Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada

2021 ◽  
pp. jrheum.201611
Author(s):  
Jennifer J.Y. Lee ◽  
Ronald M. Laxer ◽  
Brian M. Feldman ◽  
Claire E.H. Barber ◽  
Michelle Batthish ◽  
...  
Keyword(s):  
Pediatric Rheumatology ◽  
Census Data ◽  
Clinical Care ◽  
Median Number ◽  
Multidisciplinary Teams ◽  
Full Time ◽  
Allied Health Professionals ◽  
Care Processes ◽  
Outcome Monitoring ◽  
The Difference

Objective To examine Canadian pediatric rheumatology workforce and care processes. Methods Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. Results The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). Conclusion This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.

scholarly journals Resolving Rivalries and Realigning Goals: Challenges of Clinical and Research Multiteam Systems

2016 ◽  
Vol 12 (11) ◽  
pp. 1020-1028 ◽  
Author(s):  
David E. Gerber ◽  
Torsten Reimer ◽  
Erin L. Williams ◽  
Mary Gill ◽  
Laurin Loudat Priddy ◽  
...  
Keyword(s):  
Clinical Research ◽  
Collective Identity ◽  
Research Team ◽  
Clinical Care ◽  
Multidisciplinary Teams ◽  
Clinical Team ◽  
Team Members ◽  
Multiteam Systems ◽  
Care Processes ◽  
High Level

This article describes the care processes for a 64-year-old man with newly diagnosed advanced non–small-cell lung cancer who was enrolled in a first-line clinical trial of a new immunotherapy regimen. The case highlights the concept of multiteam systems in cancer clinical research and clinical care. Because clinical research represents a highly dynamic entity—with studies frequently opening, closing, and undergoing modifications—concerted efforts of multiple teams are needed to respond to these changes while continuing to provide consistent, high-level care and timely, accurate clinical data. The case illustrates typical challenges of multiteam care processes. Compared with clinical tasks that are routinely performed by single teams, multiple-team care greatly increases the demands for communication, collaboration, cohesion, and coordination among team members. As the case illustrates, the described research team and clinical team are separated, resulting in suboptimal function. Individual team members interact predominantly with members of their own team. A considerable number of team members lack regular interaction with anyone outside their team. Accompanying this separation, the teams enact rivalries that impede collaboration. The teams have misaligned goals and competing priorities that create competition. Collective identity and cohesion across the two teams are low. Research team and clinical team members have limited knowledge of the roles and work of individuals outside their team. Recommendations to increase trust and collaboration are provided. Clinical providers and researchers may incorporate these themes into development and evaluation of multiteam systems, multidisciplinary teams, and cross-functional teams within their own institutions.

Women and Entrepreneurship – Albanian Case

2016 ◽  
Vol 1 (1) ◽  
pp. 249
Author(s):  
Anna Xheka
Keyword(s):  
Gender Equality ◽  
Gender Gap ◽  
Secondary Data ◽  
Special Focus ◽  
Full Time ◽  
Men And Women ◽  
Women’S Entrepreneurship ◽  
Part Time ◽  
Women's Entrepreneurship ◽  
The Difference

Women’s entrepreneurship is a powerful source, regarding to the women’s economic independence and empowerment, as well as regarding employment generation, economic growth and innovation, development and the reduction of poverty as well as one of the terms of gender equality. This poster presents the situation of women's entrepreneurship in Europe in comparative terms, with special focus in Albania. The paper has a descriptive nature. Describes three different plans in comparative terms; the representation of men and women in entrepreneurship, the representation of women in entrepreneurship in different countries of Europe and of Europe as a whole, as well as compare to gender quota. Through the processing of secondary data from various reports and studies, this poster concludes that although that the gender equality goal is the equal participation of men and women in all sectors, including the entrepreneurship, in this sector, gender gap it is still deep. Another significant comparative aspect, it is the difference between full and part –time women entrepreneurship. While in full time entrepreneurship in a convince way, men are those that dominate, in part time entrepreneurship clearly it’s evident the opposite trend, women's representation is much higher. It’s very interesting the fact, that the women’s entrepreneurship in Albania, presented in a significant optimistic situation, ranking in the second place, after Greece in the European level

Interventions to change clinician behaviour in relation to suicide prevention care in the emergency department: A scoping review protocol

2020 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Christine Cassidy ◽  
Janet Curran ◽  
Lori Weeks ◽  
Leslie Anne Campbell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicide Prevention ◽  
Behaviour Change ◽  
Clinical Care ◽  
Grey Literature ◽  
Allied Health Professionals ◽  
Wide Range ◽  
Knowledge And Attitude ◽  
Clinician Behaviour ◽  
Google Search

Objective: This review aims to explore, characterize, and map the literature on interventions implemented to change emergency department (ED) clinicians’ behaviour related to suicide prevention using the Behaviour Change Wheel (BCW) as a guiding theoretical framework. Introduction: An ED is a critical place for suicide prevention. Yet, many patients who present with suicide-related thoughts and behaviours are discharged without proper assessment or appropriate treatment. Supporting clinicians (who provide direct clinical care, including nurses, physicians, allied health professionals) to make the desired behaviour change following evidence-based suicide prevention care is an essential step toward improving patient outcomes. However, reviews to date have yet to take a theoretical approach to investigate interventions implemented to change clinicians’ behaviour. Inclusion criteria: This review will consider literature that includes interventions that target ED clinicians’ behaviour change related to suicide prevention. Behaviour change refers to observable practice changes as well as proxy measures of behaviour change including knowledge and attitude. There are many ways in which an intervention can change clinicians’ behaviour (e.g., education, altering service delivery). This review will include a wide range of interventions that target behaviour change regardless of the type but exclude interventions that exclusively target patients.Methods: Multiple databases will be searched: PubMed, PsycInfo, CINAHL and Embase. We will also include grey literature, including Google search, ProQuest Dissertations and Theses Global, and Scopus conference papers. Full text of included studies will be reviewed, critically appraised and extracted. Extracted data will be coded to identify intervention functions using the BCW. Findings will be summarized in tables accompanied by narrative reports.

scholarly journals Review of the Health, Welfare and Care Workforce in Tasmania, Australia: 2011–2016

2021 ◽  
Vol 18 (13) ◽  
pp. 7014
Author(s):  
Belinda Jessup ◽  
Tony Barnett ◽  
Kehinde Obamiro ◽  
Merylin Cross ◽  
Edwin Mseke
Keyword(s):  
Oral Health ◽  
Rural Communities ◽  
Health Workforce ◽  
Census Data ◽  
Care Service ◽  
The State ◽  
Full Time ◽  
Full Time Equivalent ◽  
Diverse Range ◽  
Per Capita

Background: On a per capita basis, rural communities are underserviced by health professionals when compared to metropolitan areas of Australia. However, most studies evaluating health workforce focus on discrete professional groups rather than the collective contribution of the range of health, care and welfare workers within communities. The objective of this study was therefore to illustrate a novel approach for evaluating the broader composition of the health, welfare and care (HWC) workforce in Tasmania, Australia, and its potential to inform the delivery of healthcare services within rural communities. Methods: Census data (2011 and 2016) were obtained for all workers involved in health, welfare and care service provision in Tasmania and in each statistical level 4 area (SA4) of the state. Workers were grouped into seven categories: medicine, nursing, allied health, dentistry and oral health, health-other, welfare and carers. Data were aggregated for each category to obtain total headcount, total full time equivalent (FTE) positions and total annual hours of service per capita, with changes observed over the five-year period. Results: All categories of the Tasmanian HWC workforce except welfare grew between 2011 and 2016. While this growth occurred in all SA4 regions across the state, the HWC workforce remained maldistributed, with more annual hours of service per capita provided in the Hobart area. Although the HWC workforce remained highly feminised, a move toward gender balance was observed in some categories, including medicine, dentistry and oral health, and carers. The HWC workforce also saw an increase in part-time workers across all categories. Conclusions: Adopting a broad approach to health workforce planning can better reflect the reality of healthcare service delivery. For underserviced rural communities, recognising the diverse range of workers who can contribute to the provision of health, welfare and care services offers the opportunity to realise existing workforce capacity and explore how ‘total care’ may be delivered by different combinations of health, welfare and care workers.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

Recruitment, Readiness, and Retention of Providers at a Field Hospital during the Pandemic

2022 ◽  
pp. 1-21
Author(s):  
Ishaan Gupta ◽  
Zishan K. Siddiqui ◽  
Mark D. Phillips ◽  
Amteshwar Singh ◽  
Shaker M. Eid ◽  
...  
Keyword(s):  
Team Building ◽  
Well Being ◽  
Just In Time ◽  
Multidisciplinary Teams ◽  
Full Time ◽  
Full Time Equivalent ◽  
Field Hospital ◽  
Convention Center ◽  
Key Steps ◽  
Experienced Personnel

Abstract In response to the coronavirus disease 2019 (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing healthcare infrastructure. To operationalize this hospital with 65 full-time equivalent (FTE) clinicians in less than four weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided ‘just in time’ training on COVID-19 and non-COVID-19 related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration and provided leadership opportunities that allowed retention of staff.

Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S10.2-S11
Author(s):  
Christina Master ◽  
Kristi Metzger ◽  
Mr. Daniel Corwin ◽  
Catherine McDonald ◽  
Melissa Pfeiffer ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Clinical Care ◽  
Median Number ◽  
Self Report ◽  
Return To School ◽  
Self Assessment ◽  
Concussion Management ◽  
Pediatric Concussion ◽  
Concussion Recovery ◽  
Definition Of

ObjectiveTo quantify variability in pediatric concussion recovery across multiple outcomes of interest.BackgroundPediatric concussion studies are hindered by a common significant limitation: lack of agreement on a standard definition of “recovery.” A variety of clinical outcomes of interest utilized across studies, including symptom self-report, neurocognitive testing results, self-reported return to activity, and physician clearance for activity, leads to challenges for both research, as well as clinical concussion management.Design/MethodsWe enrolled concussed youth, ages 11–18 years, from a specialty sports medicine clinic = 28 days of injury. Patients were followed as part of clinical care for concussion for up to 13 weeks. At each visit, participants completed questionnaires and a battery of clinical measures. From these data, we constructed 10 potential definitions of recovery: 3 based on self-reported symptoms (change from pre-injury, no symptoms, below pre-determined thresholds), 2 based on visio-vestibular examination (VVE) deficits (none, = 1), 2 based on physician clearance (for return to school/sport), and 3 based on self-assessment (“back to normal”, return to school/exercise).ResultsOne hundred seventy-four concussed youth were enrolled (median age: 15 years, 54.6% female) with a median time from injury to initial visit of 12 days (IQR: 7, 20). Median number of visits was 2 (range: 1, 5). We observed a wide variation in the proportion of participants recovered across the 10 definitions. Depending on definition, between 4% and 45% were considered recovered within 4 weeks, and between 10% and 80% were considered recovered at the end of follow-up. The VVE-based definition (=1 deficit) consistently had the highest proportion recovered at all time points, while self-reported return to exercise had the lowest proportion.ConclusionsRecovery from concussion is not a single unitary point in time. These results will provide valuable guidance to clinicians in managing concussion and researchers in designing future observational and interventional trials of pediatric concussion.

Evaluating prediction of continuous clinical values: a glucose case study (Preprint)

2021 ◽  
Author(s):  
George Hripcsak ◽  
David J Albers
Keyword(s):  
Predictive Models ◽  
Clinical Utility ◽  
Clinical Care ◽  
Glucose Measurement ◽  
Care Processes ◽  
Low Glucose ◽  
Potential Clinical Utility ◽  
Rms Error ◽  
Error Grid

BACKGROUND Background: It would be useful to be able to assess the utility of predictive models of continuous values before clinical trials are carried out. OBJECTIVE Objective: To compare metrics to assess the potential clinical utility of models that produce continuous value forecasts. METHODS Methods: We ran a set of data assimilation forecast algorithms on time series of glucose measurements from intensive care unit patients. We evaluated the forecasts using four sets of metrics: glucose root mean square error, a set of metrics on a transformed glucose value, the estimated effect on clinical care based on an insulin guideline, and a glucose measurement error grid (Parkes grid). We assessed correlation among the metrics and created a set of factor models. RESULTS Results: The metrics generally correlated with each other, but those that estimated the effect on clinical care correlated with the others the least and were generally associated with their own independent factors. The other metrics appeared to separate into those that emphasized errors in low glucose versus errors in high glucose. The Parkes grid was well correlated with the transformed glucose but not the estimation of clinical care. CONCLUSIONS Discussion: Our results indicate that we need to be careful before we assume that commonly used metrics like RMS error in raw glucose or even metrics like the Parkes grid that are designed to measure importance of differences will correlate well with actual effect on clinical care processes. A combination of metrics appeared to explain the most variance between cases. As prediction algorithms move into practice, it will be important to measure actual effects.

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