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An introduction to articles in the issue is presented on topics including description of a free neurorehabilitation clinic staffed by volunteers to fill the gap for people with physical, cognitive, and communication disorders, concussion recovery as a dichotomous state, and how and why we do what we do in clinical practice.

An introduction to articles in the issue is presented on topics including description of a free neuro-rehabilitation clinic staffed by volunteers to fill the gap for people with physical, cognitive, and communication disorders, concussion recovery as a dichotomous state, and how and why we do what we do in clinical practice.

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

There is much discussion in the literature regarding the role public child welfare has played in disproportionately intervening with children and families of color, and debate regarding how this has impacted their wellbeing and the role systemic racism has played. The voice of individuals serving as regional and state-level administrators of public child welfare agencies regarding this topic and how to address existing inequities has been missing in this dialogue. This paper reports on semi-structured interviews conducted with sixteen such administrators regarding where they have observed these issues in their agencies and a wide array of strategies they believe have the best likelihood of promoting racial equity and antiracist practice in the child welfare system, with some describing approaches currently being implemented. Participants discussed what they need from community and university partners to support this work. [ABSTRACT FROM AUTHOR]

Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation. [ABSTRACT FROM AUTHOR]

Background: There is an increasing number of technological resources available to speech and language therapists (SLTs) for use in clinical practice, but the factors that influence SLTs' selection and use of such resources are not well understood. In related fields, technology acceptance models have been employed to explain users' adoption of technology and to inform the advancement of empirically supported technological resources. Aims: To determine the factors that influence SLTs' use of technology for clinical practice by testing a model of their technology acceptance and use. Methods & Procedures: We surveyed 209 practising SLTs in the United States representative of the speech and language membership of the American Speech–Language–Hearing Association (ASHA). Participants completed a 38‐item electronic survey representing four categories: (1) technology use, (2) technology attitudes and factors influencing technology use, (3) employment information and (4) demographics. Items measuring technology attitudes served as indicators of the research model, which mapped the primary relationships of a technology acceptance model. Survey data were collected before the Covid‐19 pandemic. Outcomes & Results: The research model accounted for 66% of the variance in SLTs' behavioural intention to use technology, which significantly and positively predicted the amount of time they reportedly spent using technology in the workplace. Subjective norms and attitudes towards technology use directly predicted the intention to use technology. Perceived usefulness and ease of use indirectly predicted intention to use technology. Survey respondents reported using technology during 48% (SD = 24%) of their overall weekly work hours on average, with a large majority reporting using technology at least once per week for planning (89% of respondents), assessment (66% of respondents) or intervention (90% of respondents). Conclusions & Implications: These findings statistically explain the relationships between SLTs' attitudes and their intention to use technology for clinical practice, contributing to our understanding of why SLTs adopt certain technologies. We also detail the nature and frequency of technology use in the clinical practice of SLTs. Future directions for this work include further exploring use categories, employing direct measurements of technology use and exploring the impact of recent changes in SLT service delivery due to the Covid‐19 pandemic on SLTs' technology attitudes. What this paper addsWhat is already known on the subjectExisting research about the adoption and use of technological resources by SLTs indicates that they select tools based on convenience, cost and recommendations by others.What this paper adds to existing knowledgeThis study is the first to develop and test a research model of SLTs' technology attitudes. The findings from model testing demonstrate the significant predictors of SLTs' behavioural intention to use technology for clinical purposes. Intent of use is related to how much SLTs use technology in the workplace.What are the potential or actual clinical implications of this work?The present findings can inform interventions targeting the design and adoption of electronic SLT resources that are empirically supported. [ABSTRACT FROM AUTHOR]

Healthcare professionals are the vanguard of battling the COVID-19 pandemic and they experience major challenges associated with their jobs in the context of this pandemic. We carried out a survey of 253 healthcare professionals and 189 employees working in other domains to explore differences in how they adapted to COVID-19. Our results show that healthcare professionals perceive a higher mortality threat, lower job satisfaction and engage in fewer counterproductive work behaviors compared to respondents from other professions. Building on the tenets of the Terror Management Theory, we show that dispositional differences in death anxiety are the main drivers of perceived mortality threat in relation to COVID-19, yet this positive association is weaker for healthcare professionals, pointing to the engagement of proximal defenses specific to this work domain. Mortality threat mediates the association between death anxiety and job satisfaction only when supervisory support is low, pointing towards the crucial role of social support at work as a buffering mechanism against the deleterious effects of COVID-19 threat. Our paper presents one of the first empirical attempts to compare healthcare professionals with other workers with respect to job satisfaction and counterproductive work behaviors during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients' perceptions, but scant research has included the perspectives of clinicians.Aims: We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care.Methods: A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to promote the trustworthiness of the analysis and reduce bias.Results: Participants (n = 13) consisted of physicians (n = 8), physician assistants (n = 3), and nurse practitioners (n = 2). The majority were women (n = 11), identified as White (n = 9), cisgender (n = 13), and ages ranged from 31 - 58 years. Five main themes were identified: (1) Knowledge Acquisition: Formal and Informal Pathways to Competency; (2) Perceived Challenges and Barriers: I didn't know what I was doing; (3) Power to Deny: Prescriptive Authority and Gatekeeping; (4) Stigma: This is really strange, and I can't really understand it; (5) Reflections: Strategies for Success, Rewards, and Personal Motivations.Discussion: Clinicians gained a sense of comfort and competence with mentorship, self-directed learning, clinical experience, and person-centered, harm-reduction approaches. Stigma, bias, and structural-level factors were barriers to providing care. This study offers a unique perspective of clinicians' motivations and strategies for providing gender-affirming care and elucidates how stigma impacts the delivery of gender-affirming care. [ABSTRACT FROM AUTHOR]

