(S): Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model (MMM) categories: one (most metropolitan) to seven (most remote). RESULTS: Over the 12 year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas (MMM1) was 78% and in rural areas (MMM categories 3-6) was 22%. In 2014 these proportions had changed to 59% (MMM1) and 40% (MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories. CONCLUSIONS: The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.

Australian critical care nursing professionals' attitudes towards the use of traditional "chest physiotherapy" techniques.

BACKGROUND: Chest physiotherapy techniques, such as percussion, postural drainage, and expiratory vibrations, may be employed in a critical care setting. Physiotherapists are primarily responsible for their provision; however, nurses have also traditionally implemented these treatments. It is unclear whether nurses consider chest physiotherapy to be a part of their role, or how they perceive their knowledge and confidence pertaining to these techniques. OBJECTIVE: To investigate the attitudes of nurses towards traditional chest physiotherapy techniques. METHOD: A total of 1222 members of the Australian College of Critical Care Nurses were invited to participate in an anonymous online survey. RESULTS: There were 142 respondents (12%) with the majority (n = 132, 93%) having performed chest physiotherapy techniques in clinical practice. Most of them considered that the provision of chest physiotherapy was a part of nurse's role. Commonly cited factors influencing nurses' use of chest physiotherapy techniques were the availability of physiotherapy services, adequacy of nursing staff training and skill, and perceptions of professional roles. CONCLUSIONS: Nurses working in critical care commonly utilised traditional chest physiotherapy techniques. Further research is required to investigate the reasons why nursing professionals might assume responsibility for the provision of chest physiotherapy techniques, and if their application of these techniques is consistent with evidence-based recommendations.

Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals.

OBJECTIVE: Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. SETTING: Rural (NSW) and remote (NT) Australian healthcare settings. PARTICIPANTS: Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation. MAIN OUTCOME MEASURE(S): Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. RESULTS: Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. CONCLUSIONS: Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.

Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?

OBJECTIVE: Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions. METHODS: The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR. RESULTS: The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support. CONCLUSIONS: The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.

Promoting effective interprofessional collaborative practice in the primary care setting: recommendations from Queensland physiotherapy private practitioners.

BACKGROUND: Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. METHODS: Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. RESULTS: Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. CONCLUSIONS: This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training.

Environmental surface monitoring as a noninvasive method for SARS-CoV-2 surveillance in community settings: Lessons from a university campus study.

Environmental testing of high-touch objects is a potential noninvasive approach for monitoring population-level trends of SARS-CoV-2 and other respiratory viruses within a defined setting. We aimed to determine the association between SARS-CoV-2 contamination on high-touch environmental surfaces, community level case incidence, and university student health data. Environmental swabs were collected from January 2022 to November 2022 from high-touch objects and surfaces from five locations on a large university campus in Florida, USA. RT-qPCR was used to detect and quantify viral RNA, and a subset of positive samples was analyzed by viral genome sequencing to identify circulating lineages. During the study period, we detected SARS-CoV-2 viral RNA on 90.7 % of 162 tested samples. Levels of environmental viral RNA correlated with trends in community-level activity and case reports from the student health center. A significant positive correlation was observed between the estimated viral gene copy number in environmental samples and the weekly confirmed cases at the university. Viral sequencing data from environmental samples identified lineages concurrently circulating in the local community and state based on genomic surveillance data. Further, we detected emerging variants in environmental samples prior to their identification by clinical genomic surveillance. Our results demonstrate the utility of viral monitoring on high-touch environmental surfaces for SARS-CoV-2 surveillance at a community level. In communities with delayed or limited testing facilities, immediate environmental surface testing may considerably inform epidemic dynamics.

Improving Bacterial Metagenomic Research through Long-Read Sequencing.

