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Introduction The aim of the Common factors, Responsiveness and Outcome in Psychotherapy (CROP) study is to identify client and psychologist characteristics and therapeutic processes associated with the outcome of psychotherapy delivered by psychologists employed in the Danish primary sector or fully self-employed. The study addresses two main questions. First, how are specific characteristics of clients and psychologists related to the outcome of therapy and do these characteristics moderate the outcome of different psychotherapeutic approaches? Second, to what extent do therapists adapt their approach to client characteristics and preferences and how does such responsiveness impact the process and outcome of therapy? Methods and analysis The study is a naturalistic prospective cohort study carried out in collaboration with psychologists in private practice in Denmark. Self-reported data are collected from the participating psychologists and their participating clients before, during (weekly and postsession) and after psychotherapy (at end of treatment and 3 months follow-up). The estimated target sample size is 573 clients. The data are analysed using multilevel modelling and structural equation modelling approaches to capture predictors and moderators of the effect and rate of change in psychotherapy as well as session-to-session changes during the therapy process. Ethics and dissemination The study has been approved by the IRB at the Department of Psychology, University of Copenhagen (IRB number: IP-IRB/01082018) and the Danish Data Protection Agency. All study data are fully anonymised and all clients have given informed consent to participation in the study. The study findings will be presented in articles in international, peer-reviewed journals as well as to psychotherapy practitioners and other professionals across Denmark. Trial registration number NCT05630560.

The purpose of this interpretative phenomenological analysis was to understand the experiences of compassion fatigue and help-seeking and coping strategies among counselors in private practice. The theories guiding this study are the transition model and the transactional theory of stress and coping. The research questions included an OARQ What are counselors in private practice’s experiences of compassion fatigue? Two SQs were also used (SQ1) What are counselors in private practice’s experiences of help-seeking behaviors? (SQ2) How do counselors in private practice make sense of coping with compassion fatigue? Participants were selected using purposive and snowball sampling methods. Data collection included semistructured video interviews through the lens of a double hermeneutic. The interviews were recorded and transcribed. The transcripts were used to identify personal experiential themes and group experiential themes to study the unique experiences of counselors in private practice. The researcher also kept a personal journal of the process. The sample consisted of seven counselors in private practice. Three main themes were identified in this study: I’m Overwhelmed on Every Side, I Don’t Know What to Do, and I Grew from It.

Question: What are the extent and characteristics of clinical placements in private practice for physiotherapy students? What do university clinical education managers perceive to be the benefits, risks, barriers and enablers of clinical placements in private practice for physiotherapy students? What training and support are available for private practitioners? Design: Mixed methods study combining a national survey and in-depth, semi-structured focus group interviews. Participants: Twenty clinical education managers from Australian universities who had graduating students in entry-level physiotherapy programs in 2017 (95% response rate) responded to the survey with data on 2,000 students. Twelve clinical education managers participated in the focus groups. Results: It was found that 44% of physiotherapy graduates in Australia in 2017 completed a 5-week private practice placement. Private practice placement experiences were perceived to be safe and beneficial for students, private practices and universities. The main risks identified by clinical education managers were related to the quality and consistency of the student's experience on placement and not risks to service or clients. The main perceived barriers were time costs (both practitioner and university clinical education managers) and perceived lost earning capacity. Clinical education managers emphasised that more time and resources to establish and support private practitioners would enable them to reduce risk and overcome barriers to increasing private practice placement capacity and quality. Engaging private practitioners and working collaboratively appear vital for establishing, monitoring and supporting private practice placements. Conclusion: By working collaboratively, universities and private practice physiotherapists can enhance private practice placement capacity and quality.

The present work aims to analyze private practice in Social Work from a current professional perspective. This research has been conducted through the dissemination of an open-ended questionnaire responded by sixteen people, all of them Social Work professionals who currently carry out their work as private practitioners. A current bibliographical analysis has been carried out on the state of the art, describing the presence of private practice in the Degree of Social Work and the areas of the professional field that are being developed, and examining the support given by state-funded schools. The results show that private practice is a choice made by the majority of people who have previously worked for others, and who do so due to the freedom it grants them, both to balance family and work life, as well as the freedom to choose methodology and to work with users or clients. Likewise, the scarcity of institutional support from Professional Association, as well as from the university itself has been noted., Este trabajo tiene como objetivo el análisis del ejercicio libre en Trabajo Social desde una perspectiva profesional actual. Esta investigación se ha logrado a través de la difusión de un cuestionario de respuesta abierta creado de forma expresa y que ha recibido la respuesta de dieciséis personas, todas ellas profesionales del Trabajo Social que actualmente desarrollan su trabajo desde el ejercicio libre. Se ha realizado un análisis bibliográfico actual sobre el estado de la cuestión, describiendo la presencia del ejercicio libre en el Grado de Trabajo Social, los ámbitos profesionales que se están desarrollando, además de examinar el soporte por parte de los colegios oficiales. Como principales resultados se revela por un lado que, el ejercicio libre de la profesión resulta una elección propia mayoritariamente de personas que han trabajo antes por cuenta ajena, y que lo hacen debido a la libertad que esta les concede, tanto para poder conciliar la vida familiar y profesional, como también por la libertad de elección metodológica y de trabajo con personas usuarias o clientes. Asimismo, se ha constatado el déficit en el apoyo institucional tanto por parte de colegios profesionales, como también de las propias universidades.

OBJECTIVE: The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. METHODS: This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. RESULTS: Australian new graduate physical therapists were perceived to be "somewhat ready" for private practice and "ready" by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. CONCLUSION: Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. IMPACT: The number of new graduate physical therapists employed

Objectives: Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate. Conclusions: Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.

Objective: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. Method: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. Results: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018-June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. Conclusions: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.

Objective: To provide reflections on the representation of and engagement with private practice psychiatrists by the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Conclusion: We consider some of the reasons for private psychiatrist disengagement with the RANZCP. We suggest approaches to better engage private psychiatrists in the RANZCP, including: involvement in mental health policy, improved committee representation, specific private practice and business training for Fellowship, broader private practice peer support networks (welfare, clinical research, leadership), tailored professional development, branch-based networks of public and private psychiatrists, and collaboration with specialist medical colleges and the Australian Medical Association.

