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The burden of physical impairments and disabilities is growing across high-, middle-, and low-income countries, but populations across the globe continue to lack access to basic physical rehabilitation. Global shortages, uneven distributions, and insufficient skill mix of human resources for health and rehabilitation (HRH&R) contribute to such inequitable access. However, there are no international standards to classify HRH&R and to promote their global monitoring and development. In this article, we conceptually develop an international classification of HRH&R based on the concept of monitoring HRH&R through their stock of practices and competencies, and not simply counting rehabilitation professionals such as physical or occupational therapists. This concept accounts for the varying HRH&R configurations as well as the different training, competencies, or practice regulations across locations, even within the same profession. Our perspective specifically develops the concept of a proposed classification, its structure, and possible applications. Among the benefits, stakeholders using the classification would be able to: (1) collect locally valid and internationally comparable data on HRH&R; (2) account for the rehabilitation practices and competencies among nonspecialized rehabilitation workers (eg, in less resourced/specialized contexts); (3) track competency upgrades or practice extensions over time; (4) implement competency-based human resources management practices, such as linking remuneration to competency levels rather than to professional categories; and (5) inform the development of (inter-)professional education, practice regulation, or even task-shifting processes for the whole of HRH&R. The proposed classification standard, still in a concept-development stage, could help drive policies to achieve the "right" stock of HRH&R, in terms of practices and competencies. [ABSTRACT FROM AUTHOR]

Introduction: Public health programmes work to improve the health and well-being of communities by identifying the risks affecting people at different stages of life and finding best ways to minimize them. This article attempts to map the public health jobs available in India and contribute towards providing new insights in recruitment strategies for public health professionals (PHPs). Methods: A total of 427 public health jobs advertised in recruitment portals, newspapers and websites of organizations during 2012–2015 were analysed for title, qualification, location and job disciplines. Results: Higher qualification in public health and/or social sciences is much preferred followed by MBBS and management. The largest group of vacancies consisted of programme management responsibilities followed by profiles in RMNCH. Delhi, Orissa, Madhya Pradesh and Bihar had the highest number of jobs. Recommendations: A dedicated public health jobs web portal can be a rich resource for employers for easy access to profiles of PHPs. It will also give due emphasis to public health as a profession. Building a public health cadre in state health services shall be a desirable step to ensure creation of enough job opportunities. Conclusion: Research should be undertaken to understand the changing trends in public health employment. Such studies can be beneficial for public health workforce planning and monitoring. [ABSTRACT FROM AUTHOR]

Accompanying population ageing is an increase in the number of older Australians living with multiple health conditions and disabilities (Australian Institute of Health and Welfare 2014). This study sought to examine the barriers to accessing healthcare faced by older Australians. Utilising the 2014 Australian Bureau of Statistics General Social Survey, it was found that 6% of respondents aged 50 years and over reported experiencing a barrier to accessing healthcare within the previous 12 months. Those with multiple health conditions are at a considerably higher risk of experiencing a barrier to healthcare (21% with four or more disabilities) compared with people with no or fewer health conditions, and this risk persists once wide-ranging control variables are included. Long waiting times or unavailability of appointments (43%) were the main type of barriers to accessing healthcare, followed by cost (23%). Points-of-care barriers experienced included accessing GPs, specialists and hospital sector care. Respondents who experienced a barrier were more likely to have low levels of trust in the healthcare system compared with people who had no experience of barriers to healthcare, and were more likely to have a perception of experiencing discrimination or unfair treatment in a healthcare setting. [ABSTRACT FROM AUTHOR]

This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature - the Registered Medical Practitioner ( RMP) - who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India - one Sarah Pinto's, the other Ananya Roy's. [ABSTRACT FROM AUTHOR]

Aims: This study examined the validity of two methods of classifying binge drinkers. Methods: Adult drinkers (n = 166) completed the Alcohol Use Questionnaire (AUQ) and a Timeline Followback (TLFB) interview to characterize drinking during the past 28 days. Using Townshend and Duka’s (2005) recommendations, answers on three AUQ items (average drinks per hour, number of times drunk within the prior 6 months and percentage of times drunk when drinking) were used to derive a binge score that was then used to classify drinkers as Binge, Non-Binge and Unclassifiable. Two methods for calculating binge scores were compared: (a) Participant-derived, using participants’ answers on the 3 AUQ items; and (b) Staff-derived, staff used TLFB interview information to answer the 3 AUQ items. Additionally, Participant- and Staff-derived classifications were used to predict future drinking behaviors assessed by a second TLFB interview. Results: Participant- and Staff-derived binge scores had a low concordance rate. Staff-derived classifications were better than Participant-derived classifications at predicting future binge drinking behavior and identifying group differences in drinking behavior reported during the second TLFB interview(average drinks per hour, number of times drunk within the prior 6 months, and percentage of times drunk when drinking). Conclusions: Classifying drinkers using staff-guided TLFB interview methods instead of self-reported participant generalizations of typical drinking habits better relates to real-world drinking. Classification schemes that rely on dichotomous categorization of drinkers (Binge vs. Non-Binge) may be missing individuals who engage in harmful patterns of drinking. A continuous scale or index characterizing problematic drinking may be more useful. [ABSTRACT FROM AUTHOR]

