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The management and delivery of bereavement care and support services present practical challenges. A national-level, qualitative study was conducted to examine the current practices in Singapore. The study's purpose was to inform bereavement care practices by drawing from perspectives of service providers offering death, dying and bereavement-related services. This qualitative study was undertaken using focused group discussion (FGD) with service providers from the health, social and death-related sectors. Ten FGDs were conducted with a total of 69 participants. Thematic analysis yield two themes – identifying challenging circumstances to provide bereavement care and strategies for dealing with the gaps in service delivery. The service providers' experiential knowledge could be borrowed to strengthen the current bereavement care practices for the good of the community. The findings have informed the reconceptualization of a local bereavement care and support service model, with the public health model as the recommended underpinning conceptual framework. [ABSTRACT FROM AUTHOR]

The evaluation of the Road Home (RH) program has revealed many learnings of interest to practitioners, researchers and evaluators. The focus of this analysis is twofold - on an innovative approach to building an evidence base using a developmental evaluation and action learning design and how research knowledge and skills can be applied in practitioner contexts and be robust, rigorous and above all useful. It particularly features the role of reflective practice, an affordable, underutilised and easy to access evaluation and program improvement method for practitioners working with evaluators and researchers. Appreciating what is involved in approaching evaluation and other forms of organisational research in this way is important if industry collaborations and innovations that bring theory to practice and practice to theory are to be successful.

The purpose of this nonrandomized study was to compare several attributes of hereditary cancer risk assessment using a collaborative model of service delivery. Arm 1 included patients seen in‐person by a board‐certified genetic counselor (CGC), Arm 2 included high‐complexity triaged patients from distant sites who received telegenetics with a CGC, and Arm 3 included low‐complexity triaged patients from distant sites who had in‐person risk assessment with a locally placed genetic counselor extender (GCE). A total of 152 patients consented and 98 had complete data available for analysis (35 in Arm 1, 33 in Arm 2, and 30 in Arm 3). The three groups were comparable in age, ethnicity, education, employment, and cancer status. There was no significant difference in median wait time or distance traveled to receive care across all three arms. However, if patients in Arms 2 and 3 had to access the CGC in‐person, they would have had to travel significantly further (p < 0.0001). The time spent in a session was significantly longer in Arm 3 with a GCE than with a CGC in‐person or by telegenetics (p < 0.01). There was no difference in the number of essential elements covered in the appointment, change in cancer worry, or appointment satisfaction across all three arms, although the sample size was small. Employing a collaborative model of service delivery with GCEs and telegenetics is feasible, satisfactory to patients and reduces the distance patients travel to access hereditary cancer genetic services. [ABSTRACT FROM AUTHOR]

Interdisciplinary collaboration between health and education professionals is one of the principles of inclusive education. This study aimed to describe the practices and service delivery by pediatric occupational therapists (OTs) in schools in Spain. Data came from a convenience sample of pediatric OTs recruited through Spanish professional colleges and associations for a web-based survey, mixed-method research study. Thirty-five respondents were excluded because they didn't meet the eligibility criteria. Ninety-two responses were obtained for data analysis. Twenty-nine OTs (31.5%) work in schools (school-OTs), and sixty-three participants (68.5%) don't work there but collaborate with schools (non-school OTs). Participants support students with and without a medical diagnosis. Services provided by OTs external to the educational system are mainly funded by families or only partially covered. Findings show that most participants use standardized assessments and apply several intervention approaches. They believe there are barriers to the collaboration and implementation of occupational therapy services in schools. This preliminary study shows a need for changes in Spain's State and Regional Education legislation and provides recommendations to improve school service delivery. Pediatric OTs are encouraged to reflect on and identify opportunities for changes to enhance school-based occupational therapy practice in Spain. [ABSTRACT FROM AUTHOR]

In preparation for the 2020–2024 Olympic cycle, members of the USA Track and Field sport psychology (SP) subcommittee investigated the SP service provision needs and preferences of 88 elite Olympic-level athletes. A mixed-methods needs analysis was employed, which consisted of surveys, interviews, and a focus group, to help understand current SP usage and shape future SP services for USA Track and Field. Findings highlighted a lack of knowledge and exposure to SP services and a desire for increased contact with SP professionals among athletes, exposing gaps and room for improvement in service delivery. Athletes cited flexibility in terms of service delivery mode and shared common core preferences for mental training, including help managing stress, pressure, emotions, and other challenges of competition and training. The results are discussed in relation to strengthening the effectiveness of service provision through increasing visibility, accessibility, and education regarding the benefits of SP services. [ABSTRACT FROM AUTHOR]

Background: Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. Methods: A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Results: Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Conclusions: Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development. [ABSTRACT FROM AUTHOR]

Background: Waiting lists for community‐based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. Aims: To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. Methods: Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal–Wallis test. Employee satisfaction and perception of the model were explored using surveys. Results: Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre‐intervention (median 57 days) to the post‐intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery. Conclusion: Waiting lists are a major challenge across the health system. STAT provides a practical, low‐cost, data‐driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and response changed clinical service delivery and practice for speech and language therapists (SLTs) in the United Kingdom. SLTs work with children with neurodisability regarding both difficulties with their communication and eating and drinking skills (oropharyngeal dysphagia). This survey aimed to specifically explore the impact of the COVID‐19 pandemic on SLT practice for school‐aged children with dysphagia. Methods: UK‐based SLTs working with school‐aged children with neurodisability and oropharyngeal dysphagia were recruited to share their perceptions on the impact of COVID‐19 on practice. Four questions focusing on COVID‐19 impact were part of a larger online survey exploring SLT clinical practice regarding mealtime management of children with neurodisability and oropharyngeal dysphagia, which included demographic information, service delivery, assessment and intervention practices. COVID‐19 impact questions were a mixture of multiple choice and free text responses. The survey was disseminated using professional networks and social media, between 14 May and 30 July 2021. Data were analysed using descriptive statistics and qualitative content analysis. Results: One hundred and two participants answered at least one of the four COVID‐19 questions. Eighty‐two per cent of SLTs either agreed or strongly agreed that COVID‐19 impacted on service delivery to children and families. Negative impacts on service delivery included school absences/closures, home visiting restrictions, families declining input and/or having barriers to telehealth use and the impact of mask wearing on interactions. Positive impacts included increased telehealth access and skills, increased contact with families and focus on children's eating and drinking function within the home environment. Participants aimed to maintain the increased contact with families alongside a hybrid service delivery approach of in‐person and virtual appointments. Conclusions: This survey provides novel information capturing SLT practice change across two waves of COVID‐19 and return to in‐person practice for UK children with neurodisability. [ABSTRACT FROM AUTHOR]

This paper identifies the current practices and challenges related to the planning, management, and operation of microtransit systems as well as the concerns associated with the (lack of) policies in place. Our work focuses on the U.S. experience and is primarily based on an in-depth analysis of six microtransit systems using a combination of quantitative and qualitative data. We investigate and classify the multiple ways public agencies form public-private partnerships to institute microtransit service in their jurisdictions and discuss the relative advantages and disadvantages of the different service delivery models. We also thoroughly examine the contracts public agencies formed with private entities to disentangle the various cost elements associated with the launch and operation of a microtransit system. Our policy discussion emphasizes the lack of sustained funding sources for microtransit and the funding formulas that lead to a reduction or loss of public transportation funding when a jurisdiction replaces a fixed route service with microtransit. We also explain the requirements for ADA compliance in microtransit systems and highlight that service equivalency between disabled and non-disabled riders is not guaranteed when only some of the microtransit vehicles and operators are ADA compliant and certified. In terms of operation practices, we describe the safety risks that microtransit users may face on a day-to-day basis due to algorithm-driven virtual pick-up and drop-off locations, and the unwillingness of some service providers to enforce inclusive practices and ensure that individuals without electronic payment options and smartphones can gain access to the service. Furthermore, we discuss the challenges with balancing supply and demand in microtransit systems, and the need for allowing for both on-demand and pre-scheduled trip requests in order to ensure that critical and time-sensitive work, school, and medical trips are accommodated and prioritized. • Quantitative and qualitative data from six microtransit implementations. • Classification of public-private partnerships for microtransit service. • Explanation of technology fees and vehicles and drivers' costs in microtransit contracts. • Lack of sustained funding sources, and ADA compliance not guaranteed. • Challenges related to operation, such as the safety of algorithm-driven virtual stops. [ABSTRACT FROM AUTHOR]

BackgroundAchieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools.MethodsA sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members’ perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison.ResultsStructural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services.ConclusionsOutcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.

Background: The Clinical School Model connects professorial staff from the university directly to practitioners in the National Health Service to promote evidence informed practice and develop clinical academic careers. These are promoted widely, but strategic adoption into organisational culture and workforce plans are challenging to overcome. Aims: To describe the development of the Clinical School Model in Cornwall and explore how it generates impact through staff engagement activities to support clinical academic career pathways. Structure, process and outcomes developments over the last 3-years are reported. Methods: Donabedian's framework (structure, process and outcome) was used to report on the development and impact of the Clinical School Model. Results: Structural and process activities are reported, illustrating strong foundations to embed clinical academic career pathway opportunities. In the absence of empirical reporting standards for such developments, quantitative and qualitative outcomes are reported against the Clinical School's 5-year strategic plan. Conclusions: This paper responds to the lack of reported evidence on developing organisational infrastructure to address the clinical academics aspirations of nurses and their employers. This important contribution leads a call for more organisations to report to the evidence base, enabling shared learning and shaping future research. [ABSTRACT FROM AUTHOR]

Abstract Background Populations around the world are ageing faster, with the majority living in low- and middle-income countries where health and social care are yet to be universal and inclusive for the ageing population. This community-integrated intermediary care (CIIC) model is a novel prevention-based, long-term care model enhancing the family-based care system traditionally practised in Thailand and neighbouring Asian countries, and many low-and middle-income countries globally. This study assessed the effectiveness of the CIIC model in Chiang Mai, Thailand. Methods The two-arm parallel intervention study was designed as a cluster-randomized controlled trial. The study population at randomization and analysis was 2788 participants: 1509 in six intervention clusters and 1279 in six control clusters. The research protocol was approved by the WHO Research Ethics Review Committee (WHO/ERC ID; ERC.0003064). The CIIC service intervention model is a combination of formal care and informal care in a subdistrict setting consisting of three components: (1) care prevention delivered as community group exercise and home exercise; (2) care capacity-building of the family caregiver; and (3) community respite service. The primary outcome was family caregivers’ burden at 6-month follow-up, and secondary outcome was activities of daily living. Analysis applied the intention-to-treat approach using cluster-level analysis via STATA 16 SE. Results Baseline characteristics did not differ between the two arms. Loss of follow up was 3.7%. Mean age of the participants was 69.53 years. Women constituted 60%. The COVID-19 pandemic caused delayed implementation. The proportion of families with reduced caregiver burden at 6-month follow-up was higher among the intervention clusters (mean 39.4%) than control clusters (mean 28.62%). The intervention clusters experienced less functional decline and fewer people with depression. Conclusions When communities are integrated for preventing care, and families are empowered for giving care, it is possible to secure universal access to health and social care for the older persons, with basic resources mobilized from communities. This study had shown the CIIC model as an effective and potential step to the realization of universal health and long-term care coverage being inclusive of ageing populations in Thailand and globally. Trial registration: This trial was registered at the Thailand Clinical Trial Registry—Trial registration number TCTR20190412004, https://www.thaiclinicaltrials.org/#

There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence‐based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video‐based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in‐person genetic counseling and found that for the majority of studied outcomes, THGC was a non‐inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID‐19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in‐person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available. [ABSTRACT FROM AUTHOR]

Although Response to Intervention (RTI) is viewed as a promising model for preventing learning difficulties in reading, several authors have highlighted the challenges associated with its implementation in educational settings (Barrio et al., 2015; Fuchs & Vaughn, 2012; Mitchell et al., 2012). After a decade of implementing this model in the United States, researchers insist on the need for more studies on the practical issues related to the implementation of this model (Barrio et al., 2015; Simonsen et al., 2010). The purpose of this article is to present the results of a multi-case study on the roles of teachers and remedial teachers in the context of the implementation of the RTI in reading in three elementary schools. It focuses more specifically on the organization of services based on the different evaluation and intervention procedures associated with the RTI. The results indicate the presence or emergence of a data culture in the three sites studied. It was possible to observe that RTI evaluation and intervention procedures are viewed as structuring benchmarks for organizing and planning services throughout the school year for first and second Grade students at-risk and those already struggling with reading difficulties. [ABSTRACT FROM AUTHOR]

Sri Lanka is a lower middle-income, small island nation in the Indian Ocean, with a multi-ethnic population of 22 million. The healthcare system of the country is well established and relatively advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka has witnessed a rapid development over the last four decades, as the care model transformed from an asylum-based model, established during the British colonial times, to a district-wise hospital-based, care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals also started to provide community-based care. The newly added community-based services include outreach clinics, residential intermediate rehabilitation centres, home-based care, community resource/ support centres and telephone help lines. There is no or very little funding dedicated to community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so, as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. However, paradoxically, this also constitutes an advantage, as the provision of care delivery from the hospital to the community is continuous, since the same team provides both hospital- and community-based care. In addition to the essential mental healthcare provision in the community with this basic infrastructure, each community service has improvised and adapted the utilization of other resources available to them, both formally as well as informally, to compensate for their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly the civil administration. Although sustainability may be questionable when services involve informal resources from the non-health sectors, these have so far proven useful and effective in a resource-poor environment, as they bring the community and various sectors together to facilitate services to support their own community.

Background: Populations around the world are ageing faster, with the majority living in low- and middle-income countries where health and social care are yet to be universal and inclusive for the ageing population. This community-integrated intermediary care (CIIC) model is a novel prevention-based, long-term care model enhancing the family-based care system traditionally practised in Thailand and neighbouring Asian countries, and many low-and middle-income countries globally. This study assessed the effectiveness of the CIIC model in Chiang Mai, Thailand.Methods: The two-arm parallel intervention study was designed as a cluster-randomized controlled trial. The study population at randomization and analysis was 2788 participants: 1509 in six intervention clusters and 1279 in six control clusters. The research protocol was approved by the WHO Research Ethics Review Committee (WHO/ERC ID; ERC.0003064). The CIIC service intervention model is a combination of formal care and informal care in a subdistrict setting consisting of three components: (1) care prevention delivered as community group exercise and home exercise; (2) care capacity-building of the family caregiver; and (3) community respite service. The primary outcome was family caregivers' burden at 6-month follow-up, and secondary outcome was activities of daily living. Analysis applied the intention-to-treat approach using cluster-level analysis via STATA 16 SE.Results: Baseline characteristics did not differ between the two arms. Loss of follow up was 3.7%. Mean age of the participants was 69.53 years. Women constituted 60%. The COVID-19 pandemic caused delayed implementation. The proportion of families with reduced caregiver burden at 6-month follow-up was higher among the intervention clusters (mean 39.4%) than control clusters (mean 28.62%). The intervention clusters experienced less functional decline and fewer people with depression.Conclusions: When communities are integrated for preventing care, and families are empowered for giving care, it is possible to secure universal access to health and social care for the older persons, with basic resources mobilized from communities. This study had shown the CIIC model as an effective and potential step to the realization of universal health and long-term care coverage being inclusive of ageing populations in Thailand and globally.Trial Registration: This trial was registered at the Thailand Clinical Trial Registry-Trial registration number TCTR20190412004, https://www.thaiclinicaltrials.org/. [ABSTRACT FROM AUTHOR]

Rehabilitation services for children with mild motor difficulties are limited. Telehealth could be a novel avenue through which to provide these services. With the input of various stakeholder groups, this study aimed to develop a logic model for a new primary care telerehabilitation intervention and to identify influencing implementation factors. A participatory research design was used. A logic model, developed in consultation with five healthcare managers, was discussed with four stakeholder groups. Focus groups were conducted with clinicians (n = 9), pediatric healthcare managers (n = 5), and technology information consultants (n = 2), while parents (n = 4) were interviewed to explore their perceptions of the proposed intervention, and factors influencing implementation. Transcribed discussions were analyzed using reflexive thematic analysis. Stakeholders supported the delivery of telerehabilitation services for children with mild motor difficulties. Although agreement was generated for each logic model component, important recommendations were voiced related to service relevance and sustainability, parent and community capacity building, and platform dependability, security, and support. Identified factors influencing the implementation encompassed consumer, provider, technological, systemic and contextual barriers and facilitators. Strategies to address them were also suggested. This study demonstrates the value of, and a process to engage stakeholders in the designing of pediatric telerehabilitation services and its implementation. Pediatric telerehabilitation service are complex interventions which operate in complicate systems. Designing telerehabilitation services with stakeholders is recommended, yet how to do so often not clear. This study demonstrated that the development of a logic model can provide a systematic framework to helps guide the co-design process with stakeholders. Resulting recommendation underscored a broader vision for the intervention and identified crucial factors and strategies required for its successful implementation and sustainability. [ABSTRACT FROM AUTHOR]

Providers of therapeutic services to children and families have, in recent times, been subject to pressure to supplement traditional service output measures with evidence-based measures, which capture outcomes for service users. In this article, we report on the near decade long establishment of a range of standardised measures within an Irish non-governmental agency providing therapeutic help to children and families across two settings, family centres and early childhood development services. We describe the organisational conditions necessary for the introduction of standardised outcome measures and provide an illustrative overview of participant characteristics and some examples of key findings across both services as they relate to the important outcome domains of child and parent functioning. We further propose a model for the introduction and sustainability of outcome measures as a necessary and enduring feature of therapeutically orientated organisations providing services to children and families. Lastly, we identify organisational commitment to the development of outcome data, plans to ensure sustainable arrangements for ongoing data analysis, and conceptual linkage between evidence informed practice and the values of an organisation as key considerations. [ABSTRACT FROM AUTHOR]

This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results.

Women with pathogenic variants in BRCA1/2 have a significantly increased lifetime risk of breast and ovarian cancers. The availability of genetic testing to identify BRCA1/2 carriers is imperative to disease prevention and treatment. We evaluated the effectiveness of a new collaborative care model in Nova Scotia, involving the integration of genetic counselors into tumor board rounds, reduction in time allotted for initial genetic counseling appointments from 60 to 45 min, and a standardized dictation template, to increase referral rate for genetic counseling. We also assessed the study cohorts' preferences on timing for genetic testing. A retrospective chart review was performed on all women diagnosed with epithelial ovarian cancer (EOC) from 2012 to 2017 (N = 386). Pertinent clinical outcomes were categorized and wait times to different nodes of the clinical pathway assessed. A questionnaire was sent to this same cohort of women to identify preference for the timing of genetic testing (n = 103). The chi‐square and Wilcoxon's rank‐sum tests were used to compare demographic and clinical variables pre‐ and post‐care model implementation. We identified a 48.2% (95% CI: 39.4–56.7, p <.001) increase in referral for genetic counseling following implementation of the new care model. Median time from diagnosis to referral decreased by 74.0 days (p <.001) and median time from referral to first appointment by 54.0 days (p <.001). 56.3% of women desired referral at the time of diagnosis. This care model for women newly diagnosed with EOC in Nova Scotia was successful in increasing referral rates for genetic counseling. Majority of women pursued genetic testing following and favored that referral for genetic counseling be made at the time of diagnosis, highlighting the importance for timely access. [ABSTRACT FROM AUTHOR]

Abstract Background China’s TB control system has been transforming its service delivery model from CDC (Centers for Disease Control and Prevention)-led model to the designated hospital-led model to combat the high disease burden of TB. The implications of the new service model on TB health workforce development remained unclear. This study aims to identify implications of the new service model on TB health workforce development and to analyze whether the new service model has been well equipped with appropriate health workforce. Methods The study applied mixed methods in Zhejiang, Jilin, and Ningxia provinces of China. Institutional survey on designated hospitals and CDC was conducted to measure the number of TB health workers. Individual questionnaire survey was conducted to measure the composition, income, and knowledge of health workers. Key informant interviews and focus group discussions were organized to explore policies in terms of recruitment, training, and motivation. Results Zhejiang, Jilin, and Ningxia provinces had 0.33, 0.95, and 0.47 TB health professionals per 10 000 population respectively. They met the national staffing standard at the provincial level but with great variety at the county level. County-designated hospitals recruited TB health professionals from other departments of the same hospital, existing TB health professionals who used to work in CDC, and from township health centers. County-designated hospitals recruited new TB health professionals from three different sources: other departments of the same hospital, CDC, and township health centers. Most newly recruited professionals had limited competence and put on fixed posts to only provide outpatient services. TB doctors got 67/100 scores from a TB knowledge test, while public health doctors got 77/100. TB professionals had an average monthly income of 4587 RMB (667 USD). Although the designated hospital had special financial incentives to support, they still had lower income than other health professionals due to their limited capacity to generate revenue through service provision. Conclusions The financing mechanism in designated hospitals and the job design need to be improved to provide sufficient incentive to attract qualified health professionals and motivate them to provide high-quality TB services.