The purpose of this paper is to clarify the relationship between medical practitioners (MPs) and nurse practitioners (NPs) in general, and privately practising NPs (PPNPs) in particular, in relation to collaboration, control and supervision in Australia, as well as to explore the difficulties reported by PPNPs in establishing mandated collaborative arrangements with MPs in Australia. In order for the PPNPs to have access to the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) in Australia, they are required, by law, to establish a collaborative arrangement with an MP or an entity that employs MPs. This paper begins by describing the history of and requirements for collaborative arrangements, then outlines the nature of successful collaboration and the reported difficulties. It goes on to address some of the commonly held misconceptions in order to allay medical concerns and enable less restrictive access to the MBS and PBS for PPNPs. This, in turn, would improve patient access to highly specialised and expert PPNP care. What is known about the topic?: NPs have been part of the Australian health workforce since 1998, but until 2009 their patients did not receive any reimbursement for care delivered by PPNPs. In 2009, the Federal government introduced limited access for PPNPs to the MBS and PBS, but only if they entered into a collaborative arrangement with either an MP or an entity that employs MPs. What does this paper add?: The introduction of collaborative arrangements between PPNPs and MPs seems, in some instances, to have created confusion and misunderstanding about the way in which these collaborative arrangements are to operate. This paper provides clarification of the relationship between MPs and NPs in general, and PPNPs in particular, in relation to collaboration, control and supervision. What are the implications for practitioners?: A clearer understanding of these issues will hopefully enable greater collegial generosity and imp

Objective: To assess the implication of COVID-19 pandemic on the practice of restorative dentistry in Nigeria.Materials and Methods: A cross-sectional study regarding the impact of COVID-19 on restorative dental practice was carried out among dentists across different cadres working in either private or public practice. Data was obtained using an online survey questionnaire regarding the infection control practice, availability and use of personal protective equipment, practice modifications to combat COVID-19 outbreak and the impact of COVID-19. Data was analysed using the chi-square test and p-value <0.05 was considered statistically significant.Results: Amongst 137 dentists that participated in the study, majority of respondents were males (58.4%), a greater proportion (49.6%) were in the age range 35-44 years and 78.1% worked in public hospitals. A significantly higher number of male respondents (p=0.019) and public dental workers (p=0.036) immediately changed their mode of dental service delivery following the COVID-19 outbreak. Majority of respondents (60.6%) carried out restorative dental procedures despite the pandemic; most of these procedures being emergency dental treatment and non-aerosol generating dental procedures. About half of respondents had respiratory masks (51.8%) and isolation gowns (54.0%) available. Majority reported that the pandemic had decreased patient flow (88.3%), increased treatment fee (53.3%) and had an impact on the income generated (92%). Only 20.4% of respondents hadproblems with their staff; the problems being emotional problems, work abandonment and demand of salary increase. The pandemic has had a negative impact on most respondents (74.5%) and only 31.4% respondents were optimally prepared to render dental services.Conclusion: COVID-19 pandemic has changed the mode of restorative dental practice in Nigeria; resulting in a psychological impact on dentists and a financial burden on dental practice. &nbsp

Objective: To assess the implication of COVID-19 pandemic on the practice of restorative dentistry in Nigeria.Materials and Methods: A cross-sectional study regarding the impact of COVID-19 on restorative dental practice was carried out among dentists across different cadres working in either private or public practice. Data was obtained using an online survey questionnaire regarding the infection control practice, availability and use of personal protective equipment, practice modifications to combat COVID-19 outbreak and the impact of COVID-19. Data was analysed using the chi-square test and p-value <0.05 was considered statistically significant.Results: Amongst 137 dentists that participated in the study, majority of respondents were males (58.4%), a greater proportion (49.6%) were in the age range 35-44 years and 78.1% worked in public hospitals. A significantly higher number of male respondents (p=0.019) and public dental workers (p=0.036) immediately changed their mode of dental service delivery following the COVID-19 outbreak. Majority of respondents (60.6%) carried out restorative dental procedures despite the pandemic; most of these procedures being emergency dental treatment and non-aerosol generating dental procedures. About half of respondents had respiratory masks (51.8%) and isolation gowns (54.0%) available. Majority reported that the pandemic had decreased patient flow (88.3%), increased treatment fee (53.3%) and had an impact on the income generated (92%). Only 20.4% of respondents hadproblems with their staff; the problems being emotional problems, work abandonment and demand of salary increase. The pandemic has had a negative impact on most respondents (74.5%) and only 31.4% respondents were optimally prepared to render dental services.Conclusion: COVID-19 pandemic has changed the mode of restorative dental practice in Nigeria; resulting in a psychological impact on dentists and a financial burden on dental practice. &nbsp

Private practice counselors who own their practice are unique from agency practitioners in that they function as both counselor and business owner. Therefore, these counselors must work to find a balance between the human aspects of practicing and the logistical business components of owning and operating a practice. The combination of these two roles can pose unique threats to a private practice counselor’s wellness and how they experience of burnout and resilience - which may differ from agency counterparts. Although resilience and burnout experiences and practices in agency and community counselors are prevalent in the literature, there is a lack of research regarding these concepts in private practice counselors and business owners. A descriptive phenomenological study using Husserl’s perspective and Colaizzi’s 7-step method of data analysis was implemented with a sample of 14 private practice counselors who own and operate their own practice in the United States. Private practice counselors described nuanced differences related to owning and operating their own business. Five themes were identified and developed during data analysis: 1. Being Independent but Needing Connection; the need for control, to make and maintain personal and professional relationships, and obstacles to interconnectedness. 2. Successes and Stressors; clients, personal, and professional. 3. Managing The Many Roles; learning by doing, counselor versus business owner, trying to find balance while doing it all. 4. Caring For Self While Caring For Others; tuning into oneself, caring for the busine to care for oneself, and making time for self-care/burnout prevention. 5. Business Beyond The Clients; personal growth, professional growth, and business growth. Study findings affirm the need for further research in the experience of private practice counselors and the need for more extensive trainings to adequately prepare future counseling private practice owners. Study implications and findings

During the Wild West era of American history (approximately 1870-1900), at least 53 dermatologists settled between the Mississippi River and the Pacific Coast. In 1870, two dermatologists began their practice in the city of St Louis, Missouri (William Augustus Hardaway and Solomon Claiborne Martin, Sr) and one dermatologist started his practice in San Francisco, California (George J. Bucknall). By 1900, 50 more dermatologists had settled in 19 cities located in the American West (Tables 1,2). There, they established practices, initiated academic programs, and pioneered dermatology as a medical specialty in the western United States. This contribution provides brief biographic profiles of these early western American dermatologists. It also presents several dermatology-related vignettes from the Wild West that involved such colorful personalities as Doc Holiday, Calamity Jane, and Sister Mary Joseph. From these beginnings, 150 years ago, the specialty of dermatology would further spread and develop across the American West during the 20th century.

Background: Women's decisions regarding vaccination during pregnancy are heavily influenced by maternity care provider (MCP) recommendations. Understanding why MCPs may not recommend vaccination is central to improving vaccination rates. Aim(s): To examine the knowledge, attitudes and practice of Australian MCPs to maternal vaccination. Method(s): We surveyed obstetricians, midwives and general practitioners (GPs) between September and November 2016. Providers were asked about their knowledge and current practice, and about their perceived roles in discussing and administering maternal vaccinations. Result(s): Eight hundred and seventy surveys were completed. Each MCP group believed they had the primary responsibility for discussing vaccinations but all groups perceived GPs as primarily responsible for administering vaccines. More midwives had concerns about safety (21/129, 16%) than obstetricians (9/359, 3%) and GPs (7/326, 2%) (P < 0.001). Overall, 83% of MCPs recommended diphtheria-tetanus-acellular pertussis vaccination (dTpa) and 78% inactivated influenza vaccination (IIV) according to guidelines, with no differences between groups. Overall 77% provided dTpa onsite (GPs 99%, midwives 70%, obstetricians 60%, P < 0.001) and 71% provided IIV (GPs 99%, midwives 48%, obstetricians 54%, P < 0.001). Factors associated with recommending vaccination in accordance with guidelines and providing vaccination onsite were similar across groups: personal history of vaccination, confidence in vaccine knowledge, and awareness of recommendations for and belief in the safety of maternal dTpa. Conclusion(s): Among MCPs, the rates of recommending and providing maternal vaccination were higher than previously reported. Further improvements might be expected with increased awareness of guidelines, further education around vaccine safety, and by changing perceptions of the role of obstetricians and midwives in providing maternal vaccinations.Copyright © 2018 The Royal Australian and Ne

Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim(s): To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Method(s): A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Result(s): Two hundred and twenty-four patients were identified; 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion(s): In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.Copyright © 2018 Royal Australasian College of Physicians

Background: Women's decisions regarding vaccination during pregnancy are heavily influenced by maternity care provider (MCP) recommendations. Understanding why MCPs may not recommend vaccination is central to improving vaccination rates. Aim(s): To examine the knowledge, attitudes and practice of Australian MCPs to maternal vaccination. Method(s): We surveyed obstetricians, midwives and general practitioners (GPs) between September and November 2016. Providers were asked about their knowledge and current practice, and about their perceived roles in discussing and administering maternal vaccinations. Result(s): Eight hundred and seventy surveys were completed. Each MCP group believed they had the primary responsibility for discussing vaccinations but all groups perceived GPs as primarily responsible for administering vaccines. More midwives had concerns about safety (21/129, 16%) than obstetricians (9/359, 3%) and GPs (7/326, 2%) (P < 0.001). Overall, 83% of MCPs recommended diphtheria-tetanus-acellular pertussis vaccination (dTpa) and 78% inactivated influenza vaccination (IIV) according to guidelines, with no differences between groups. Overall 77% provided dTpa onsite (GPs 99%, midwives 70%, obstetricians 60%, P < 0.001) and 71% provided IIV (GPs 99%, midwives 48%, obstetricians 54%, P < 0.001). Factors associated with recommending vaccination in accordance with guidelines and providing vaccination onsite were similar across groups: personal history of vaccination, confidence in vaccine knowledge, and awareness of recommendations for and belief in the safety of maternal dTpa. Conclusion(s): Among MCPs, the rates of recommending and providing maternal vaccination were higher than previously reported. Further improvements might be expected with increased awareness of guidelines, further education around vaccine safety, and by changing perceptions of the role of obstetricians and midwives in providing maternal vaccinations.Copyright © 2018 The Royal Australian and Ne

Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim(s): To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Method(s): A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Result(s): Two hundred and twenty-four patients were identified; 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion(s): In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.Copyright © 2018 Royal Australasian College of Physicians

Background: Nurse practitioners (NPs) have been practising in Australia since 2001, predominantly in the public sector. To facilitate the expansion of NPs working in community and primary health care settings, legislative changes in 2010 led to privately practising NPs (PPNPs) being eligible to provide care subsidised through the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). To date, there has been little evaluation of PPNP services in Australia. Reported in this paper is the process through which national survey data enabled the refinement and development of theories on PPNP services in Australia. Aim: To describe the development and refinement of theories to answer the research question how, why and in which contexts PPNP services impact on patient access to care. Methods: The first part of a realist evaluation of privately practising nurse practitioner (PPNP) services in Australia has been conducted. A literature review and a national survey (n = 73) of PPNPs was undertaken to develop and refine preliminary realist theories and hypotheses. Findings: The theories developed relate to three broad aspects of PPNP practice activities: reimbursement, collaborative arrangements and scope of practice. National survey results support the preliminary theory that the current structure of the NP MBS items heavily influenced PPNPs’ reasoning processes in the design and delivery of patient services. Survey data also supports the theory that medical practitioners’ level of understanding of PPNPs’ roles and of collaborative arrangement legislation influences how they engage with PPNPs and the concomitant service outcomes. Conclusions: The national survey data confirmed the significance of theories about reimbursement, collaborative arrangements and scope of practice and how these have impacted on how PPNPs provide patient access to services.

INTRODUCTION:To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. OBJECTIVES:The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. METHODS:Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. RESULTS:Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P < 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. CONCLUSION:The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising

Objective: To explore the perceptions, beliefs and attitudes of women who opted for a home birth in Andalusia (Spain). Background: Home birth is currently an unusual choice among Spanish women. It is not an option covered by the Spanish National Health Service and women who opt for a home birth have to pay for an independent midwife. Design: A qualitative study with a phenomenological approach was adopted. All participants who took part in this study had chosen to have a home birth and given written consent to take part in the study. Methods: Data collection was conducted in 2015–16. Face-to-face, semi-structured interviews were undertaken with women who chose a home birth in the last 5 years. Findings: The sample consisted of thirteen women. Seven themes were created through analysis: 1. Getting informed about home birth; 2. Home birth as a choice, despite feeling unsupported; 3. The best way to have a personalized and a physiological birth; 4. Seeking a healing and empowering experience 5. The need for emotional safety, establishing a relationship and trusting the midwife; 6. Preparing for birth and working on fears; 7. Inequality of access (because of financial implications). Conclusions: Women opted to plan birth at home because they wanted a personalised birth and control over their decision-making in labour, which they felt would not have been afforded to them in hospital settings. Andalusian maternity care leaders should strive to ensure that all pregnant women receive respectful and high-quality personalised care, by appropriately trained staff, both in the hospital and in the community.

To facilitate expansion of privately-practicing nurse practitioners in community and primary care settings, a legislative amendment in 2010 made privately-practicing nurse practitioners eligible to provide services subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. To evaluate their practice activities, a national survey of privately-practicing nurse practitioners in Australia was conducted, and data analysed using descriptive statistics and thematic analysis (n = 73). As part of their role, 96% (n = 70) participants reported undertaking direct patient care, 95% (n = 69) patient education and health promotion, 95% (n = 69) prescribed medications, 92% (n = 67) referred patients for diagnostic investigations, and 88% (n = 64) reported making a diagnosis. Over 50% of participants saw up to 15 patients daily, and 80% (n = 58) treated the same patients on a regular basis. Of the participants, 59% (n = 43) perceived that they worked to their full scope of practice. The mainstay of privately-practicing nurse practitioner services is provision of direct patient care in community and primary healthcare settings, suggesting they have emerging potential in addressing the ever-increasing demand for healthcare in Australia.

Background: To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia. Purpose: To explore how, why and in which contexts PPNP services in Australia impact on patient access to care. Methods: Semistructured interviews using realist evaluation were undertaken with 20 participants, selected through stratified sampling using geographic criteria (State/territory in which practicing) and dividing the sample representatively between those who worked solely in private practice and those who worked in both private and public practice. Thematic analysis of qualitative data was undertaken. Conclusion: Findings suggest that PPNPs have increased access to care for patients, predominantly in community and primary health settings. Implications for practice: In increasing access to care, PPNPs have the potential to reduce hospital and general practitioner attendance, thereby potentially reducing the ever-increasing demand for health care.

This work revises the relationship of Social Work with Human Rights, understanding that Social Work has been and continues to be an ideal means for the social and political implementation of Human Rights. In this long-standing dialogue, events such as the recent economic crisis, the progressive specialization of social intervention, changes in the socio-demographic structure and the questioning of the Welfare State model have posed professional challenges to Social Work. Among these events, the re-reading of the free exercise of Social Work in Spain and its relationship with Human Rights. Without neglecting the principles and values characterizing Social Work since its beginning as a scientific discipline and its close relationship with Human Rights, the aim of this work is to identify whether or not the relationship between Human Rights and the private practice of Social Work is recognised. After a profuse bibliographic review it can be stated that sufficient evidences (theoretical evidences or practical experiences) to make the reality of such relationship explicit have not been found. Everything suggests that the free exercise is a reality which still needs to methodize its practice and demonstrate its close relationship with the principles and values of Social Work and Human Rights., El presente artículo es una revisión teórica que parte de la relación del Trabajo Social con los Derechos Humanos, entendiendo que el Trabajo Social ha sido y continúa siendo un medio idóneo para la implementación social y política de los Derechos Humanos. En ese diálogo de larga trayectoria, acontecimientos como la reciente crisis económica, la progresiva especialización de la intervención social, los cambios en la estructura sociodemográfica y el cuestionamiento del modelo del Estado de Bienestar, han introducido retos profesionales para el Trabajo Social. Entre ellos, la relectura del ejercicio libre de la profesión en España y su relación con los Derechos Humanos. Sin dejar de lado los principios y valores que han caracterizado desde sus inicios al Trabajo Social como disciplina científica y su estrecha relación con los Derechos Humanos, el objetivo planteado es identificar si se reconoce la relación entre los Derechos Humanos y el ejercicio libre de la profesión. Realizada una profusa revisión bibliográfica se puede afirmar que no se han encontrado evidencias suficientes (ni referencias teóricas ni experiencias prácticas) que expliciten cuál es la realidad de dicha relación. Todo apunta a que el ejercicio libre es una realidad que todavía necesita sistematizar su práctica y demostrar su estrecha relación con los principios y valores, tanto del Trabajo Social, como de los Derechos Humanos.

This practice-led research reflects upon the testimonies and engagement of participants and audience in my art practice, The Letting Go, which is performed both privately and in galleries and is informed by the intersections of visual art, psychotherapy, somatic practices, Buddhism and ritual tattooing. Drawing on my experiences, private sessions and participatory performances the thesis asks the question: Can this practice inform a new social practice for artists - a “private practice” model that collaboratively addresses shared vulnerability and self-awareness?

This work revises the relationship of Social Work with Human Rights, understanding that Social Work has been and continues to be an ideal means for the social and political implementation of Human Rights. In this long-standing dialogue, events such as the recent economic crisis, the progressive specialization of social intervention, changes in the socio-demographic structure and the questioning of the Welfare State model have posed professional challenges to Social Work. Among these events, the re-reading of the free exercise of Social Work in Spain and its relationship with Human Rights. Without neglecting the principles and values characterizing Social Work since its beginning as a scientific discipline and its close relationship with Human Rights, the aim of this work is to identify whether or not the relationship between Human Rights and the private practice of Social Work is recognised. After a profuse bibliographic review it can be stated that sufficient evidences (theoretical evidences or practical experiences) to make the reality of such relationship explicit have not been found. Everything suggests that the free exercise is a reality which still needs to methodize its practice and demonstrate its close relationship with the principles and values of Social Work and Human Rights., El presente artículo es una revisión teórica que parte de la relación del Trabajo Social con los Derechos Humanos, entendiendo que el Trabajo Social ha sido y continúa siendo un medio idóneo para la implementación social y política de los Derechos Humanos. En ese diálogo de larga trayectoria, acontecimientos como la reciente crisis económica, la progresiva especialización de la intervención social, los cambios en la estructura sociodemográfica y el cuestionamiento del modelo del Estado de Bienestar, han introducido retos profesionales para el Trabajo Social. Entre ellos, la relectura del ejercicio libre de la profesión en España y su relación con los Derechos Humanos. Sin dejar de lado los principios y valores que han caracterizado desde sus inicios al Trabajo Social como disciplina científica y su estrecha relación con los Derechos Humanos, el objetivo planteado es identificar si se reconoce la relación entre los Derechos Humanos y el ejercicio libre de la profesión. Realizada una profusa revisión bibliográfica se puede afirmar que no se han encontrado evidencias suficientes (ni referencias teóricas ni experiencias prácticas) que expliciten cuál es la realidad de dicha relación. Todo apunta a que el ejercicio libre es una realidad que todavía necesita sistematizar su práctica y demostrar su estrecha relación con los principios y valores, tanto del Trabajo Social, como de los Derechos Humanos.

Starting out in private practice can be daunting for those used to working in public settings. Patients are generally very ill and have frequently been admitted under certificate. Trainees become used to working in a particular way. In the private practice domain, patients are free to leave at any time should they happen to feel dissatisfied with their treatment. In addition, many are anxious about seeing a psychiatrist and need to be encouraged to continue the work; there is an ever-present risk of patients dropping out, causing treatments to end prematurely. The work is therefore very different, and many psychiatrists struggle to make the necessary adjustment. This workshop is likely to be of interest to colleagues who are embarking on private practice work. The intended audience is senior trainees and early career psychiatrists, with an emphasis on practitioners who want to work with patients in an ongoing way. The workshop aims to be very practical, focussing on the common issues and problems that arise from the commencement of private practice. For example: setting up rooms - the consulting room, the waiting room; intake - how to manage referrals; assessment - how to identify suitable patients; how to engage patients and get them interested - establishing a therapeutic alliance; setting up appropriate boundaries; managing practice and patient risk; ensuring support - the role of supervision, second opinions and peer review groups; privacy and confidentiality of clinical records - how to deal with subpoenas from lawyers.

BACKGROUND: Workplace injury is an international costly burden. Health care workers are an essential component to managing musculoskeletal disorders, however in doing this, they may increase their own susceptibility. While there is substantial evidence about work-related musculoskeletal disorders across the health workforce, understanding risk factors in specific occupational groups, such as podiatry, is limited. The primary aim of this study was to determine the prevalence and intensity of work related low back pain in podiatrists. METHODS: This was an international cross-sectional survey targeting podiatrists in Australia, New Zealand and the United Kingdom. The survey had two components; general demographic variables and variables relating to general musculoskeletal pain in general or podiatry work-related musculoskeletal pain. Multivariable regression analyses were used to identify factors associated with musculoskeletal stiffness and pain and low back pain intensity. Thematic analysis was used to group comments podiatrists made about their musculoskeletal health. RESULTS: There were 948 survey responses (5% of Australian, New Zealand and United Kingdom registered podiatrists). There were 719 (76%) podiatrists reporting musculoskeletal pain as a result of their work practices throughout their career. The majority of injuries reported were in the first five years of practice (n=320, 45%). The body area reported as being the location of the most significant injury was the low back (203 of 705 responses, 29%). Being female (p<0.001) and working in private practice (p=0.003) was associated with musculoskeletal pain or stiffness in the past 12 months. There were no variables associated with pain or stiffness in the past four weeks. Being female was the only variable associated with higher pain (p=0.018). There were four main themes to workplace musculoskeletal pain: 1. Organisational and procedural responses to injury, 2. Giving up work, taking time off, reducing hou

BACKGROUND: Workplace injury is an international costly burden. Health care workers are an essential component to managing musculoskeletal disorders, however in doing this, they may increase their own susceptibility. While there is substantial evidence about work-related musculoskeletal disorders across the health workforce, understanding risk factors in specific occupational groups, such as podiatry, is limited. The primary aim of this study was to determine the prevalence and intensity of work related low back pain in podiatrists. METHODS: This was an international cross-sectional survey targeting podiatrists in Australia, New Zealand and the United Kingdom. The survey had two components; general demographic variables and variables relating to general musculoskeletal pain in general or podiatry work-related musculoskeletal pain. Multivariable regression analyses were used to identify factors associated with musculoskeletal stiffness and pain and low back pain intensity. Thematic analysis was used to group comments podiatrists made about their musculoskeletal health. RESULTS: There were 948 survey responses (5% of Australian, New Zealand and United Kingdom registered podiatrists). There were 719 (76%) podiatrists reporting musculoskeletal pain as a result of their work practices throughout their career. The majority of injuries reported were in the first five years of practice (n=320, 45%). The body area reported as being the location of the most significant injury was the low back (203 of 705 responses, 29%). Being female (p<0.001) and working in private practice (p=0.003) was associated with musculoskeletal pain or stiffness in the past 12 months. There were no variables associated with pain or stiffness in the past four weeks. Being female was the only variable associated with higher pain (p=0.018). There were four main themes to workplace musculoskeletal pain: 1. Organisational and procedural responses to injury, 2. Giving up work, taking time off, reducing hou

Starting out in private practice can be daunting for those used to working in public settings. Patients are generally very ill and have frequently been admitted under certificate. Trainees become used to working in a particular way. In the private practice domain, patients are free to leave at any time should they happen to feel dissatisfied with their treatment. In addition, many are anxious about seeing a psychiatrist and need to be encouraged to continue the work; there is an ever-present risk of patients dropping out, causing treatments to end prematurely. The work is therefore very different, and many psychiatrists struggle to make the necessary adjustment. This workshop is likely to be of interest to colleagues who are embarking on private practice work. The intended audience is senior trainees and early career psychiatrists, with an emphasis on practitioners who want to work with patients in an ongoing way. The workshop aims to be very practical, focussing on the common issues and problems that arise from the commencement of private practice. For example: setting up rooms - the consulting room, the waiting room; intake - how to manage referrals; assessment - how to identify suitable patients; how to engage patients and get them interested - establishing a therapeutic alliance; setting up appropriate boundaries; managing practice and patient risk; ensuring support - the role of supervision, second opinions and peer review groups; privacy and confidentiality of clinical records - how to deal with subpoenas from lawyers.

Interacting with patients is integral to the practice of physiotherapy. Notably, however, empirically derived knowledge about how physiotherapists interact with their patients is limited, particularly in the private practice setting. In addition, heavily promoted approaches for interacting with patients, such as patient-centred care and the biopsychosocial approach, have been adopted from the medical profession, are not derived from research evidence, and therefore may not adequately reflect how physiotherapists interact with patients in physiotherapy practice. Thus, this qualitative research had two aims: first, to detail how patients and physiotherapists interact in private practice; second, to consider how the research findings related to promoted healthcare interaction approaches. Methodologically, the research incorporated features of both ethnography and grounded theory. Observations of 52 consultations, as well as in-depth interviews with 9 patient and 9 physiotherapist participants, were undertaken. Data comprised field notes and audio-recordings of observations and interviews, and were analyzed iteratively using principles of thematic analysis and grounded theory. The data analysis yielded two central and complementary themes. The theme ‘physiotherapist-led communication’ encapsulates how physiotherapists directed the style and content of communication to achieve clinical goals by providing structure, making decisions, and focussing on biomedical aspects. The second theme, ‘adapting to build rapport’, describes how physiotherapists incorporated adaptive communication such as eye contact, body language, touch, casual conversation, and humour into their interactions with patients. These adaptations were often intuitively enacted, were responsive to individual patient characteristics, and functioned to build rapport. The findings neither clearly correlated to features of patient-centred care nor to the biopsychosocial approach. Rather, the findings portrayed a

ObjectiveTo examine adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices.Data sources/study settingNational Ambulatory Medical Care Survey from 2006 to 2010.Study designWe examined four guideline-concordant treatment practices: initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHC with private physicians' offices overall and by payer group.Data collection/extraction methodsWe identified visits of nonpregnant adults with hypertension at CHCs and private physicians' offices.Principal findingsMedicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95 percent CI: 0.6-1.9), whereas Medicaid patients at private physicians' offices were less likely to receive a new medication (AOR 0.3, 95 percent CI: 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95 percent CI: 0.4-0.9). Thiazide use for patients was similar in both settings (AOR 0.8, 95 percent CI: 0.4-1.7). Use of aldosterone antagonists was too rare (2.1 percent at CHCs and 1.5 percent at private clinics) to allow for statistically reliable comparisons.ConclusionsIncreasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.

Aims: In inflammatory bowel disease (IBD), large studies have suggested a benefit with using immunomodulator (IM) co-therapy with anti-tumour necrosis factor alpha (anti-TNF) agents over anti-TNF monotherapy to prevent loss of response (LOR). We recently showed similar rates of LOR and outcomes, regardless of IM use, at both short-term and extended follow-up in a real-world cohort of anti-TNF treated patients. There is limited existing data on outcomes after anti-TNF LOR. Our aims were to assess rates of clinical response recapture post first LOR. Method(s): A retrospective audit was conducted of all patients with IBD receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients on anti-TNF therapy with an accurate date for TNF commencement and adequate correspondence to determine end-points were included. LOR was defined by an admission or surgery post-induction, escalation of anti-TNF dose or concurrent IMs for clinical LOR or emergence of a new fistula. Patients <18 years of age, and those with prior exposure to any anti-TNF agent were excluded. Outcomes measured included biochemical parameters, IM co-therapy, cause of first LOR and days to second LOR. Statistical analysis was performed with GraphPad Prism v6. Result(s): A total of 211 IBD (Crohn's disease (CD) n = 188, ulcerative colitis (UC) n = 23) patients on anti-TNF therapy were identified, of which 94 experienced LOR (CD n = 85, (45% of CD patients), UC n = 9, (39% of UC patients) [p = 0.660]). Of patients with LOR, 54 (57%) were on combination therapy and 40 (43%) on monotherapy at anti-TNF induction. Thirty-nine (41%) were treated with infliximab and 55 (59%) with adalimumab. Mean days to first LOR was 449 +/- 398.7 in the combination group and 620 +/- 553.4 in the monotherapy group (p = 0.165). Causes for LOR included clinical LOR (n = 60, 64%), hospital admission (n = 21, 22%), surgery (n = 10, 11%) or new fistula (n = 3, 3%). First LOR was managed with corticosteroids

Aims: In inflammatory bowel disease (IBD), studies have not shown a significant difference in patients treated with anti-tumour necrosis factor alpha (anti-TNF) monotherapy versus with immunomodulator co-therapy; however, recent data proposed a benefit with combination therapy to reduce immunogenicity to anti-TNFs. We recently showed similar rates of loss of response (LOR) and outcomes, despite immunomodulator use, at both short and long-term follow-up in a small cohort of patients on anti-TNF therapy. This is an expanded analysis of a larger real-world cohort including private outpatients, to better assess whether anti-TNF monotherapy was associated with earlier LOR versus combination therapy. Method(s): A retrospective audit was conducted of all patients with IBD receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients on anti-TNF therapy with an accurate date for TNF commencement and adequate correspondence to determine end-points were included. Patients <18 years of age, and those with prior exposure to any anti-TNF agent were excluded. Outcomes measured included biochemical parameters and immunomodulator therapy pre and post anti-TNF and days to first loss of response; defined by an admission or surgery post-induction, escalation of TNF dose or concurrent immunomodulators for clinical LOR or emergence of a new fistula. Statistical analysis was performed with GraphPad Prism v6. Result(s): A total of 211 patients were included for analysis: 188 patients treated for Crohn's disease and 23 for ulcerative colitis. Baseline characteristics are highlighted in Table 1. One hundred twenty-eight (61%) patients received combination therapy, whereas 83 (39%) had monotherapy. Ninety-nine (47%) patients had loss of response during follow-up; 58 (59%) on combination therapy and 41 (41%) on monotherapy (p =0.433). Causes for LOR included clinical LOR (n = 62, 63%), hospital admission (n = 22, 22%), surgery (n = 12, 12%) or new fistula (n =

Aim Autism spectrum disorder (ASD) is a neurodevelopmental disorder with reported prevalence of more than 1/100. In Australia, paediatricians are often involved in diagnosing ASD and providing long-term management. However, it is not known how paediatricians diagnose ASD. This study aimed to investigate whether the way Australian paediatricians diagnose ASD is in line with current recommendations. Methods Members of the Australian Paediatric Research Network were invited to answer questions about their ASD diagnostic practice in a multi-topic survey and also as part of a study about parents needs around the time of a diagnosis of ASD. Results The majority of the 124 paediatricians who responded to the multi-topic survey and most who responded to the parent needs survey reported taking more than one session to make a diagnosis of ASD. Most paediatricians included information from preschool, child care or school when making a diagnosis, and over half included information from speech pathology or psychology colleagues more than 50% of the time. The main reasons for not including assessment information in the diagnostic process were service barriers such as no regular service available or long waiting lists. More than 70% reported ordering audiology and genetic tests more than half of the time. Conclusion Not all paediatricians are following current recommendations for diagnosing ASD more than 50% of the time. While there are good reasons why current diagnostic approaches may fall short of expected standards, these need to be overcome to ensure diagnostic validity and optimal services for all children and their families.Copyright © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Introduction: Inflammatory bowel disease (IBD) often requires expensive anti-tumour necrosis factor alpha (anti-TNF) therapy, and many of these patients require dose intensification for loss of response (LOR). Most patients who receive co-therapy are on thiopurines due to potential teratogenic risks, clinician familiarity and concerns about methotrexate toxicity. Pharmacokinetic data have shown an increase of 20% in serum levels of adalimumab with methotrexate co-therapy. Our hypothesis is that methotrexate (MTX) may recapture treatment response in IBD patients with secondary LOR, thereby reducing the need for anti-TNF dose escalation and reducing cost. Method(s): A retrospective audit was conducted of all patients with IBD receiving MTX and anti-TNF therapy in a tertiary centre and outpatient private practices. All patients on anti-TNF who then had MTX therapy commenced were included. Patients <18 years of age or had intermittent therapy due to non-compliance were excluded. Outcomes measured included biochemical parameters, clinical response, days to treatment escalation and days to LOR. LOR was defined as admission or surgery for active disease, elevation of inflammatory markers or faecal calprotectin, endoscopic evidence of active disease or emergence of a new fistula. Serum anti-TNF antibody levels and anti-drug antibodies were not routinely measured or collected. Data are presented as mean +/- standard deviation if normally distributed and as median +/- interquartile range for non-normal distributions. Result(s): A total of 21 patients met the inclusion criteria and were analysed. Patient mean age was 37 +/- 13 years, the majority of which were male (n = 14, 67%), on infliximab (n = 11, 52%) and all patients had Crohn's disease. The number of patients receiving co-therapy with thiopurines at the time was 6 (29%), with all other patients on anti-TNF monotherapy. Median dose of MTX initiated was 10 mg weekly (IQR 10-20), and all patients were treated orally. Reas

Aims: In inflammatory bowel disease (IBD), large studies have suggested a benefit with using immunomodulator (IM) co-therapy with anti-tumour necrosis factor alpha (anti-TNF) agents over anti-TNF monotherapy to prevent loss of response (LOR). We recently showed similar rates of LOR and outcomes, regardless of IM use, at both short-term and extended follow-up in a real-world cohort of anti-TNF treated patients. There is limited existing data on outcomes after anti-TNF LOR. Our aims were to assess rates of clinical response recapture post first LOR. Method(s): A retrospective audit was conducted of all patients with IBD receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients on anti-TNF therapy with an accurate date for TNF commencement and adequate correspondence to determine end-points were included. LOR was defined by an admission or surgery post-induction, escalation of anti-TNF dose or concurrent IMs for clinical LOR or emergence of a new fistula. Patients <18 years of age, and those with prior exposure to any anti-TNF agent were excluded. Outcomes measured included biochemical parameters, IM co-therapy, cause of first LOR and days to second LOR. Statistical analysis was performed with GraphPad Prism v6. Result(s): A total of 211 IBD (Crohn's disease (CD) n = 188, ulcerative colitis (UC) n = 23) patients on anti-TNF therapy were identified, of which 94 experienced LOR (CD n = 85, (45% of CD patients), UC n = 9, (39% of UC patients) [p = 0.660]). Of patients with LOR, 54 (57%) were on combination therapy and 40 (43%) on monotherapy at anti-TNF induction. Thirty-nine (41%) were treated with infliximab and 55 (59%) with adalimumab. Mean days to first LOR was 449 +/- 398.7 in the combination group and 620 +/- 553.4 in the monotherapy group (p = 0.165). Causes for LOR included clinical LOR (n = 60, 64%), hospital admission (n = 21, 22%), surgery (n = 10, 11%) or new fistula (n = 3, 3%). First LOR was managed with corticosteroids

Aim Autism spectrum disorder (ASD) is a neurodevelopmental disorder with reported prevalence of more than 1/100. In Australia, paediatricians are often involved in diagnosing ASD and providing long-term management. However, it is not known how paediatricians diagnose ASD. This study aimed to investigate whether the way Australian paediatricians diagnose ASD is in line with current recommendations. Methods Members of the Australian Paediatric Research Network were invited to answer questions about their ASD diagnostic practice in a multi-topic survey and also as part of a study about parents needs around the time of a diagnosis of ASD. Results The majority of the 124 paediatricians who responded to the multi-topic survey and most who responded to the parent needs survey reported taking more than one session to make a diagnosis of ASD. Most paediatricians included information from preschool, child care or school when making a diagnosis, and over half included information from speech pathology or psychology colleagues more than 50% of the time. The main reasons for not including assessment information in the diagnostic process were service barriers such as no regular service available or long waiting lists. More than 70% reported ordering audiology and genetic tests more than half of the time. Conclusion Not all paediatricians are following current recommendations for diagnosing ASD more than 50% of the time. While there are good reasons why current diagnostic approaches may fall short of expected standards, these need to be overcome to ensure diagnostic validity and optimal services for all children and their families.Copyright © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Introduction: Inflammatory bowel disease (IBD) often requires expensive anti-tumour necrosis factor alpha (anti-TNF) therapy, and many of these patients require dose intensification for loss of response (LOR). Most patients who receive co-therapy are on thiopurines due to potential teratogenic risks, clinician familiarity and concerns about methotrexate toxicity. Pharmacokinetic data have shown an increase of 20% in serum levels of adalimumab with methotrexate co-therapy. Our hypothesis is that methotrexate (MTX) may recapture treatment response in IBD patients with secondary LOR, thereby reducing the need for anti-TNF dose escalation and reducing cost. Method(s): A retrospective audit was conducted of all patients with IBD receiving MTX and anti-TNF therapy in a tertiary centre and outpatient private practices. All patients on anti-TNF who then had MTX therapy commenced were included. Patients <18 years of age or had intermittent therapy due to non-compliance were excluded. Outcomes measured included biochemical parameters, clinical response, days to treatment escalation and days to LOR. LOR was defined as admission or surgery for active disease, elevation of inflammatory markers or faecal calprotectin, endoscopic evidence of active disease or emergence of a new fistula. Serum anti-TNF antibody levels and anti-drug antibodies were not routinely measured or collected. Data are presented as mean +/- standard deviation if normally distributed and as median +/- interquartile range for non-normal distributions. Result(s): A total of 21 patients met the inclusion criteria and were analysed. Patient mean age was 37 +/- 13 years, the majority of which were male (n = 14, 67%), on infliximab (n = 11, 52%) and all patients had Crohn's disease. The number of patients receiving co-therapy with thiopurines at the time was 6 (29%), with all other patients on anti-TNF monotherapy. Median dose of MTX initiated was 10 mg weekly (IQR 10-20), and all patients were treated orally. Reas

Aims: In inflammatory bowel disease (IBD), studies have not shown a significant difference in patients treated with anti-tumour necrosis factor alpha (anti-TNF) monotherapy versus with immunomodulator co-therapy; however, recent data proposed a benefit with combination therapy to reduce immunogenicity to anti-TNFs. We recently showed similar rates of loss of response (LOR) and outcomes, despite immunomodulator use, at both short and long-term follow-up in a small cohort of patients on anti-TNF therapy. This is an expanded analysis of a larger real-world cohort including private outpatients, to better assess whether anti-TNF monotherapy was associated with earlier LOR versus combination therapy. Method(s): A retrospective audit was conducted of all patients with IBD receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients on anti-TNF therapy with an accurate date for TNF commencement and adequate correspondence to determine end-points were included. Patients <18 years of age, and those with prior exposure to any anti-TNF agent were excluded. Outcomes measured included biochemical parameters and immunomodulator therapy pre and post anti-TNF and days to first loss of response; defined by an admission or surgery post-induction, escalation of TNF dose or concurrent immunomodulators for clinical LOR or emergence of a new fistula. Statistical analysis was performed with GraphPad Prism v6. Result(s): A total of 211 patients were included for analysis: 188 patients treated for Crohn's disease and 23 for ulcerative colitis. Baseline characteristics are highlighted in Table 1. One hundred twenty-eight (61%) patients received combination therapy, whereas 83 (39%) had monotherapy. Ninety-nine (47%) patients had loss of response during follow-up; 58 (59%) on combination therapy and 41 (41%) on monotherapy (p =0.433). Causes for LOR included clinical LOR (n = 62, 63%), hospital admission (n = 22, 22%), surgery (n = 12, 12%) or new fistula (n =

Purpose: Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. Method: PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. Conclusions: One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients’ access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. Implications for practice: The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years.

Therapists are continuously entering the private counselling sector, and as a result extending their occupational roles, becoming business owners and evolving in their professional identity. The purpose of this study is to understand the process of establishing a private practice while examining the development of the professional identity of private practice therapists. Specifically, the decision to enter private practice, the process of opening a business, and ethical and supervisory concerns within this field. Using systematic grounded theory, 10 female counsellors in private practice in Manitoba were interviewed. This inquiry led to the development of Professional Development in Private Practice: A Phase Model, providing an overview of therapists’ professional development in their roles as private practitioners. The five phases are seeking autonomy, logistics, transition and attitude, embracing the business and authenticity. The implications of this study are multi-faceted, influencing institutions, professional groups and therapists.

Therapists are continuously entering the private counselling sector, and as a result extending their occupational roles, becoming business owners and evolving in their professional identity. The purpose of this study is to understand the process of establishing a private practice while examining the development of the professional identity of private practice therapists. Specifically, the decision to enter private practice, the process of opening a business, and ethical and supervisory concerns within this field. Using systematic grounded theory, 10 female counsellors in private practice in Manitoba were interviewed. This inquiry led to the development of Professional Development in Private Practice: A Phase Model, providing an overview of therapists’ professional development in their roles as private practitioners. The five phases are seeking autonomy, logistics, transition and attitude, embracing the business and authenticity. The implications of this study are multi-faceted, influencing institutions, professional groups and therapists.

Therapists are continuously entering the private counselling sector, and as a result extending their occupational roles, becoming business owners and evolving in their professional identity. The purpose of this study is to understand the process of establishing a private practice while examining the development of the professional identity of private practice therapists. Specifically, the decision to enter private practice, the process of opening a business, and ethical and supervisory concerns within this field. Using systematic grounded theory, 10 female counsellors in private practice in Manitoba were interviewed. This inquiry led to the development of Professional Development in Private Practice: A Phase Model, providing an overview of therapists’ professional development in their roles as private practitioners. The five phases are seeking autonomy, logistics, transition and attitude, embracing the business and authenticity. The implications of this study are multi-faceted, influencing institutions, professional groups and therapists.

Therapists are continuously entering the private counselling sector, and as a result extending their occupational roles, becoming business owners and evolving in their professional identity. The purpose of this study is to understand the process of establishing a private practice while examining the development of the professional identity of private practice therapists. Specifically, the decision to enter private practice, the process of opening a business, and ethical and supervisory concerns within this field. Using systematic grounded theory, 10 female counsellors in private practice in Manitoba were interviewed. This inquiry led to the development of Professional Development in Private Practice: A Phase Model, providing an overview of therapists’ professional development in their roles as private practitioners. The five phases are seeking autonomy, logistics, transition and attitude, embracing the business and authenticity. The implications of this study are multi-faceted, influencing institutions, professional groups and therapists.

Purpose Radiology has lagged behind other disciplines in using medicolegal data to improve patient safety. The aim of this study was to characterize a sample of closed claims files to inform radiology practice and identify opportunities for system change. Methods A retrospective analysis of 443 medicolegal closed claims provided to the Radiology Events Register. Data were provided by 2 medical defense organizations that provide medical indemnity insurance to Australian private practitioners. We calculated a procedural risk ratio (prevalence in the closed claims dataset divided by prevalence among all diagnostic imaging procedures reimbursed by the Australian Government over the corresponding timeframe) for each modality (CT, ultrasound, radiography, MRI, nuclear medicine) and some procedures. For each closed claim, the incident type was determined, and a classification of 12 patient safety fields was conducted. Results Misdiagnosis (delay or failure to correctly read imaging) accounted for 62% of error types. Modalities and procedures at higher risk of leading to a claim were: mammography (risk ratio [RR] = 4.0, 95% CI 2.9-5.5); breast ultrasound (RR = 2.8, 95% CI 1.7-4.7); total MRI (RR = 3.4, 95% CI 2.0-5.6); total CT (RR = 1.9, 95% CI 1.5-2.5), and obstetrics and gynecology ultrasound (RR = 1.9, 95% CI 1.4-2.4). Lower-risk modalities and procedures were: cardiac ultrasound (RR = 0.1, 95% CI 0.0-0.8); radiography extremities (RR = 0.7, 95% CI 0.5-0.9); and total radiography (RR = 0.8, 95% CI 0.7-0.9). Information to inform patient safety classification was limited, with a mean of 5.8 +/- 1.8 (SD) fields available. Conclusions Despite its limitations, medicolegal data deserve further attention from patient safety analysts.Copyright © 2015 American College of Radiology.

Purpose Radiology has lagged behind other disciplines in using medicolegal data to improve patient safety. The aim of this study was to characterize a sample of closed claims files to inform radiology practice and identify opportunities for system change. Methods A retrospective analysis of 443 medicolegal closed claims provided to the Radiology Events Register. Data were provided by 2 medical defense organizations that provide medical indemnity insurance to Australian private practitioners. We calculated a procedural risk ratio (prevalence in the closed claims dataset divided by prevalence among all diagnostic imaging procedures reimbursed by the Australian Government over the corresponding timeframe) for each modality (CT, ultrasound, radiography, MRI, nuclear medicine) and some procedures. For each closed claim, the incident type was determined, and a classification of 12 patient safety fields was conducted. Results Misdiagnosis (delay or failure to correctly read imaging) accounted for 62% of error types. Modalities and procedures at higher risk of leading to a claim were: mammography (risk ratio [RR] = 4.0, 95% CI 2.9-5.5); breast ultrasound (RR = 2.8, 95% CI 1.7-4.7); total MRI (RR = 3.4, 95% CI 2.0-5.6); total CT (RR = 1.9, 95% CI 1.5-2.5), and obstetrics and gynecology ultrasound (RR = 1.9, 95% CI 1.4-2.4). Lower-risk modalities and procedures were: cardiac ultrasound (RR = 0.1, 95% CI 0.0-0.8); radiography extremities (RR = 0.7, 95% CI 0.5-0.9); and total radiography (RR = 0.8, 95% CI 0.7-0.9). Information to inform patient safety classification was limited, with a mean of 5.8 +/- 1.8 (SD) fields available. Conclusions Despite its limitations, medicolegal data deserve further attention from patient safety analysts.Copyright © 2015 American College of Radiology.

This brief report presents preliminary findings on the exploration of strengths (fortigenic) qualities of psychotherapists which can buffer them against compassion fatigue. Participants were seven South African psychologists in private practice. Data were collected using qualitative interviews and thematically analysed using narrative analysis. Findings suggest fortigenic qualities such as resilience, acceptance, appreciation and passion, humour, philosophy of life and a higher level of logic act as buffers against compassion fatigue.

This brief report presents preliminary findings on the exploration of strengths (fortigenic) qualities of psychotherapists which can buffer them against compassion fatigue. Participants were seven South African psychologists in private practice. Data were collected using qualitative interviews and thematically analysed using narrative analysis. Findings suggest fortigenic qualities such as resilience, acceptance, appreciation and passion, humour, philosophy of life and a higher level of logic act as buffers against compassion fatigue.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and