Several interventions aimed at increasing positive attitudes towards older adults among health-care professionals have been introduced. These interventions tend to focus on a small subset of clinical employees, ignoring other clinical and nonclinical hospital staff. The objective of this study was to evaluate the efficacy of a short aging simulation workshop toward increasing positive attitudes towards older adults among a multidisciplinary group of workshop participants using a pre/post quasiexperimental design. Four hundred seventy six new employees of the Department of Veterans Affairs completed the Kogan's Attitudes Toward Old People Scale (KOP) immediately before and after participating in a short aging simulation workshop. Significant pre- to-posttest increases in KOP scores were identified for nurses, physicians, psychologists, other clinical employees, and nonclinical employees, but not among medical support assistants, nurse assistants, and social workers. There existed no significant differences between each group's pretest scores; however, staff of higher educational achievement had significantly higher posttest scores as compared to persons of lower educational status. This short aging simulation workshop was successful in increasing positive attitudes towards older adults among staff who had higher educational achievement. [ABSTRACT FROM AUTHOR]

Background The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins. Methods We report on an interventionist video-reflexive ethnographic (VRE) study that explored how clinicians used the built environment to achieve safe communication in an intensive care unit (ICU) in a metropolitan Sydney hospital. We conducted 40 semistructured interviews, 5 weeks of observation and four reflexive focus groups with a total of 87 participants (including medical, nursing, allied health and clerical staff ). Results We found that the accessibility of staff and patients in the open spaces of the ICU was both a safety feature and a safety risk, enabling safe communication flow, but also allowing potentially unsafe interruptions. Staff managed interruptions while allowing for a safe degree of accessibility by creating temporary protected spaces, using physical markers such as curtains, tape and signs as well as behavioural cues, movement and the development of policies restricting activities at certain areas. Furthermore, clinicians were able to use the VRE method to gain insight into their own practices and problems, and to develop meaningful solutions for other problematic spaces. Conclusions ICU staff enable safe communication in their wards by creating temporary spaces that are both 'connected' and 'protected'. The flexibility of these 'soft' strategies is especially well suited to the fast-paced clinical context of intensive care. [ABSTRACT FROM AUTHOR]

The article presents a study on health care waste management of a private hospital and social care organizations in Great Britain. Topics discussed include the emergence of domestic waste bin as the most commonly used by employees to dispose of waste, significant different between the four health and social care sites used in the study, and the need to focus the transfer of waste from the domestic waste stream to the recycling waste stream.

The authors discuss a study by M. Raffoul and colleagues, published within the issue, which examined who cares for midlife women who seek office-based care. Topics include the proportion of mildlife women who receive primary care from obstetrician/gynecologists or both obstetrician/gynecologists and family medicine/internal medicine, the importance of understanding which professionals provide primary care for women, and the effect of the differences in state licensure for healthcare providers.

Aim: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. Methods: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. Results: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). Conclusions: This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions. [ABSTRACT FROM AUTHOR]

Purpose: The authors sought to investigate the influence of a comprehensive range of factors on the decision making of caregivers of children with hearing loss regarding the use of speech, the use of sign, spoken language multilingualism, and spoken language choice. This is a companion article to the qualitative investigation described in Crowe, Fordham, McLeod, and Ching (2014). Method: Through a questionnaire, 177 caregivers of 157 Australian children with hearing loss (ages 3;5 to 9;4 [years;months], Mage = 6;6) rated the importance of a range of potential influences on their decision making regarding their children's communication. The majority of children were reported to use speech (96.6%) as part or all of their communication system, with fewer children reported to use sign (20.9%). Few children used more than one spoken language (8.3%). Results: Proportional analyses and exploratory factor analyses were conducted. Overall, caregivers' decisions were influenced by their children's audiological and intervention characteristics, communication with those around them, community participation, access to intervention and education services in English, and concerns about their children's future lives. The advice of speech-language pathologists, audiologists, and specialist teachers was more important to caregivers than advice from medical practitioners and nonprofessionals. Conclusion: Caregivers' decision making regarding communication mode and language use is influenced by factors that are not equally weighted and that relate to child, family, community, and advice from others. Knowledge of these factors can assist professionals in supporting caregivers making choices regarding communication. [ABSTRACT FROM AUTHOR]

There are few evaluated economic tools to assess change in autism. This study examined the inter-rater reliability of the Developmental Disabilities Children's Global Assessment Scale (DD-CGAS), and the OSU Autism Clinical Global Impression (OSU Autism CGI) in a European setting. Using these scales, 16 clinicians with multidisciplinary background and varying experience independently rated eight vignettes of autism spectrum disorder for severity and general psychosocial functioning at referral and discharge. Intraclass correlation coefficient ( ICCs) for experienced clinicians were .75 for the DD-CGAS and .72 for the OSU Autism CGI. In inexperienced clinicians these ICCs were .58 and .59. Results confirm previous North American studies, and further extents the reliability of the instruments to untrained, less experienced clinicians with different professions. [ABSTRACT FROM AUTHOR]

Background: Decision makers in hospitals are regularly faced with choices about the adoption of new technologies. Wrong decisions lead to a waste of resources and can have serious effects on the patients’ and hospital’s well-being. Purpose: The goal of this research was to contribute to the understanding of decision making in hospitals. This study produced insights regarding relevant decision criteria and explored their specific relevance. Methodology/Approach: An initial empirical survey was used to collect the relevant criteria for technological decision making in hospitals. In total, 220 experts in the field of health technology assessment from 34 countries participated in the survey. As a second step, the abovementioned criteria were used to form the basis of an analytic hierarchy process model. A group of 115 physicians, medical technical assistants, and other staff, all of whom worked in the field of radiooncology, prioritized the criteria. An analysis of variance was performed to explore differences among groups in terms of institutional and personal categorization variables. Findings: The first part of the research revealed seven key criteria for technological decision making in hospitals. The analytic hierarchy process model revealed that organizational impact was the most important criterion, followed by budget impact. The analysis of variance indicated that there were differences in the perceptions of the importance of the identified criteria. Practical Implications: This exploration of the criteria for technological decision making in hospitals will help decision makers consider all of the relevant aspects, leading to more structured and rational decisions. For the optimal resource allocation, all of the relevant stakeholder perspectives and local issues must be considered appropriately. [ABSTRACT FROM AUTHOR]

Background: Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. Purpose: The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. Methodology: The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. [ABSTRACT FROM AUTHOR]

In Fiji, the government has recognised the importance of services for people with communication disability (PWCD); however, the need for services still exceeds supply, and it is unclear who is providing services to this population. It has been suggested that agents of delivery of intervention can comprise seven groups: qualified speech-language pathologists (SLPs), mid-tier workers, already qualified professionals trained for an additional new role, disability care workers, traditional healers and other professionals or family members guided by SLPs. In this paper, the role of each of these groups in the provision of services to PWCD in Fiji was reviewed. Results revealed that qualified SLP services in Fiji are restricted to those provided by international volunteer programs. Numerous other agents of delivery of intervention are available; however, their skill base and intervention methods remain largely unknown. There is a need to identify the skills and practices of non-SLP agents and to consider the potential for future direct SLP input, to ensure timely and adequate services are available to people with communication disability in Fiji. [ABSTRACT FROM AUTHOR]

Objective The goal of this study was to identify barriers and facilitators to the optimal management of critically ill children who present initially to community hospitals and how best to support the needs of front-line healthcare providers in these settings prior to transfer to the regional academic paediatric health sciences centre. Methods A qualitative needs assessment was performed in five community hospitals targeting healthcare providers in leadership and front-line roles who could discuss their experiences of managing critically ill children that had presented to their institutions. Focused individual and focus group interviews of physicians, nurses and respiratory therapists from the participating hospitals were conducted and analysed to identify common themes. Results Five community hospitals participated in the study with a total of 57 participants and included 36 registered nurses, 4 respiratory therapists, 13 community hospital physicians and 4 paediatric intensive care specialists. Most participants did not report seeing more than one critically ill child per month. The management of very young paediatric patients was reported as a greater source of anxiety than patients presenting in cardiac arrest and despite being more frequently reported, respiratory conditions were identified as the most anxiety provoking and having the greatest educational need. The care required for a single critically ill child was often reported to render the emergency department staff incapable of meeting other patient care needs and was influenced by staffing resources, physical layout and access to proper equipment. Increased comfort and management ability was attributed to previous real-world experience and support from content experts in dealing with acutely ill children. Participants did not use web-based best practice guidelines. Conclusions This study identifies the need to fully understand the management realities of front-line caregivers of critically ill children in community hospital settings. We demonstrate the need to focus on the management of younger paediatric patients, technical skills development, practice of acute situations with less than optimal staffing resources, and access to facilitated real-world experiences with appropriate supervision and mentoring. Passive interventions such as web-based guidelines should not be used in isolation but as a support to ongoing exposure and engagement by content experts. [ABSTRACT FROM AUTHOR]

Integrated behavioral health and primary care is emerging as a superior means by which to address the needs of the whole person, but we know neither the extent nor the distribution of integration. Using the Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System (NPPES) Downloadable File, this study reports where colocation exists for (a) primary care providers and any behavioral health provider and (b) primary care providers and psychologists specifically. The NPPES database offers new insights into where opportunities are limited for integration due to workforce shortages or non- proximity of providers and where possibilities exist for colocation, a prerequisite for integration. [ABSTRACT FROM AUTHOR]

Early intervention (EI) has been characterized by considerable advances in its domain, which has had great repercussions in the implementation of the family-centered approach. These changes have had implications in the practices and in the adoption and learning of new values that should be implemented in EI. This study evaluates the professional perspectives regarding family-centered practices in EI programs in Portugal. The results highlight the importance of effective collaboration and coordination between health, education, and social services and the importance of providing child and family support in a natural context. These results reinforce the need to invest in professional training to improve the quality of services offered to families in EI. [ABSTRACT FROM AUTHOR]

Background Obesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments in new capacity allowing the service to improve patient experience and meet future anticipated demand. Methods We developed computer models of patient flows in an obesity service in an Academic Health Science Centre that provides lifestyle, pharmacotherapy and surgery treatment options for the UK's National Health Service. Using these models we experiment with different scenarios to investigate the likely impact of alternative resource configurations on patient waiting times. Results Simulation results show that the timing and combination of adding extra resources (eg, surgeons and physicians) to the service are important. For example, increasing the capacity of the pharmacotherapy clinics equivalent to adding one physician reduced the relevant waiting list size and waiting times, but it then led to increased waiting times for surgical patients. Better service levels were achieved when the service operates with the resource capacity of two physicians and three surgeons. The results obtained from this study had an impact on the planning and organisation of the obesity service. Conclusions Resource configuration combined with demand management (reduction in referral rates) along the care service can help improve patient waiting time targets for obesity services, such as the 18 week target of UK's National Health Service. The use of simulation models can help stakeholders understand the interconnectedness of the multiple microsystems (eg, clinics) comprising a complex clinical service for the same patient population, therefore, making stakeholders aware of the likely impact of resourcing decisions on the different microsystems. [ABSTRACT FROM AUTHOR]

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% ( n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses ( Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues. [ABSTRACT FROM AUTHOR]

Parents of children with autism spectrum disorders (ASD) use a wide range of interventions including poorly evidenced dietary interventions. To investigate parents' and professionals' experience of dietary interventions and attitudes towards a proposed trial to evaluate the gluten free casein free diet (GFCFD). Survey of UK parents of children with ASD, and professionals. 258 parents and 244 professionals participated. 83 % of children had received a range of dietary manipulations; three quarters of professionals have been asked for advice about GFCFD. Respondents identified an inadequate evidence base for dietary interventions in ASD and suggested modifications to a proposed trial design. Both parents and professionals supported the need for further evaluation of dietary interventions in ASD. [ABSTRACT FROM AUTHOR]

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field. [ABSTRACT FROM AUTHOR]

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This qualitative study explored individuals' preferences regarding the provision of nutrition care from Australian health professionals and the factors influencing their preferences. Thirty-eight individuals aged 53 ± 8 years, living with a lifestyle-related chronic disease or risk factor for lifestyle-related chronic disease, participated in a semi-structured telephone interview. Participants were asked questions regarding their perceptions of which Australian health professionals provide nutrition care, their preferences for this care and the factors influencing their preferences. Interviews were transcribed verbatim and analysed thematically using a constant-comparison approach. General practitioners were the most recognised health professional that provided nutrition care to patients, followed by dietitians. General practitioners were regarded by most participants as the preferred provider of nutrition care because they were perceived to provide trustworthy and personalised nutrition care. Participants reported confusion regarding the professional differences between dietitians and nutritionists, and appealed for more information to be available to individuals that are considering consulting an Australian health professional for nutrition care. The findings of this study suggest that general practitioners are the preferred providers of nutrition care for many individuals living with a lifestyle-related chronic disease. Considering the increasing presentation of patients with lifestyle-related chronic disease in general practice, it is anticipated that the demand on general practitioners to provide nutrition care to patients will increase in the future. [ABSTRACT FROM AUTHOR]

Health care professional (HCP) attitudes towards suicide prevention vary with their training and could influence assessment and management of suicidal patients. We aimed to examine attitudes towards suicide and health care interventions to prevent suicide in mental health and other health care professionals. The sample was obtained from two separate study cohorts: 1) a controlled psychological autopsy study of suicide (n = 301), with HCP interviewed by telephone or face-to-face in Queensland and New South Wales, Australia, and 2) an anonymous online survey (n = 61) by email invitation to mental health service clinicians and general practitioners (GP) in eastern Sydney. Attitudes towards suicide and suicide prevention were measured by a 14- item survey. The sample of HCP included GPs (n = 172), psychiatrists and trainee psychiatrists (n = 67), mental health nurses (n = 36), psychologists (n = 28), medical specialists (n = 26), and other health professionals, including counsellors, social workers, allied health professionals, general nurses and dentists (n = 33). The majority were male (66.3%), were in private practice (62.2%) and had experienced a suicide in their practice (84.0%). Medical specialists had significantly more negative attitudes towards suicide prevention than the other HCP groups. Mental health professionals had more positive attitudes towards suicide prevention and felt more competent about identifying and managing suicidal patients than other HCPs. Psychiatrists had more positive attitudes than mental health nurses. Attitudes towards suicide prevention interventions vary significantly between HCP occupational groups, and this has the potential to affect the assessment and management of suicidal individuals. [ABSTRACT FROM AUTHOR]

Objective. The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning. Methods. An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners' website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression. Results. Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P < 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance. Conclusions. Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group. [ABSTRACT FROM AUTHOR]

Introduction. This report describes the extent to which 12 workplace aggression prevention and minimisation actions have been implemented in Australian clinical medical practice settings. Methods. Using a cross-sectional, self-report survey conducted as part of a national longitudinal study of the Australian medical workforce, differences in the proportions of medical clinicians reporting the implementation of 12 aggression prevention and minimisation actions in their main workplace were determined. Results. Only one-third of aggression prevention and minimisation actions achieved point-prevalence rates of greater than 60%, including aggression policies and protocols (65.7%) and incident reporting systems (68.2%). Overall, lower point-prevalence rates were detected for general practitioners and specialists compared with hospital non-specialists and specialists in training, largely reflecting those for doctors mainly working in private rooms compared with public hospitals. Key environmental interventions had relatively low point-prevalence overall, including duress alarms and optimised clinician escape in consulting and treatment areas, and after-hours and off-site safety strategies. Conclusions. More widespread adoption of aggression prevention and minimisation measures in medical practice settings is required. Specific legislative and accreditation provisions and funding support may provide the necessary impetus for reform. Further studies can enhance the evidence base on the most effective approaches to the prevention and minimisation of workplace aggression in medical practice settings. [ABSTRACT FROM AUTHOR]

The purposes of this study were to compare music therapy salary data with those of related helping professions in 2011 and descriptively analyze music therapy salary data from 1998-2012. To compare music therapy salaries with other helping professionals' salaries, a database was constructed utilizing data from the United States Department of Labor website. Music therapy salary data were obtained from the 1998-2012 American Music Therapy Association Descriptive Statistical Profiles. Results indicated that although music therapists tended to have higher mean salaries than recreational therapists, their salaries were lower than those of other comparison professions. From 1998-2011, music therapists' salaries increased by an overall mean of $16,440. Concerning music therapists' age categories, their salaries tended to increase in accordance with the number of years in the profession. Music therapists working with older adults tended to have lower salaries. Limitations and suggestions for future inquiry are provided. [ABSTRACT FROM AUTHOR]

While current research on the factors affecting the HIV epidemic within the general population has considered the role of HIV case managers, much remains to be known about case management effectiveness and how it might be enhanced. This article presents the data from a statewide survey of case management professionals in Florida. The study focused on case managers' preparation for practice and barriers to successful practice. The study results reflect a very broad educational preparation in multiple disciplines with highly varied means of case manager training and orientation at entry to practice. Further, the results highlighted the existence of multiple barriers that challenge the ability of case managers to cope with the demands of case management practice in sites serving people living with HIV/AIDS who are socially and economically challenged. The article concludes with recommendations for changes in the system that would enhance the preparation of case management professionals for entry to practice. [ABSTRACT FROM AUTHOR]

Objective: The Malaysian Clinical Practice Guidelines (CPG) for Management of Dementia (second edition) was launched in April 2010 by the Ministry of Health Malaysia. A training programme for the management of dementia, involving all categories of staff working at primary and secondary centres, was implemented to ensure that care delivery for people with dementia was in accordance with the guidelines. The study aimed to look into improving knowledge and understanding of dementia following training, and to evaluate the effectiveness of the training programme using a clinical audit indicator recommended in the guidelines. Methods: The study entailed 2 phases (at national and state levels). The first phase involved the CPG training programme run as a 1.5-day workshop, in which participants filled up pre- and post-workshop questionnaires. A second phase involved analysing all the referral letters to the memory clinic at the Hospital Sultan Ismail, Johor Bahru 1 year before and after the training programme. Results: There was a significant improvement in knowledge about dementia and its management among the health care professionals following training. The mean percentage score for the pre-workshop test was 63% while for the post-workshop test it was 78%, giving a difference of 15%. Although there was an overall improvement in knowledge gain following training in both specialist and non-specialist groups, these differences were not statistically significant (t = 1.32; 95% confidence interval, -2.61 to 9.61; p = 0.25). The proportion of referrals with a possible diagnosis of dementia from primary clinic referrals to the memory clinic also increased from 18% to 44% after training. Conclusion: There was an overall improvement in the knowledge about dementia among the health care professionals following the training, which was reflected in the increase in referrals to the memory clinic. Although the initial results appeared to be promising, a multicentre study is warranted to conclude that the training had been effective. [ABSTRACT FROM AUTHOR]

It is observed that in India there is a wide gap between health care service output and the health care expenditure. In 2004–05 health care expenditure was 4.25 per cent of the GDP whereas the output, measured in terms of GDP was 1.8 per cent of the total GDP. This poor inefficient performance might be a misleading picture due to the application of improper estimation methods. As a major part of the health care services in India is delivered by the private sector (consisting of private organized and private unorganized segments), serious attention is required for the method of estimation of private health care service output. For both the private organized and the private unorganized part, GDP is estimated through the Labour Input Method (LIM). In LIM the implicit assumption is that each worker contributes the same value addition to private Health Care Services. This implies that all categories of workers (from physicians to sweepers) are equally accountable in providing health care services irrespective of the skill and occupational heterogeneity, which is unrealistic. The present study is an endeavour to improve the existing method of GDP estimation of private health care services in India by giving proper weight to labour input according to their service accountability. [ABSTRACT FROM PUBLISHER]

Background A trial of a new model of triage (Specific and Timely Appointments for Triage: STAT) at a community rehabilitation program (CRP) reduced the mean time to first appointment from 17.5 to 10.0 days. However, quantitative findings reveal little about the impact of the system on those who used it. We aimed to explore the experiences of patients and clinicians following the introduction of STAT. Method Qualitative study within a convergent mixed-methods design applied to a controlled before and after trial at a CRP. Semi-structured interviews (n = 32) were conducted with clinicians who experienced the change to STAT, patients admitted to the CRP using STAT and patients who attended rehabilitation via a triaged wait list at another site. Results Clinicians reported shorter waiting times, more flexibility and increased efficiency with STAT, and noted the importance of effective change management. Patients reported a more efficient and consistent pathway to rehabilitation with STAT. Waiting had negative consequences for some patients at the triaged wait list site. Conclusions The qualitative data provide context to the quantitative results by showing that the changes that reduced waiting times were also well accepted and perceived to be beneficial by both patients and clinicians. What is known about the topic? Triage systems are widely used but can contribute to inefficiencies in health care. An alternative method of triage (STAT) using early allocation to face-to-face appointments has been shown to reduce waiting times in a community rehabilitation service. What does this paper add? This paper explains and adds important context to the quantitative findings by exploring the perceptions of the staff and patients who experienced both the existing and alternative models of triage. What are the implications for practitioners? The STAT model was well received by staff and patients, suggesting that this simple intervention was a feasible and effective method of reducing waiting times for community rehabilitation, and may be applicable to other services that share similar features. [ABSTRACT FROM AUTHOR]

The article offers information on auditory processing (AP) and (central) auditory processing (CAP), which refers to the processing of auditory stimuli. There are a myriad of definitions of these terms varying from the long list of skills, and addition of disorder (D) to the end of each of these terms indicates "the disorder" that interferes with "the processing."

This article attempts to answer the obvious question of who are the people that can be included in the definition of Human Resources for Health and what might they be called. To answer the question an extensive search of literature was conducted. The search was aimed at identifying the nomenclature and classifications of human resources for health.The search resulted in a variety of nomenclature and a large number of classification frameworks which were then narrowed down to seven frameworks. It was found that there is a lot of overlap in the definitions used for various nomenclatures. The terms ‘health workers’ and ‘public health workers’ are a major area of disagreement and confusion. The classifications also indicated a lot of difference of opinions on who should be included in the various categories suggested in the different classifications. However, almost all these classifications identify at least three major categories of health workers; the specialist health workers, the specialist public health workers and the health management/support workers.The article points out an important area which is generally neglected in the human resource policy making. An attention to better classification can have a tremendous impact on human resource planning and monitoring. [ABSTRACT FROM PUBLISHER]

Objectives. Emergency response involving mass vaccination requires the involvement of traditional vaccine providers as well as other health-care providers, including pharmacists, obstetricians, and health-care providers at correctional facilities. We explored differences in provider experiences administering pandemic vaccine during a public health emergency. Methods. We conducted a cross-sectional survey of H1N1 vaccine providers in Washington State, examining topics regarding pandemic vaccine administration, participation in preparedness activities, and communication with public health agencies. We also examined differences among provider types in responses received (n =619, 80.9% response rate). Results. Compared with other types of vaccine providers (e.g., family practitioners, obstetricians, and specialists), pharmacists reported higher patient volumes as well as higher patient-to-practitioner ratios, indicating a broad capacity for community reach. Pharmacists and correctional health-care providers reported lower staff coverage with seasonal and H1N1 vaccines. Compared with other vaccine providers, pharmacists were also more likely to report relying on public health information from federal sources. They were less likely to report relying on local health departments (LHDs) for pandemic-related information, but indicated a desire to be included in LHD communications and plans. While all provider types indicated a high willingness to respond to a public health emergency, pharmacists were less likely to have participated in training, actual emergency response, or surge capacity initiatives. No obstetricians reported participating in surge capacity initiatives. Conclusions. Results from this survey suggest that efforts to increase communication and interaction between public health agencies and pharmacy, obstetric, and correctional health-care vaccine providers may improve future preparedness and emergency response capability and reach. [ABSTRACT FROM AUTHOR]