The social, financial, and emotional repercussions of the COVID-19 pandemic has left many organizations that support survivors of intimate partner violence questioning how to maintain core services while addressing compounding individual, organizational, and public health issues. Stay-at-home orders and other COVID-19 mitigation strategies have resulted in reduced shelter availability and increased intimate partner violence rates. Coupled with the economic impact of the pandemic, these factors have threatened financial and housing stability. To better understand these challenges and provide immediate support, The National Alliance for Safe Housing (NASH) co-hosted a peer support call to provide a virtual platform for practitioners to ask questions, discuss challenges, and share strategies for quality service provision during the COVID-19 pandemic. Over 800 practitioners from across the United States participated in the NASH call, most of whom were advocates, program directors, and managers. NASH gathered data on practitioners' needs from a brief survey from the registration form analyzed using conventional inductive content analysis. Practitioners' primary concerns were situated within eight questions, which we categorized into four meta-categories: (1) managing residential housing programs; (2) getting survivors materials resources; (3) keeping staff safe; and (4) maintaining organizational operations. The paper concludes with community-grounded and empirically supported practice recommendations aligned with practitioners' expressed needs. [ABSTRACT FROM AUTHOR]

Purpose: Karen people from Burma are a new population in resettlement countries. While research increasingly documents their health needs, few studies describe how health-care providers adapt their practices to serve this group. The purpose of this study was to explore the experiences of providers who work with Karen patients/clients in health settings, documenting the challenges they face, how they adapt their practice and recommendations. Design/methodology/approach: This study used a qualitative survey and one phone interview with a total of 20 providers who had first-hand experience caring for Karen people in health settings. Data were analyzed using qualitative content analysis. Findings: Two main categories described challenges providers faced in working with Karen people in health settings: system-level challenges and interpersonal communication challenges. Five main categories described specific strategies and support needed to adapt practice for Karen patients in health settings: strategies for improving communication and mutual understanding; partnering with Karen staff, interpreters and cultural brokers; strategies for building trust and rapport; addressing needs related to case management, care coordination and social determinants of health; recommendations for provider training. Originality/value: This paper contributes suggestions for adapting practice to meet the health needs of Karen people from the perspective of health-care providers in a location that is nationally recognized for its excellence in refugee health. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]

There has been little research on domestic violence (DV) within ethnic minority communities in high-income countries. This study reports on the findings of a meta-ethnography that examined the barriers and facilitators of help-seeking behaviors in South Asian women living in high-income countries who have experienced DV to inform practice, understand the limits of the evidence, and identify research gaps. Qualitative studies were identified which were available in English by electronic databases. After an initial search, 2,465 articles were reviewed by title and abstract and 135 articles were reviewed for full text. Thirty-five papers were included for this review and were synthesized using meta-ethnography. Key findings included barriers and facilitators of help-seeking behaviors: (1) Socio-cultural norms to prohibit help-seeking behaviors, (2) Fear of negative consequences, (3) Negative aspects of immigration status, (4) Insufficient support from statutory, and voluntary agencies, (5) Safety strategies and facilitators for surviving. Although this review investigated the perceptions of two different populations (survivors and service providers) both groups had similar views about the barriers and facilitators of help-seeking behaviors. It is crucial for the government and non-government organizations to understand the barriers for women who are DV survivors to seek help from their organizations and also from South Asian ethnicities. The awareness and understanding of these barriers and facilitators may help support the development of interventions to encourage effective help-seeking amongst South Asian women affected by DV. Suggestions for research, practice, and policies are discussed. [ABSTRACT FROM AUTHOR]

Online platforms can support health and educational professionals in their daily work; however, it is challenging to keep online platforms sustainable. This paper aims to indicate the most important factors of platform sustainability from the perspective of professionals involved in online platforms. Further, it aims to understand how these factors operate. A mixed methods study was carried out among professionals from Europe, Australia, the USA and Canada. In the first phase, the importance of 54 factors from the literature was assessed with a questionnaire among 17 professionals. The relative importance of the factors and the consensus regarding this importance were calculated using median scores and interquartile deviations. In total, 19 factors were selected representing general characteristics, characteristics related to the platform, communication, visitor and context. In the second phase, insight was gained regarding the experiences with those factors through 12 individual Skype interviews. The most frequently mentioned important factors of platform sustainability were (i) having sufficient time, resources and expertise, (ii) user friendliness and (iii) creating a sense of belonging. Platforms should use a planned approach to address a combination of factors directly from platform development. Gaining long-term resources is challenging and should be considered from the start of a project by building partnerships. To promote user friendliness, platforms should be simple, have a clear set-up and provide high-quality tools. Finally, establishing a sense of belonging could be supported by branding and face-to-face networking activities. For all aspects, involving visitors and stakeholders is essential. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a narrative review of the literature pertaining to strategies employed by health professional programs to teach social determinants of health (SDOH) and use the results to describe pathways for integrating SDOH education into Doctor of Chiropractic programs (DCPs). Methods: A narrative review of peer-reviewed literature describing SDOH education in health professional programs within the United States was performed. The results were used to inform potential pathways of integrating SDOH education into all aspects of DCPs. Results: Twenty-eight papers demonstrated health professional programs' incorporation of SDOH education and assessment into didactic and experiential learning opportunities. Educational interventions resulted in positive changes in knowledge and attitudes toward SDOH. Conclusion: This review demonstrates existing methods for integrating SDOH in health professional programs. Methods may be adopted and assimilated into an existing DCP. Further research is needed to understand barriers and facilitators to the implementation of SDOH education into DCPs. [ABSTRACT FROM AUTHOR]

Background: Cultural competency is often promoted as a strategy to address health inequities; however, there is little evidence linking cultural competency with improved patient outcomes. This article describes the characteristics of recent educational interventions designed to improve cultural competency in healthcare workers for First Nations peoples of Australia, New Zealand, Canada and the USA. Methods: In total, 13 electronic databases and 14 websites for the period from January 2015 to May 2021 were searched. Information on the characteristics and methodological quality of included studies was extracted using standardised assessment tools. Results: Thirteen published evaluations were identified; 10 for Australian Aboriginal and Torres Strait Islander peoples. The main positive outcomes reported were improvements in health professionals' attitudes and knowledge, and improved confidence in working with First Nations patients. The methodological quality of evaluations and the reporting of methodological criteria were moderate. Conclusions: Cultural competency education programs can improve knowledge, attitudes and confidence of healthcare workers to improve the health of First Nations peoples. Providing culturally safe health care should be routine practice, particularly in places where there are concentrations of First Nations peoples, yet there is relatively little research in this area. There remains limited evidence of the effectiveness of cultural education programs alone on community or patient outcomes. Cultural competency is often promoted as a strategy to address health inequities, although evidence linking cultural competency to patient outcomes is scarce. We conducted a narrative review of the recent literature on cultural education programs and found 13 published evaluations, mainly reporting improvements in health professionals' attitudes and knowledge, and improved confidence in working with First Nations patients. Although cultural education has a positive short-term impact, none of the studies included measured improved patient health outcomes. [ABSTRACT FROM AUTHOR]

Abortion is a common medical procedure in the United States that is frequently the target of political and legal restrictions. These restrictions can negatively impact care and interfere with the patient-provider relationship. In this paper, we aim to review the historic context in which feticidal agents became more utilized in later abortion; describe current practices and protocols of using feticidal agents use for later abortion by dilation and evacuation and induction of labor; evaluate patient and provider perspectives on feticidal agent use; and propose areas of further ethical and research inquiry to characterize the use of these agents in later abortion procedures. [ABSTRACT FROM AUTHOR]

Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients' readiness can conflict with perceptions of what readiness means for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families. [ABSTRACT FROM AUTHOR]

Little is known about how athletic trainers (ATs) learn clinical documentation, but previous studies have identified that ATs have a need for more educational resources specific to documentation. To obtain ATs' perspectives on learning clinical documentation. Qualitative study. Web-based audio interviews. Twenty-nine ATs who completed 2 different continuing education (CE) clinical documentation modules. Participants averaged 36.2 ± 9.0 years of age and included 16 women and 13 men representing 21 US states and 8 clinical practice settings. Participants were recruited from a group of ATs who completed 1 of 2 web-based CE clinical documentation modules. Within 3 weeks of completing the educational modules, participants were interviewed regarding their perceptions of how they learn clinical documentation, including their experiences completing the modules. Using the Consensual Qualitative Research approach, 3 researchers and 1 internal auditor inductively analyzed the data during 5 rounds of consensus coding. Trustworthiness measures included multianalyst triangulation, data source triangulation, and peer review. Two themes emerged from the data, including (1) mechanisms of learning documentation and (2) benefits of the educational modules. Athletic trainers primarily learn documentation through professional education and workforce training, but training appears to be inconsistent. Participants perceived that both educational modules were effective at increasing their knowledge and confidence related to learning documentation. The CE modules incited a growth mindset and intention to change behavior. Athletic trainers are satisfied with web-based CE learning experiences specific to clinical documentation and may benefit from more CE offered in these formats. Educators are encouraged to integrate clinical documentation principles throughout the curriculum during both didactic and clinical education. Workforce training is also valuable for improving knowledge and skills related to clinical documentation, and employers should onboard and support ATs as they start new positions. [ABSTRACT FROM AUTHOR]

Mobile health (mHealth) screening tools for autism are gaining in prevalence, and have benefits such as video content and direct resources linkage. However, it is unclear whether such tools will ameliorate autism inequities or will help only those already advantaged in autism care. To investigate this issue, we conducted semi-structured qualitative interviews with 18 primary care and Early Intervention/Early Childhood Special Education providers in six US states. Providers were given hypothetical scenarios in which a family presents to care with results from one of 9 mHealth autism screening tools. Providers discussed their clinical approach and assessed the tool's fit with their patient/client population. Each transcript was audio-recorded, transcribed, and coded; a phenomenological approach was used to develop key themes. 4 themes and 18 subthemes emerged. These included Clinical and business factors (e.g. scope of practice concerns and clinical efficiency), Validity and trustworthiness (e.g. familiarity, data privacy/security), Family interaction quality (e.g. supporting family advocacy, provision of information, affecting family anxiety, and emotional support), and Accessibility (e.g. English proficiency/language issues, cultural inclusivity, and literacy/educational level). Providers suggested modifications to enhance equity, such as portraying diverse families, reducing the reading level of text, and making tools shorter to better fit clinical context. Families may find information about autism online, and health care and education providers may use online tools to screen for autism. However, we do not know if online autism screening tools are easily used by families and providers. We interviewed primary care and educational providers, asking them to review results from online tools that screen for autism. Providers had concerns about how usable and accessible these tools are for diverse families and suggested changes to make tools easier to use. [ABSTRACT FROM AUTHOR]

Background: Physical agent modalities (PAMs) are used by occupational therapists to prepare for or facilitate participation in purposeful activities. However, little has been published in the last quarter century regarding how U.S. occupational therapists use and are prepared to use of PAMs in contemporary clinical practice. In this study, U.S.-based occupational therapists were surveyed regarding their use of PAMs, preparation for use, and perceptions of that preparation. Methods: Survey data was collected from a purposive sample of 141 U.S.-based occupational therapists and occupational therapy assistants as part of this exploratory-descriptive, mixed-methods study. Thematic and descriptive statistical analyses were completed using quantitative and qualitative data. Results: Quantitative data provided a current profile of types, frequency, and settings in which PAMs are used, along with sources and perceptions of training. Qualitative data yielded three themes, including (a) benefit of experiential learning, (b) benefit of continuing education, and (c) relative adequacy of entry-level training. Conclusions: Findings from this study serve as an initial step in understanding contemporary use of PAMs in clinical occupational therapy practice. Further study is needed to expand the knowledge base in the profession and support an evidence-informed approach to care. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients’ health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED. [ABSTRACT FROM AUTHOR]