Metagenomic sequencing analysis is central to investigating microbial communities in clinical and environmental studies. Short-read sequencing remains the primary approach for metagenomic research; however, long-read sequencing may offer advantages of improved metagenomic assembly and resolved taxonomic identification. To compare the relative performance for metagenomic studies, we simulated short- and long-read datasets using increasingly complex metagenomes comprising 10, 20, and 50 microbial taxa. Additionally, we used an empirical dataset of paired short- and long-read data generated from mouse fecal pellets to assess real-world performance. We compared metagenomic assembly quality, taxonomic classification, and metagenome-assembled genome (MAG) recovery rates. We show that long-read sequencing data significantly improve taxonomic classification and assembly quality. Metagenomic assemblies using simulated long reads were more complete and more contiguous with higher rates of MAG recovery. This resulted in more precise taxonomic classifications. Principal component analysis of empirical data demonstrated that sequencing technology affects compositional results as samples clustered by sequence type, not sample type. Overall, we highlight strengths of long-read metagenomic sequencing for microbiome studies, including improving the accuracy of classification and relative abundance estimates. These results will aid researchers when considering which sequencing approaches to use for metagenomic projects.

Improving chronic lung disease management in rural and remote Australia: the Breathe Easy Walk Easy programme.

BACKGROUND AND OBJECTIVE: To evaluate the impact of a chronic lung disease management training programme, Breathe Easy Walk Easy (BEWE), for rural and remote health-care practitioners. METHODS: Quasi-experimental, before and after repeated measures design. Health-care practitioners (n = 33) from various professional backgrounds who attended the BEWE training workshop were eligible to participate. Breathe Easy Walk Easy, an interactive educational programme, consisted of a training workshop, access to online resources, provision of community awareness-raising materials and ongoing telephone/email support. Participant confidence, knowledge and attitudes were assessed via anonymous questionnaire before, immediately after and at 3 and 12 months following the BEWE workshop. At 12 months, local provision of pulmonary rehabilitation services and patient outcome data (6-min walk test results before and after pulmonary rehabilitation) were also recorded. RESULTS: Measured knowledge (score out of 19) improved significantly after the workshop (mean difference 7.6 correct answers, 95% confidence interval: 5.8-9.3). Participants' self-rated confidence and knowledge also increased. At 12-month follow up, three locally run pulmonary rehabilitation programmes had been established. For completing patients, there was a significant increase in 6-min walk distance following rehabilitation of 48 m (95% confidence interval: 18-70 m). CONCLUSIONS: The BEWE programme increased rural and remote health-care practitioner knowledge and confidence in delivering management for people living with chronic lung disease and facilitated the establishment of effective pulmonary rehabilitation programmes in regional and remote Australian settings where access to such programmes is limited.

An exploration of factors influencing physiotherapists' involvement in student clinical education.

BACKGROUND: The demand for physiotherapy student clinical placements is increasing in many countries, including Australia, and there is continued reliance on physiotherapists to assume the student clinical educator role. Exploring factors influencing physiotherapists' decision to be involved in clinical education is essential to maintaining and building clinical education capacity for the future. OBJECTIVE: To explore factors influencing Australian physiotherapists' decision to be involved in student clinical education. METHODS: A qualitative study using data collected from a valid and reliable online survey tool. Respondents were physiotherapists representing public and private workplaces across varied geographical settings in Australia. Data were thematically analyzed. RESULTS: Surveys were completed by 170 physiotherapists. Most respondents were employed in hospital (81/170, 48%) and private (53/170, 31%) settings in metropolitan locations (105/170, 62%). Six themes representing factors influencing physiotherapists' involvement in student clinical education were identified, including perceptions of: professional duty, personal benefits or gains, suitability of workplace, support requirements, role related challenges, and readiness to be a clinical educator. CONCLUSION: Many factors influence physiotherapists' decisions to assume the clinical educator role. This study could assist clinical education stakeholders to provide practical and targeted strategies to overcome challenges, and optimize support, for physiotherapists in the clinical educator role.

A national survey of urinary incontinence in professional Team England female athletes.