Background: Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain. We aim to understand ICU staff perspectives on collaborative QI based on involvement in a multiorganisational improvement network and hypothesise about theoretical constructs that might explain the effect of collaboration in such networks. Methods: Qualitative study using a modified grounded theory approach. Key informant interviews were conducted with staff from 12 community hospital ICUs that participated in a cluster randomized control trial (RCT) of a QI intervention using a collaborative approach between 2006 and 2008. Data analysis followed the standard procedure for grounded theory using constant comparative methodology. Results: The collaborative network was perceived to promote increased intrateam cooperation over interorganisational cooperation, but friendly competition with other ICUs appeared to be a prominent driver of behaviour change. Bedsides, clinicians reported that belonging to a collaborative network provided recognition for the high-quality patient care that they already provided. However, the existing communication structure was perceived to be ineffective for staff engagement since it was based on a hierarchical approach to knowledge transfer and project awareness. Conclusions: QI collaborative networks may promote behaviour change by improving intrateam communication, fostering competition with other institutions, and increasing recognition for providing high-quality care. Other commonly held assumptions about their potential impact, for instance, increasing interorganisational legitimisation, communication and collaboration, may be less important. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the perspectives on the options for the integration of western and traditional Korean medical services among three types of medical doctors with different disciplines in Korea. We surveyed and analyzed responses from 167 conventional Western medicine (WM), 135 traditional Korean medicine (KM), and 103 dual-licensed (DL) doctors who can practice both. All three kinds of doctors shared similar attitude toward license unitarization. KM doctors most strongly agreed on the need of the cooperative practice (CP) between KM and WM and on the possibility of license unitarization among three groups. DL doctors believed that CP is currently impracticable and copractice is more efficient than CR WM doctors presented the lowest agreement on the need of CP and showed lower expectation for DL doctors as mediators between WM and KM than others. This study showed the difference of perspectives on the options for the integrative medical services among three different doctor groups in Korea. More studies are required to explore the underlying reasons for these discrepancies among WM, KM, and DL doctors. [ABSTRACT FROM AUTHOR]

Background: Stress is one of the most common problems; one manifestation of stress is burnout. Burnout and other stress-related illnesses among medical professionals are receiving increased attention and have been described in many branches of medical practice including dentists, nurses, etc., The purpose of this study was to measure the prevalence of stress and burnout in medical professionals in Rajasthan. Materials and Methods: The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) and a demographic questionnaire of our own design were sent to 1,735 medical professional of various branches and different location throughout the state of Rajasthan. In response to that, 627 (36%) surveys were returned, of which 576 (92%) were found complete for analysis so later group constitute as sample for analysis. Result: 29.16% of medical professional showed high level of emotional exhaustion (EE), 20% showed high level of depersonalization (DP), and 17.9% showed low personal accomplishment (PA). Young professionals showed more sensitivity towards burnout (r = -0.122, P < 0.003). Females were more prone to burnout (40%) as compared to males (27%). Conclusion: Burnout is an important problem in medical professionals in Rajasthan. Difference in approach to work and perceived environment at workplace, unrewarding career, unsupported behavior of peer group, balance between work and family needs appear to be important factors in burnout. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to determine the association between practice member perceptions of relational coordination and reciprocal learning with the presence of Chronic Care Model(CCM) elements in community-based primary care practices. Strategies to strengthen relational coordination and reciprocal learning among team members should be incorporated while implementing complex models of care.

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This research attempted to explore the public healthcare providers understanding the quality dimensions and patient priorities in Oman. It also addresses the issue of risks confronting health professionals in management without "a customer focused" approach. Methods: A descriptive study was carried out using a self-administered questionnaire distributed around two tertiary public hospitals. A total of 838 respondents from several specialties and levels of hierarchy participated in the study. The data was analyzed to compare the perception of two groups; the group of junior and frontline staff, as well as of managers and senior staff involved in management. Results: The results showed that 61% of the junior and frontline staff, and 68.3% of the senior staff and managers think that cure or improvement in overall health is the single most important quality dimension in healthcare. Both groups perceive that technical dimensions have greater importance (to patients) over interpersonal aspects such as communication with the exception of dignity and respect. There was no significant difference between the perception of the managers and senior staff vis-à-vis the perception of junior and frontline staff on the importance of technical dimensions and the interpersonal aspects of service quality. Despite the proven contribution of empathy to patient satisfaction, it was ranked by both groups as the least important among the dimensions examined. Conclusion: The findings of this research are therefore informative of the need to implement strategies that deal effectively with such attitudes and create the platform and programs that reinforce the culture of good quality service amongst healthcare providers, managers in particular, and to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

During a time of budget cuts around the world, Singapore has instead taken steps to raise the status of social workers. This article analyzes the experiences of social service agencies in implementing salary revisions and the challenges faced in light of the funding structure of social services. Based on focus group discussions and interviews with 17 field experts, and anchored in economic theory, the findings suggest a well-resourced and well-organized sector that has kept social work salaries on par with other professions. Challenges remain in expanding the manpower pool, distributing resources to different types of social workers, and addressing issues related to program-based funding. [ABSTRACT FROM AUTHOR]

Copyright of Polish Nursing / Pielegniarstwo Polskie is the property of Poznan University of Medical Sciences Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Barriers to providing quality end-of-life (EOL) care in the intensive care unit (ICU) are common, but little is known about how these barriers vary by level of training or discipline. Methods: Medical residents and ICU fellows, attendings, and nurses at two teaching hospitals were surveyed about barriers to EOL care in the ICU. The survey consisted of questions about possible barriers in four domains: patient-family factors, clinician factors, institutional factors, and education-training factors. Results: There were significant differences in reported barriers to EOL care by level of training, discipline, and institution, particularly in the education-training domain. Insufficient resident training in EOL care was reported as a large or huge barrier by a smaller proportion of residents (20%) than attendings (62%), fellows (55%) or nurses (36%) ( p=0.001). Nurses' perceptions of barriers to EOL care varied between institutions. Barriers that varied significantly between nurses included difficulty communicating due to language ( p=0.008), and inadequate training in recognition of pain and anxiety ( p=0.001). Conclusions: We found that perceived barriers to EOL care differed significantly by level of training, discipline and institution, suggesting the interventions to improve EOL care may need to be locally targeted and specific to level of training and discipline. [ABSTRACT FROM AUTHOR]

Objectives: Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need. Methods: Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey. Results: Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement).Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times. Conclusion: Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use. [ABSTRACT FROM AUTHOR]

The article describes a pilot test on the Structured Problem and Success Inventory (SPI) instrument, aimed at collecting individual perceptions of workers in health care organizations, on their organizational and work-related problems. The study showed that the SPI is a promising tool for health care organizations to collect these work-related perceptions from different organizational levels, and that there are varying and similar perceptions among levels.

This study was concerned with indentifying reasons behind patterns of social media (Web 2.0) usage associated with eight of Australia's major health professions. Attention was given to uncovering some of the more significant motivations for the resistance or adoption of Web 2.0 technologies for health care delivery and practice promotion by Australian health professionals. Surveys were developed from a common set of questions with specific variations between professions negotiated with professional health societies. Survey questions were constructed in an attempt to identify Web 2.0 adoption trends. An online survey (www.limesurvey.org) was used to collect data. Initial data preparation involved the development of one integrated SPSS file to incorporate all responses from the eight surveys undertaken. Initial data analysis applied Frequencies and Crosstabs to the identified groups and provided a profile of respondents by key business and demographic characteristics. Of the 935 respondents, 9.5% of participants indicated that they used Web 2.0 for their professional work, 19.1% of them did not use it for work but used it for their personal needs and 71.3% of them did not use Web 2.0 at all. Participants have indicated that the main reason for 'choosing not to adopt' Web 2.0 applications as a way of delivering health care to their patients is due to the health professionals' lack of understanding of Web 2.0 (83.3%), while the main reason for 'choosing to adopt' Web 2.0 applications is the perception of Web 2.0 as a quick and effective method of communication (73.0%). This study has indicated that Australian health professionals 'choose not to adopt' Web 2.0 usage as a way of delivering health care primarily due to 'a lack of understanding as to how social media would be used in health care' (83.3%). This study identifies that Australian health professionals are interacting with Web 2.0 technologies in their private lives but are failing to see how such technologies might be used throughout their professions. Australian health professionals are willing to undertake online educational courses (n = 553, 58%) designed to upskill them about how Web 2.0 may be used for practice promotion and health care delivery. [ABSTRACT FROM AUTHOR]

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). he 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d. = 4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice. [ABSTRACT FROM AUTHOR]

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce. Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level. This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform. [ABSTRACT FROM AUTHOR]

Introduction: Family (i.e., unpaid) caregiving has long been thought of as a 'woman's issue', which ultimately results not only in gendered, but also financial and health inequities. Because of this, gender-based analyses have been prioritized in caregiving research. However, trends in current feminist scholarship demonstrate that gender intersects with other axes of difference, such as culture, socio-economic status, and geography to create diverse experiences. In this analysis we examine how formal front-line palliative care providers understand the role of such diversities in shaping Canadian family caregivers' experiences of end-of-life care. In doing so we consider the implications of these findings for a social benefit program aimed at supporting family caregivers, namely the Compassionate Care Benefit (CCB). Methods: This analysis contributes to a utilization-focused evaluation of Canada's CCB, a social program that provides job security and limited income assistance to Canadian family caregivers who take a temporary leave from employment to provide care for a dying family member at end-of-life. Fifty semi-structured phone interviews with front-line palliative care providers from across Canada were conducted and thematic diversity analysis of the transcripts ensued. Results: Findings reveal that experiences of caregiving are not homogenous and access to services and supports are not universal across Canada. Five axes of difference were commonly raised by front-line palliative care providers when discussing important differences in family caregivers' experiences: culture, gender, geography, lifecourse stage, and material resources. Our findings reveal inequities with regard to accessing needed caregiver services and resources, including the CCB, based on these axes of difference. Conclusions: We contend that without considering diversity, patterns in vulnerability and inequity are overlooked, and thus continually reinforced in health policy. Based on our findings, we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities and inequities while identifying implications for the CCB program as it is currently administered. From a policy perspective, this analysis demonstrates why diversity needs to be acknowledged in policy circles, including in relation to the CCB, and seeks to counteract single dimensional approaches for understanding caregiver needs at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance evaluative health policy research. [ABSTRACT FROM AUTHOR]