Healthcare chaplains address broad social and emotional dimensions of care within a pluralistic religious landscape. Although the development and evaluation of chaplaincy interventions has advanced the field, little research has investigated factors influencing the implementation of new chaplain interventions. In this mixed-method study, we examined attitudes about evidence-based interventions held by chaplain residents (n = 39) at the outset of an ACPE-accredited residency program in the southeast United States. We also used semi-structured interviews (n = 9) to examine residents' attitudes, beliefs, and decision-making processes after they trained in the delivery of a novel manualized intervention, Compassion-Centered Spiritual Health (CCSH). Most residents reported favorable attitudes toward manualized approaches prior to training. Interviews revealed complex decision-making processes and highlighted personal motivations and challenges to learning and implementing CCSH. Implementation science can reveal factors related to motivation, intention, and training that may be optimized to improve the implementation of healthcare chaplaincy interventions. [ABSTRACT FROM AUTHOR]

In recreational therapy (RT), job satisfaction and thriving in the workplace is a relatively unexplored research topic. Supporting literature highlights employee and organizational benefits associated with job satisfaction and thriving that are worth exploring in RT. This study sought to further the understanding of RTs' perceptions of job satisfaction and sense of "thriving" in the workplace, anticipating that research will contribute to the further study of RTs and the organizations in which they work. The sample consisted of 260 Certified Therapeutic Recreation Specialists (CTRSs®) who completed an e-survey mailed through the National Council for Therapeutic Recreation Certification. Respondents noted job satisfaction was linked to the nature of work and to the relationships in the workplace. No significant differences were found by sector or number of years in the profession. Sense of thriving was tied to on-the-job learning. Findings indicated that thriving in the workplace was a predictor of one's job satisfaction. The manuscript outlines study limitations and future research directions. [ABSTRACT FROM AUTHOR]

Introduction: Many countries are enacting tobacco treatment training, guidelines and policies in order to fulfil Framework Convention on Tobacco Control (FCTC) treaty agreements. This study tapped the perspectives of international treatment providers to identify challenges and recommendations for improvement. Methods: The cross-sectional survey included closed- and open-ended items. Distribution included professional listservs (ATTUD; Global Bridges; ENSH Global) and word-of-mouth. The survey collected data using an open-source platform (Enketo Smart Paper/Ona). We used R for quantitative analysis and Google Sheets to categorize open-ended responses. Results: There were 155 respondents from 49 countries. Most (78.6%) provided direct services. Almost half (48.1%) reported receiving less than 6 hours of tobacco treatment training; respondents from low and lower-middle income countries (LMICs) received significantly less training (Fisher's p < 0.014). Likewise, among all respondents, 43% rated poor access to treatment; this rose to 100% among LMICs (Fisher's p < 0.001). To improve treatment and training, respondents suggested increasing government funding for pharmacotherapy and behavioural services; providing training in local languages and in the treatment of smokeless tobacco forms; trainee certification and access to online support for providers. Conclusions: Globally, half of front-line treatment providers reported having poor access to training; this was true for all providers in LMICs and most in upper middle-income countries. Existing online trainings, available mainly in English, could be migrated to open-access formats to permit countries to tailor them to their local needs and languages. Countries in geographical proximity or historical linguistic/political alliances could forge cross-country mentoring relationships and mutual support for training. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the attitudes of speech-language pathology--related specialists (SPs) and speech-language pathology (SLP) students toward stuttering. Furthermore, we identified the factors that influence changes in the attitudes of SLP students and SPs in various countries. Method: Using a search formula, the PubMed and ScienceDirect databases were used to conduct primary and secondary screening for analysis. All previous studies included in the systematic review focused on SPs or SLP students and were published in English. Studies were collected and screened independently by the first and second authors and then discussed between them. Twenty-two studies with varying research designs and sample sizes were included in the systematic review. Finally, information on authors, publishing year, participant, country or region, assessment materials, and the results were extracted and organized before analysis. Results: Twenty-two articles from eight countries and one region (Middle East) were extracted. The results showed that SLP students and SPs in different countries have different attitudes toward stuttering depending on their education, experience, geographic location, cultural status, and societal development, but stereotypes of people who stutter (PWS) persist (e.g., nervous), and the attitudes toward the clinics appear to be more negative in Western countries. Conclusions: Negative attitudes toward PWS remain among both SLP students and SPs. Thus, the factors that may influence the attitudes of SLP students and SPs should be taken into account in academic and clinical education in fluency disorders, and the education content must be structured to improve the quality of education and the attitude toward PWS. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. Local Problem: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. Methods: This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. Results: During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. Conclusions: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding. [ABSTRACT FROM AUTHOR]

Objective: Qualitative research methods are based on the analysis of words rather than numbers; they encourage self-reflection on the investigator's part; they are attuned to social interaction and nuance; and they incorporate their subjects' thoughts and feelings as primary sources. Despite appearing well suited for research in child and adolescent psychiatry (CAP), qualitative methods have had relatively minor uptake in the discipline. We conducted a qualitative study of CAPs involved in qualitative research to learn about these investigators' lived experiences, and to identify modifiable factors to promote qualitative methods within the field of youth mental health. Methods: We conducted individual, semi-structured 1-h long interviews through Zoom. Using purposive sample, we selected 23 participants drawn from the US (n = 12) and from France (n = 11), and equally divided in each country across seniority level. All participants were current or aspiring CAPs and had published at least one peer-reviewed qualitative article. Ten participants were women (44%). We recorded all interviews digitally and transcribed them for analysis. We coded the transcripts according to the principles of thematic analysis and approached data analysis, interpretation, and conceptualization informed by an interpersonal phenomenological analysis (IPA) framework. Results: Through iterative thematic analysis we developed a conceptual model consisting of three domains: (1) Becoming a qualitativist: embracing a different way of knowing (in turn divided into the three themes of priming factors/personal fit; discovering qualitative research; and transitioning in); (2) Being a qualitativist: immersing oneself in a different kind of research (in turn divided into quality: doing qualitative research well; and community: mentors, mentees, and teams); and (3) Nurturing: toward a higher quality future in CAP (in turn divided into current state of qualitative methods in CAP; and advocating for qualitative methods in CAP). For each domain, we go on to propose specific strategies to enhance entry into qualitative careers and research in CAP: (1) Becoming: personalizing the investigator's research focus; balancing inward and outward views; and leveraging practical advantages; (2) Being: seeking epistemological flexibility; moving beyond bibliometrics; and the potential and risks of mixing methods; and (3) Nurturing: invigorating a quality pipeline; and building communities. Conclusions: We have identified factors that can support or impede entry into qualitative research among CAPs. Based on these modifiable findings, we propose possible solutions to enhance entry into qualitative methods in CAP (pathways), and to foster longer-term commitment to this type of research (identity). [ABSTRACT FROM AUTHOR]

Aims: To share lessons learned from an evidence-based practice (EBP) initiative that implemented near-infrared (NIR) technology in a large US hospital system. A Clinical Technology Implementation Model (CTIM©) that can be adapted for use in other health institutions is presented. Background: EBP implementation, including the adoption of new cutting-edge technologies, is crucial to improving patient care. Yet there are significant delays in changes to clinical practice, often due to organisational challenges that stifle the implementation process. The evidence−practice gap is increasingly evident in peripheral intravenous access (PIV). Implementation science offers new insights into the challenges of updating clinical practice, which can support EBP implementation. Evaluation: Recent literature on implementation science, change theory, PIV access, NIR technology, and patient outcomes were reviewed. A model that can help nurse managers implement technology that aligns with EBP is presented, drawing on experience from the adoption of NIR vein visualisation to enhance PIV access in a large US hospital system. Key issue: A pervasive hesitancy in healthcare to embrace technology, coupled with the challenges of implementing a change to practice, has led to limited application of EBP PIV access guidelines and a stagnant standard of care. Conclusion: This article provides nurse managers with the tools necessary to successfully implement EBP, drawing on the experience from implementing NIR in a large US hospital. Nurse managers are uniquely positioned to lead the way in embracing technology to improve care and reduce the evidence−practice gap. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations. [ABSTRACT FROM AUTHOR]

Purpose: Family--professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3--21 years), specifically during the COVID-19 pandemic. Method: Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). Results: SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Conclusions: Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family--professional partnerships could in turn improve outcomes for students who use AAC. [ABSTRACT FROM AUTHOR]

Purpose: This study had two aims. Aim 1 was to query both communication science and disorders (CSD) faculty and school-based speech-language pathologists (SLPs) regarding how written language is/was covered in their graduate programs. Aim 2 was to query school-based SLPs about their written language service provision. Method: CSD faculty (n = 143) and school-based SLPs (n = 610) completed an online survey examining (a) if and how written language was addressed in their graduate program, (b) what content related to written language was covered in graduate school, and (c) provision of written language services in schools (SLPs only). Results: There was a discrepancy in reports of training provision. Faculty reported providing more training than SLPs reported receiving. However, SLPs with fewer years of experience reported slightly higher levels of training compared to those with more years of experience. Additionally, there was variability among SLPs in how often they targeted written language in therapy. Finally, receipt of training in written language was a significant predictor of provision of written language services, as reported by SLPs. Conclusions: SLPs play a key role on literacy teams in schools, but many SLPs did not receive adequate training in written language. In order to ensure SLPs are trained to work with children with reading difficulties, graduate programs should ensure that written language is part of the clinical and academic curricula. [ABSTRACT FROM AUTHOR]

Background: The chiropractic profession in the United States (US) has a long history of intra-professional discourse surrounding ideology and beliefs. Large-scale efforts have evaluated 3 distinctive subgroups of US chiropractors focused on these areas of practice: spine/neuromusculoskeletal, primary care, and vertebral subluxation. To our knowledge, there have not been any prior studies exploring the factors associated with these ideology and belief characteristics of these subgroups. The purpose of this study was to explore, describe, and characterize the association of US chiropractors' ideology, beliefs, and practice patterns with: 1) chiropractic degree program of graduation, 2) years since completion of chiropractic degree, and 3) US geographic region of primary practice. Methods: This was a secondary analysis of a cross-sectional survey of a random sample of US licensed chiropractors (n = 8975). A 10% random sample was extracted from each of the 50 states and District of Columbia chiropractic regulatory board lists. The survey was conducted between March 2018-January 2020. The survey instrument consisted of 7 items that were developed to elicit these differentiating ideologies, beliefs, and practice patterns: 1) clinical examination/assessment, 2) health conditions treated, 3) role of chiropractors in the healthcare system, 4) the impact of chiropractic adjustments [spinal manipulation] in treating patients with cancer, 5) vaccination attitudes, 6) detection of subluxation on x-ray, and 7) x-ray utilization rates. Multinomial regression was used to analyze associations between these 7 ideology and practice characteristic items from the survey (dependent variables) and the 3 demographic items listed above (independent variables). Results: Data from 3538 respondents (74.6% male) were collected with an overall response rate of 39.4%. Patterns of responses to the 7 survey items for ideologies, beliefs, and practice characteristics were significantly different based on chiropractic degree program of graduation, years since completion of chiropractic degree, and geographic region of primary practice. Conclusions: Among US chiropractors, chiropractic program of graduation, years since completion of chiropractic degree, and geographic region of primary practice are associated with variations in clinical ideology, beliefs, and practice patterns. The wide variation and inconsistent beliefs of US chiropractors could result in public confusion and impede interprofessional integration. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused significant changes for family-- professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent--SLP partnerships, particularly for parents with children who use aided AAC. Method: Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent--SLP partnerships. Results: The parent--SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. Conclusions: It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent--SLP partnerships. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine school-based speech-language pathologists' (SLPs') implementation of services to address students' executive function (EF) needs, with particular emphasis on the prevalence and characteristics of EF interventions and the factors and barriers that influence service provision for students with EF needs. Method: We applied an explanatory sequential mixed-methods research design, beginning with a quantitative survey followed by a series of qualitative interviews. We analyzed the survey results using descriptive data and binary logistic regressions and used the emergent trends to inform our interview protocol, so that we could explore those trends in greater detail and context. We synthesized our quantitative and qualitative data to evaluate the characteristics of EF interventions and the factors influencing services. Results: Most SLPs reported that they addressed their students' EF needs through some sort of direct or indirect intervention. Direct interventions varied by targeted domain, service delivery setting, and teaching techniques, though most SLPs favored strategy instruction and highly contextualized services. Indirect services included accommodations and consultation. SLPs commonly reported the lack of collaborative support, time, and knowledge as barriers, and most reported that professional development would be helpful to improve their services. Conclusions: Speech-language pathology graduate programs and providers of professional development should be mindful of their role in preparing SLPs to address EF needs, while SLPs may use these results to inform their own practice. Further guidance and research are necessary to elucidate the SLPs' role in mitigating the negative impact of EF challenges on students' education. [ABSTRACT FROM AUTHOR]

Objective We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Study Design Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. Key Points Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible. Perceptions of teleneonatology do not differ based on professional role or years of experience. Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to online professionalism for physicians. It informs that the American College of Physicians (ACP), a professional organization for internal medicine and the Federation of State Medical Boards of the U.S. (FSMB), a national not-for-profit organization, have suggested that the U.S. physicians should carefully use online social networks and e-mails for professional purpose. According to the study, 92 percent of state medical boards have received reports in which they found that physicians violate rules of medical professionalism. It also mentions that physicians should create separate accounts for their professional use on social media.

Objectives: Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. Methods: Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. Results: Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = − 0.27, p < 0.01), and burnout (r = − 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. Conclusions for Practice: Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life. Significance: What is already known on this subject? Studies on traumatic birth experiences rarely consider the impact on the providers caring for those patients. Few studies have elucidated the impact of work-related trauma on labor and delivery clinicians or considered whether it may contribute to burnout. What this study adds? This study found that involvement in traumatic birth experiences can affect labor and delivery clinician's professional quality of life, their interactions with patients, and desire to stay in the field. However, there is little acknowledgement or supports to mitigate these impacts in the workplace. Proactively investing in health care system supports for clinicians may mitigate clinician burnout and secondary traumatic stress and improve compassion satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To assess use of mammography information systems (MISs) and explore features associated with breast imaging radiologist satisfaction. Methods: A 22-question survey regarding MISs was distributed electronically to the Society of Breast Imaging membership between February 16, 2022 and June 28, 2022. Differences in responses between respondents satisfied and dissatisfied with their MIS were analyzed using Pearson chi-squared test, Fisher exact test, and multivariate logistic regression. Results: The response rate was 11.4% (228/2007). Most respondents used a commercial MIS (195/228, 85.5%). Most used were Epic (47/228, 21%), MagView (47/228, 21%), and PenRad (37/228, 16%). Only 4.4% (10/228) reported that patient tracking was not integrated with results reporting. The majority (129/226, 57%) reported satisfaction with their MIS. Satisfaction correlated (P < 0.05) with features such as picture archiving and communication system integration, structured reporting, access to physician outcomes metrics, and ability to query data. Less commonly reported features such as non-English language options and recognition of laterality and patient mismatch errors also correlated with satisfaction. Lack of these features correlated with dissatisfaction (P < 0.05). Satisfaction also correlated with adequate training (P < 0.001) and technology support (P < 0.001). On multivariate analysis, longer time using the current MIS was independently associated with satisfaction. Conclusion: Most respondents used a commercial MIS and were satisfied with their system. Satisfied users reported several helpful MIS features and adequate training and support. The survey results could help MIS companies when designing new products and inform radiologists and administrators when considering a new MIS. [ABSTRACT FROM AUTHOR]