OBJECTIVES: To investigate the prevalence of urinary incontinence in Team England female athletes participating in the 2018 Commonwealth Games, the self-imposed lifestyle modifications used to manage symptoms in training and competition and the impact on performance. STUDY DESIGN: This was a Cross-Sectional Survey. All Team England female athletes participating in 2018 Commonwealth Games were asked to complete a structured questionnaire regarding symptoms and management of urinary incontinence. Chi-squared statistical analysis was applied to relevant data. RESULTS: 103 athletes were included. 52 % reported experiencing urinary incontinence (38 % in training vs 27 % in competition X2 = 2.68, p0.13). Highest rates of incontinence were seen in cycling and gymnastics, with lowest rates of incontinence in swimming and rugby. In sports requiring form fitting garments, 64 % did not feel they could wear a pad in training, compared with 19 % in sports with less form-fitting clothing. In competition, 75 % of athletes wearing form-fitting clothing did not feel they could wear a pad, compared with 24 % of those with less form-fitting attire (X2 = 16.9, p < 0.001 in training; X2 = 24.04, p = <0.001 in competition). 11 % of athletes reported reducing fluid intake to reduce urinary incontinence in training and 8 % reported doing this in competition. Only 3 % of athletes reported that their performance is affected by urinary incontinence. CONCLUSION: Prevalence of urinary incontinence is higher in athletes than in the general population. Tight-fitting sportswear is a barrier to athletes using pads to manage urinary incontinence. Athletes may reduce fluid intake to reduce urinary leakage in training and competition, which may affect performance. However, few athletes report that urinary incontinence has an impact overall.

Joining Forces against Antibiotic Resistance: The One Health Solution.

Antibiotic resistance is a significant global health concern that affects both human and animal populations. The One Health approach acknowledges the interconnectedness of human health, animal health, and the environment. It emphasizes the importance of collaboration and coordination across these sectors to tackle complex health challenges such as antibiotic resistance. In the context of One Health, antibiotic resistance refers to the ability of bacteria to withstand the efficacy of antibiotics, rendering them less effective or completely ineffective in treating infections. The emergence and spread of antibiotic-resistant bacteria pose a threat to human and animal health, as well as to the effectiveness of medical treatments and veterinary interventions. In particular, One Health recognizes that antibiotic use in human medicine, animal agriculture, and the environment are interconnected factors contributing to the development and spread of antibiotic resistance. For example, the misuse and overuse of antibiotics in human healthcare, including inappropriate prescribing and patient non-compliance, can contribute to the selection and spread of resistant bacteria. Similarly, the use of antibiotics in livestock production for growth promotion and disease prevention can contribute to the development of antibiotic resistance in animals and subsequent transmission to humans through the food chain. Addressing antibiotic resistance requires a collaborative One Health approach that involves multiple participants, including healthcare professionals, veterinarians, researchers, and policymakers.

Antigen test swabs are comparable to nasopharyngeal swabs for sequencing of SARS-CoV-2.

Viral genomic surveillance has been integral in the global response to the SARS-CoV-2 pandemic. Surveillance efforts rely on the availability of representative clinical specimens from ongoing testing activities. However, testing practices have recently shifted due to the widespread availability and use of rapid antigen tests, which could lead to gaps in future monitoring efforts. As such, genomic surveillance strategies must adapt to include laboratory workflows that are robust to sample type. To that end, we compare the results of RT-qPCR and viral genome sequencing using samples from positive BinaxNOW COVID-19 Antigen Card swabs (N = 555) to those obtained from nasopharyngeal (NP) swabs used for nucleic acid amplification testing (N = 135). We show that swabs obtained from antigen cards are comparable in performance to samples from NP swabs, providing a viable alternative and allowing for the potential expansion of viral genomic surveillance to outpatient clinic as well as other settings where rapid antigen tests are often used.

How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease?

OBJECTIVE: To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD). DESIGN: Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners. SETTING: Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services. PARTICIPANTS: Health care practitioners who registered to attend the BEWE training program (n = 31). MAIN OUTCOME MEASURES: Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD. RESULTS: Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation. CONCLUSION: The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.

Mapping Simulated-Based Learning Experiences Incorporated Into Professional Placements in Allied Health Programs: A Scoping Review.

SUMMARY STATEMENT: Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

Osteoporosis in Older Adults.

Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patients with osteoporosis. Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators.