Purpose: We explored physiotherapists’ perceptions of clinical supervision. Method: Individual semi-structured interviews were conducted with a purposive sample of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS–26) was administered to evaluate the participants’ perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.
BACKGROUND: Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA. METHODS: Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009–2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture. RESULTS: Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%–80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05–1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21–1.50]), history of prior fracture(s; IRR, 2.56 [95% CI, 1.77–3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10–1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49–0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort. CONCLUSIONS: Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
Background: Currently there is a paucity of quality evidence to support the use of restricted diets in Autism Spectrum Disorder (ASD) and NICE guidelines do not recommend the use of restricted diets to treat ASD (1) although there are considerable positive anecdotal reports on the efficacy of the Gluten Free Casein Free diet (GFCF). Moreover, since there is a lack of medical treatment available for autism, parents often turn to various complementary and alternative therapies including restrictive diets as a means of treating their children (2) . The aim of this study was to evaluate the use of four different types of restricted diet -the (GFCF), the Specific Carbohydrate Diet (SCD), the Gut and Psychology Syndrome (GAPS) and the Ketogenic Diet (KD) as a means of treating children with ASD. Methods: An unvalidated online questionnaire, with both open and closed questions, exploring aspects of diet in children with ASD was developed for this study by a paediatric dietitian and posted on the "Research Autism" website. Participants were also recruited via social media over two months in early 2016, following ethical approval by the Research Ethics Committee of London Metropolitan University. This study analysed a subset of this data, limiting inclusion to children based in the UK aged 19 years and under and to computer literate respondents.Results: Despite inviting respondents from across the UK, there were only 162 respondents representing approximately 0.023% of the total UK autism population. The mean age of children 11.2 years AE 4.0 years and 82.7% (n = 134) were male and 17.3% (n = 28) female reflecting the recognized male to female ratio of prevalence for ASD of 4:1. 30.8%, (n = 50) respondents had previously tried the GFCF diet and the 3% (n = 5) that had tried the SCD and GAPS diet had also tried the GFCF diet. No respondents had tried the KD. 58% (n = 29) parents for GFCF and 80% (n = 4) parents for SCD and GAPS diet hoped for 'improvements in general health and wellbeing' when commencing restriction diets. 46% (n = 23) and 50% (n = 25) of parents reported improvements in 'overall health and wellbeing' and 'participation in daily activities' on the GFCF diet respectively. 20% (n = 10) reported that 'range of food eaten' was negatively affected following GFCF diet. 60% (n = 3) of parents reported improvements on the SCD and GAPS diet in respect of 'participation in daily activities' and 'overall health and wellbeing'. Discussion: The results suggest that parental use of the GFCF diet (30.8%) is similar to that reported in a US parental internet survey (32.4%). This study is the first to evaluate parents views on the GAPS diet and one of the first to evaluate SCD although the small sample cannot be representative of the current ASD population. Following restrictive diets can risk nutritional adequacy, be costly and affect mealtime interactions and therefore it is vital that parents have appropriate support when considering commencing these diets. Conclusion: These findings add to the evidence that use of t...
ObjectivesPatient-reported outcomes (PROs) are increasingly used to measure the patient’s perspective of their outcomes following healthcare interventions. The aim of this study was to determine the preferred formats for reporting service-level PROs data to clinicians, researchers and managers to support greater utility of these data to improve healthcare and patient outcomes.SettingHealthcare professionals receiving PRO data feedback at the health service level.ParticipantsAn interdisciplinary Project Working Group comprised of clinicians participated in three workshops to codesign reporting templates of summarised PRO data (modified Rankin Scale, EuroQol Five Dimension Descriptive System, EuroQol Visual Analogue Scale and Hospital Anxiety and Depression Scale) using a modified Delphi process. An electronic survey was then distributed to short list the preferred templates among a broad sample of clinical end users. A final workshop was undertaken with the Project Working Group to review results and reach consensus on the final templates.Primary and secondary outcome measuresThe recommendation of preferred PRO summary data feedback templates and guiding principles for reporting aggregate PRO data to clinicians was the primary outcome. A secondary outcome was the identification of perceived barriers and enablers to the use of PRO data in hospitals. For each outcome measure, quantitative and qualitative data were summarised.Results31 Working Group members (19 stroke, 2 psychology, 1 pharmacy, 9 researchers) participated in the workshops, where 25/55 templates were shortlisted for wider assessment. The survey was completed by 114 end users. Strongest preferences were identified for bar charts (37/82 votes, 45%) and stacked bar charts (37/91 votes, 41%). At the final workshop, recommendations to enhance communication of PROs data for comparing health service performance were made including tailoring feedback to professional roles and use of case-mix adjustment to ensure fair comparisons.ConclusionsOur research provides guidance on PROs reporting for optimising data interpretation and comparing hospital performance.
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