Purpose: This study examined public school (PS) speech-language pathologists’ (SLPs’) perceived confidence in managing pediatric feeding disorders (PFDs). Perceived confidence is a rater’s self-reported assurance level to manage PFDs. The study then looked for relationships between personal and professional factors that might account for perceived confidence. Geographic location as well as administrative supports and resources were also examined. Method: Participants were PS SLPs from across the United States who were recruited via American Speech-Language-Hearing Association Special Interest Groups. This study measured perceived confidence with a 5-point Likert-type scale for 17 roles and responsibilities in PFD management. Pearson and Spearman correlations were used to identify relationships with personal and professional characteristics. Results: PS SLPs perceived themselves as having low confidence in managing PFDs. Personal and professional characteristics account for low perceived confidence (e.g., number of graduate courses, clinical experience with swallowing and feeding in early intervention or medical settings, managing swallowing and feeding currently, having more administrative support). Conclusions: This study provided a more representative sample (i.e., geographic regions) of PS SLPs. Perceived confidence in PFD management is linked to factors that can be modified through personal and professional changes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore 232 service providers' and policymakers' experiences of supporting children's well-being during the pandemic, across sectors, in 22 countries – including Kenya, the Philippines, South Africa, India, Scotland, Sweden, Canada and the USA, in the last quarter of 2020. Design/methodology/approach: A smartphone survey delivered via a custom-built app containing mostly open-ended questions was used. Respondents were recruited via professional networks, newsletters and social media. Qualitative content analysis was used. Findings: The findings reveal numerous system-level challenges to supporting children's well-being, particularly virus containment measures, resource deficiencies and inadequate governance and stakeholder coordination. Those challenges compounded preexisting inequalities and poorly affected the quality, effectiveness and reach of services. As a result, children's rights to an adequate standard of living; protection from violence; education; play; and right to be heard were impinged upon. Concurrently, the findings illustrate a range of adaptive and innovative practices in humanitarian and subsistence support; child protection; capacity-building; advocacy; digitalisation; and psychosocial and educational support. Respondents identified several priority areas – increasing service capacity and equity; expanding technology use; mobilising cross-sectoral partnerships; involving children in decision-making; and ensuring more effective child protection mechanisms. Practical implications: This study seeks to inform resilience-enabling policies and practices that foster equity, child and community empowerment and organisational resilience and innovation, particularly in anticipation of future crises. Originality/value: Using a novel approach to gather in-the-moment insights remotely, this study offers a unique international and multi-sectoral perspective, particularly from low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Although clozapine has demonstrated unique efficacy for the treatment of seriously ill patients with refractory psychosis, its real-world use presents challenges to clinicians in a variety of settings, leading to its underutilization in the United States. The barriers include a lack of prescriber knowledge and confidence, negative prescriber attitudes, special monitoring requirements, administrative burden, unprepared health systems, and inadequate appreciation of clozapine's unique nature by policy makers and payers. In 2016, the National Association of State Mental Health Program Directors (NASMHPD) gathered a national team of expert clinicians and researchers to identify and address barriers to clozapine use. NASMHPD has since expanded the work group, which convenes monthly to continue addressing specific recommendations. This Open Forum describes the deliberations of the work group and urges practitioners, administrators, local and state governments, researchers, families, and patients to join similar efforts to promote better access to clozapine and improve the treatment management for patients receiving clozapine. [ABSTRACT FROM AUTHOR]

• InPlace® Learning is a feasible and acceptable approach to suicide prevention education for youth services workers in a large and varied workforce. • InPlace® Learning participants demonstrated knowledge and increased self-efficacy in suicide prevention skills. • Perception of training relevance and potential for transfer to practice was strong across human services roles and settings. • Leveraging implementation science frameworks and strategies strengthened the workforce education suicide prevention initiative. Suicide is the second leading cause of death for youth in the U.S. and equipping clinical and non-clinical staff in youth services to address suicide concerns is a challenge. This paper evaluates InPlace Learning, an innovative and sustainable blended learning approach to suicide prevention workforce education in youth services. InPlace Learning combines group video-guided workshops, follow-up Q&A via web-based 'office hours', and continual learning through job aids and brief refreshers. Hillside identified 25 programs to adopt InPlace Learning for suicide prevention training, and 1,162 staff to participate in the training. The purpose of the first phase of this program evaluation was to evaluate the feasibility of this approach, including examining adoption and reach of InPlace Learning, as well as education outcomes for staff, including knowledge, self-efficacy, and transfer of learning. The program evaluation sample consisted of 556 staff who completed post-training evaluations. Ten staff shared their experience and feedback through post-training interviews. Results show that 100 % (N = 25) of programs adopted InPlace Learning and 64 % of staff participated in the training, showing evidence of reach. Post-training evaluations indicated participants learned skills in suicide prevention. Self-efficacy in connecting around and assessing and responding to suicide concerns rose significantly for both clinical and non-clinical staff. Non-clinical staff who had lower ratings for self-efficacy before training showed the greatest gains post-training. The perception of transfer of learning to practice was high. Staff interview data aligned with quantitative findings. Taken together, these findings indicate that InPlace Learning is a feasible and acceptable approach to suicide prevention workforce education in youth services with a positive impact on educational outcomes for staff. [ABSTRACT FROM AUTHOR]

Health outcomes are markedly influenced by health-related social needs (HRSN) such as food insecurity and housing instability. Under new Joint Commission requirements, hospitals have recently increased attention to HRSN to reduce health disparities. To evaluate prevailing attitudes and guide hospital efforts, the authors conducted a systematic review to describe patients' and health care providers' perceptions related to screening for and addressing patients' HRSN in US hospitals. Articles were identified through PubMed and by expert recommendations, and synthesized by relevance of findings and basic study characteristics. The review included 22 articles, which showed that most health care providers believed that unmet social needs impact health and that screening for HRSN should be a standard part of hospital care. Notable differences existed between perceived importance of HRSN and actual screening rates, however. Patients reported high receptiveness to screening in hospital encounters, but cautioned to avoid stigmatization and protect privacy when screening. Limited knowledge of resources available, lack of time, and lack of actual resources were the most frequently reported barriers to screening for HRSN. Hospital efforts to screen and address HRSN will likely be facilitated by stakeholders' positive perceptions, but common barriers to screening and referral will need to be addressed to effectively scale up efforts and impact health disparities. [ABSTRACT FROM AUTHOR]