Over one billion people with disabilities (PWDs) and older adults with mobility impairment are currently in need of assistive technology devices (ATDs) and only 10% of those population have ordinarily access to them. The need for advancement in mobility-assistive technology is growing to address the gap in ATDs provision globally. The purpose of this review is to identify potential future areas of development and research in mobility-assistive technology. Publications were identified using scientific and medical electronic databases. Also, a limited grey literature search was conducted to muster a variety of sources. A combination of keyword search terms was used, corresponding to the medical subject heading (MeSH) terms. A total of 392 articles were identified, of which 75 were selected for detailed review. Twenty-eight articles were identified that met the review's inclusion criteria. Future areas of research for mobility-assistive technology were identified by grouping the publications into four main categories. The findings of this review identified several areas of research and development in ATDs in general and mobility-assistive technology, in particular, with special attention to the importance of engaging users and stakeholders in the process of research and design. It is apparent that users' needs and priorities vary between regions within countries. The majority of studies were noted to mainly identify consumers' perspectives on a national basis. The authors, therefore, suggest that further research should be conducted on a global level to determine the knowledge and perspectives concerning future research and development needs and priorities in mobility-assistive technologies. Despite the benefits derived from the use of ATDs, only 10% of people with disabilities have access to them. Increasing access, quality and affordable ATDs in all countries is global demand. Identifying mobility consumers' needs and priorities would help in enhancing their quality of life by translating research into new technologies that meet their environment and culture needs. Users' involvement in research and design process is a crucial approach to re-shape the future research agenda. [ABSTRACT FROM AUTHOR]

This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results. [ABSTRACT FROM AUTHOR]

School-based speech-language pathologists (SLPs) are implementing telecommunication technologies for service provision. Telepractice is one among an array of service delivery models that can be successfully implemented in the public-school setting. While many school-based SLPs have been plunged into telepractice with the recent pandemic, this temporary shift to emergency instruction is not the same as fully implementing a telepractice service delivery model. SLPs who recognize the potential application of telecommunications would profit from additional training and experience to take advantage of the benefits of this service delivery model. The purpose of this article is to explore the concept of telepractice as a service delivery model, and to answer the who, what, when, where, and why questions of school-based telepractice. Telepractice is one of several service delivery models that school-based SLPs can confidently utilize to provide effective speech and language therapy services to school-age students. [ABSTRACT FROM AUTHOR]

Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group's management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient's presenting urethral pathology. Level of evidence: Level IV [ABSTRACT FROM AUTHOR]

Aims: Occupational therapists (OTs) often face barriers when trying to collaborate with teachers in school-based settings. Partnering for change (P4C), a collaborative practice model designed to support children with developmental coordination disorder, could potentially support all students with special needs. Therefore, the aim of this study was to explore how teachers experience OT services delivered using the P4C model to support children with a variety of special needs. Methods: P4C was implemented at one elementary school in Courtenay, British Columbia. Eleven teachers participated in two focus groups and a one-on-one interview to gather descriptive, qualitative data. Grounded theory techniques were used for data analysis. Results: Four themes (collaborating in the thick of it all, learning and taking risks, managing limited time and resources, and appreciating responsive OT support) represented teachers' experiences of P4C. Conclusions: Teachers strongly preferred collaborative OT services based on the P4C model. Students with a variety of special needs were supported within their classrooms as teachers learned new strategies from the OT and found ways to embed these strategies into their daily routines. [ABSTRACT FROM AUTHOR]

Communicating personalized genomic risk results for common diseases to the general population as a form of tailored prevention is novel and may require alternative genetic counseling service delivery models. We describe the development and evaluation of a communication protocol for disclosing melanoma genomic risk information to the asymptomatic general population and assess participants’ satisfaction and acceptability. Participants (n = 117) were aged 22-69 years, living in New South Wales, Australia and unselected for family history. They provided a saliva sample and had genomic testing for melanoma for low to moderate penetrant melanoma susceptibility variants in 21 genes. Participants could choose to receive their results from a genetic counselor via telephone, followed by a mailed booklet or to receive their risk result via mailed booklet only with a follow-up call for those at high risk. A follow-up questionnaire was completed by 85% of participants 3-months later. Most participants (80%) elected to receive their result via telephone. Participants were highly satisfied with the delivery of results (mean 3.4 out of 4, standard deviation 0.5), and this did not differ by delivery mode, risk category, age or sex. On follow-up, 75% accurately recalled their risk category, 6% indicated a preference for a different delivery mode, either electronic or face-to-face. The process of disclosing genomic risk results to the general population over the telephone with accompanying written material was feasible and acceptable, and may be useful for communicating polygenic risk for common diseases in the context of increasing demands for genomic testing. [ABSTRACT FROM AUTHOR]