Objectives: Fentanyl test strips (FTSs) are increasingly used to address fentanyl contamination of the illicit drug supply by testing a drug for the presence of fentanyl, allowing people who use drugs (PWUD) to engage in overdose prevention. While emergency departments (EDs) have implemented various harm reduction strategies for PWUD, to date distribution of FTSs in EDs is limited and not evaluated. Thus, we sought to explore ED staff experiences distributing FTSs. Methods: Twenty‐one staff serving different roles (e.g., physician, nurse, technician, social worker, certified recovery specialist) within two urban EDs in a major metropolitan area were enrolled in a pilot study to distribute FTS to patients who use drugs. Participants were interviewed about their experience at 3 weeks and again at 3 months. Interviews were recorded, transcribed verbatim, and coded using a conventional content analysis approach. Results: All participants endorsed the utility of FTS distribution in the ED. Across 42 interviews, participants discussed evolving strategies to approach patients about FTS, primarily favorable patient reactions to FTSs, improved dynamics between participants and patients, mixed intervention support from other staff, and named challenges of FTS distribution and recommendations to make FTS distribution in the ED widespread. Recommendations included medical records prompts to offer FTS, offering via different types of staff, and offering FTS during triage. Conclusions: Implementing FTS distribution may improve patient rapport while providing patients with tools to avoid a fentanyl overdose. Participants generally reported positive experiences distributing FTSs within the ED but the barriers they identified limited opportunities to make distribution more integrated into their workflow. EDs considering this intervention should train staff on FTSs and how to identify and train patients and explore mechanisms to routinize distribution in the ED environment. [ABSTRACT FROM AUTHOR]

Background: The Institute for Healthcare Improvement's 4‐Ms framework of care for older adults recommends a multidisciplinary assessment of a patient's Medications, Mentation, Mobility, and What Matters Most. Electronic health record (EHR) systems were developed prior to this emphasis on the 4‐Ms. We sought to understand how healthcare providers across the healthcare system perceive their EHRs and to identify any current best practices and ideas for improvement regarding integration of the 4‐Ms. Methods: Anonymous survey of healthcare providers who care for older adults. The survey aimed to evaluate efficiency, error tolerance, and satisfaction (usefulness and likeability). The survey was distributed through organizational list serves that focus on the care of older adults and through social media. Results: Sixty‐six respondents from all geographic segments of the U.S. (n = 62) and non‐U.S. practices (n = 4) responded. Most (82%) were physicians. Respondents used a range of EHRs and 82% had >5 years of experience with their current EHR. Over half of respondents agreed that their EHR had easy to find contact information (56%) and advance directives. Finding a patient's prior cognitive status (26% agreement), goals of care (24%), functional status (14%), and multidisciplinary geriatric assessments (27%) was more difficult. Only 3% were satisfied with how their EHR handles geriatric syndromes. In free text responses, respondents (79%) described three areas that the EHR assists in the care of older adults: screening tied to actions or orders; advance care planning, and medication alerts or review. Common suggestions on how to improve the EHR included incorporating geriatric assessments in notes, establishing a unified place to review the 4‐Ms, and creating age‐specific best practice alerts. Conclusions: The majority of healthcare providers were not satisfied with how their EHR handles multidisciplinary geriatric assessment and geriatric care. EHR modifications would aide in reporting, communicating, and tracking the 4‐Ms in EHRs. [ABSTRACT FROM AUTHOR]

HIV testing rates among US youth aged 13–24 years are sub-optimal, with high rates of missed testing opportunities in emergency departments (EDs). We assessed barriers to routine HIV testing of youth in urban ED settings from the perspective of healthcare providers. Ten physicians and nurses were recruited from the pediatric and adult EDs at a high-volume hospital in New York City, USA to complete in-depth interviews to provide their perspectives on barriers to routine HIV testing of youth ages 13 to 24 in EDs. Interviews were conducted using a semi-structured interview guide with questions and probes. All interviews were conducted via Zoom due to the COVID-19 pandemic and were audio-recorded and transcribed verbatim. Transcripts were coded independently by two researchers using an inductive thematic analysis approach. Participants often offered HIV testing to youth in the ED based on their perceptions of patients' HIV risk, with pediatric providers sometimes discouraging adolescents they perceived to be at low HIV risk from testing. Participants cited other priorities, logistics of blood-based testing, and discomfort discussing HIV as other reasons for not offering HIV testing to all youth in the ED. Efforts are needed to encourage providers to offer HIV testing to all youth regardless of perceived risk, as the ED often serves as youths' only point of contact with the healthcare system. Emphasis on this and the importance of early detection, along with institutional change, clear guidance, and support for the testing process may help increase youth testing and avoid missed HIV diagnosis opportunities. [ABSTRACT FROM AUTHOR]

This study surveyed a national sample of victim service professionals (N = 222) and compared rural versus urban/suburban participants' perceptions of a variety of issues, such as the impact of the pandemic on gender-based violence victimization and safety advice for isolated victims. Increased interference with victim employment and the abuser monitoring of online activities were reported by participants across all communities. However, urban/suburban participants rated the magnitude of all victim challenges as greater, while more rural participants noted child abuse as a particular problem in their communities. The results highlight the importance of community context for improving coordinated responses to gender-based violence (n = 101). [ABSTRACT FROM AUTHOR]

Patients with limited English proficiency receive worse care due to communication barriers. Little is known about which cancer hospitals have written language access policies addressing bilingual clinicians. We conducted a cross-sectional survey of healthcare organizations, matching survey data to American Hospital Association Survey and American Community Survey data. We analyzed characteristics associated with hospitals having bilingual clinician policies. The response rate was 71% (127/178). Many hospitals (53 [42%]) did not have written policies on bilingual clinicians. Having bilingual clinicians available at the hospital was associated with having a written policy on bilingual clinicians, while being an NCORP site was associated with not having a written policy on bilingual clinicians. Patient demographic characteristics were not associated with hospitals having written policies on bilingual clinicians. A substantial proportion of cancer hospitals do not have policies that cover language use by bilingual clinicians, particularly at NCORP sites. Having written policies on bilingual clinicians has the potential to mitigate cancer disparities by facilitating accountability, improving communication, and reducing errors. [ABSTRACT FROM AUTHOR]