The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review.

The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.

Transforming nursing care for children with serious long-term conditions: A mixed methods exploration of the impact of Roald Dahl Specialist Nurses in the United Kingdom.

PURPOSE: A new model of paediatric nursing, funded initially by a charitable organisation working in partnership with UK healthcare providers, was implemented to support children living with serious long-term conditions. This study explored, from the perspective of multiple stakeholders, the impact of services provided by 21 'Roald Dahl Specialist Nurses' (RDSN) within 14 NHS Trust hospitals. DESIGN AND METHODS: A Mixed Methods Exploratory design commenced with interviews with RDSNs (n = 21) and their managers (n = 15), alongside a medical clinician questionnaire (n = 17). Initial themes (constructivist grounded theory) were validated through four RDSN focus groups, and informed development of an online survey of parents (n = 159) and children (n = 32). Findings related to impact were integrated using a six-step triangulation protocol. RESULTS: Zones of significant impact included: Improving quality and experience of care; Improved efficiencies and cost-effectiveness; Provision of holistic family-centred care; and Impactful leadership and innovation. The RDSNs forged networks across inter-agency boundaries to safeguard the child and enhance the family experience of care. RDSNs delivered improvements across a range of metrics, and were valued for their emotional support, care navigation and advocacy. CONCLUSIONS: Children living with serious long-term conditions have complex needs. Regardless of the specialty, location, organisation or service focus, this new model of care crosses organisational and inter-agency boundaries to ensure that the healthcare delivered has maximum impact. It has a profoundly positive impact on families. PRACTICE IMPLICATIONS: This integrated and family-centred model of care is strongly recommended for children with complex needs crossing organisational divides.

Multiple stakeholder perspectives of factors influencing differential outcomes for ethnic minority students on health and social care placements: a qualitative exploration.

BACKGROUND: Despite considerable efforts there continues to be a degree awarding gap within the United Kingdom (UK) between the proportion of White British students receiving higher classifications, compared to ethnic minority UK-domiciled students. Practice placement elements constitute approximately 50% of most health and social care programmes, yet surprisingly little research exists related to the factors which may contribute to ethnic minority student placement outcomes or experiences. This study bridges this evidence gap by exploring factors influencing differential placement outcomes of ethnic minority students from the perspectives of key stakeholders. METHODS: The study followed a descriptive qualitative research design and was multi-disciplinary, with participants drawn from across nursing, midwifery, social work and the allied health professions. Participants from four stakeholder categories (ethnic minority students, academic staff, placement educators and student union advisors) were invited to join separate focus groups. Focus groups were recorded and transcribed and analysed thematically. RESULTS: Ten separate focus groups [n = 66] yielded three primary themes: 1) recognition, which highlighted stakeholder perceptions of the issues [sub-themes: acknowledging concerns; cultural norms; challenging environments]; 2) the lived experience, which primarily captured ethnic minority student perspectives [sub-themes: problematising language and stereotyping, and being treated differently]; 3) surviving not thriving, which outlines the consequences of the lived experience [sub-themes: withdrawing mentally, feeling like an alien]. CONCLUSION: This study presents a rich exploration of the factors affecting differential outcomes of ethnic minority students on practice placements through the lens of four different stakeholder groups. To our knowledge this is the first study in which this comprehensive approach has been taken to enable multiple viewpoints to be accessed across a wide range of health and social care professions. The issues and challenges raised appear to be common to most if not all of these disciplines. This study highlights the urgent need to value and support our ethnic minority students to remove the barriers they face in their practice learning settings. This is a monumental challenge and requires both individuals and organisations to step up and take collective responsibility.

Twitter Journal Club in Medical Radiation Science.

INTRODUCTION: Social media has emerged as a powerful platform for engagement and learning. There is a growing trend toward the use of social media among health care professionals and professional groups to disseminate and discuss knowledge. Twitter is one tool that may enhance continuing professional development (CPD) for the medical radiation technologist. To evaluate the potential benefits of Twitter to CPD among medical radiation technologists, this study explored the integration of Bloom's taxonomy with Twitter-based professional activities. APPROACH: In 2015, the Medical Radiation Journal Club (https://medradjclub.wordpress.com/) commenced a monthly Twitter-based journal club for medical radiation professionals. This study investigates the application of Bloom's taxonomy of the Twitter-based journal club for CPD purposes. OUTCOME: The Twitter-based journal club provides a valuable platform for CPD. The combination of journal articles, supplementary reading, online blog, and the one-hour Twitter discussion engages all levels of Bloom's taxonomy; remember, understand, apply, analyze, evaluate, and create. A deeper insight revealed that the Twitter journal club provides an authentic learning environment suitable for CPD in which participants consume, collaborate, and produce. CONCLUSIONS: This evaluation demonstrated that the Twitter journal club can provide an authentic learning environment with all the cognitive dimensions afforded in a formal classroom or face-to-face journal club. Indeed, in some ways, these cognitive dimensions are enhanced in the Twittersphere.

Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening.

The most effective method of detecting breast cancer among asymptomatic women is by mammography screening. Most countries have this preventive measure in place for women within their society; however, most of these programs struggle with attendance. This article discusses four health behavioural theories and models in relation to mammography screening that may explain the factors affecting women's participation, including the health belief model, theory of planned behaviour, trans-theoretical model, and the theory of care seeking behaviour. In summary, analysis of these theories indicates that the theory of care seeking behaviour has value for exploring these factors because of its sensitivity to socioeconomic differences that exist among women in society and because it has a broader construct (such as habit and external factors) compared to the other health behavioural theories.

The Role of 18F-Sodium Fluoride PET/CT Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer.

We describe the role of 18F-sodium fluoride (18F-NaF) PET/CT bone scanning in the staging of breast and prostate cancer. 18F-NaF PET was initially utilized as a bone scanning agent in the 1960s and early 1970s, however, its use was restricted by the then-available γ-cameras. The advent of hybrid PET/CT cameras in the late 1990s has shown a resurgence of interest in its use and role. After a brief introduction, this paper describes the radiopharmaceutical properties, dosimetry, pharmacokinetics, and mechanism of uptake of 18F-NaF. The performance of 18F-NaF PET/CT is then compared with that of conventional bone scintigraphy using current evidence from the literature. Strengths and weaknesses of 18F-NaF PET/CT imaging are highlighted. Clinical examples of improved accuracy of diagnosis and impact on patient management are illustrated. Limitations of 18F-NaF PET/CT imaging are outlined.

The Clinical Dilemma of Incidental Findings on the Low-Resolution CT Images from SPECT/CT MPI Studies.

Incidental findings are common in medical imaging. There is a particularly high prevalence of incidental findings within the thorax, the most frequent being pulmonary nodules. Although pulmonary nodules have the potential to be malignant, most are benign, resulting in a high number of false-positive findings. Low-resolution CT images produced for attenuation correction of SPECT images are essentially a by-product of the imaging process. The high number of false-positive incidental findings detected on these attenuation-correction images causes a reporting dilemma. Early detection of cancer can be beneficial, but false-positive findings and overdiagnosis can be detrimental to the patient. Attenuation-correction CT images are not of diagnostic quality, and further diagnostic tests are usually necessary for a definitive diagnosis to be reached. Given the high number of false-positive findings, the psychologic effect on the patient should be considered. This review recommends caution when the findings on attenuation-correction CT images are routinely reported.

Paper 1: Conceptualizing the Transition from Advanced to Consultant Practitioner: Career Promotion or Significant Life Event?

BACKGROUND: The diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. OBJECTIVES: To explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. DESIGN: Longitudinal qualitative enquiry. METHODS AND SETTINGS: Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. RESULTS: A challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. CONCLUSIONS: Current emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.

Paper 2: Conceptualizing the Transition from Advanced to Consultant Practitioner: Role Clarity, Self-perception, and Adjustment.

BACKGROUND: Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. OBJECTIVES: To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. DESIGN: Longitudinal qualitative enquiry. METHODS AND SETTINGS: Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. RESULTS: Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. CONCLUSIONS: This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition.

Reprint of "Citation analysis as a measure of article quality, journal influence and individual researcher performance".

The research-related performance of universities, as well as that of individual researchers, is increasingly evaluated through the use of objective measures, or metrics, which seek to support or in some cases even replace more traditional methods of peer review. In particular there is a growing awareness in research communities, government organisations and funding bodies around the concept of using evaluation metrics to analyse research citations. The tools available for 'citation analysis' are many and varied, enabling a quantification of scientific quality, academic impact and prestige. However there is increasing concern regarding the potential misuse of such tools, which have limitations in certain research disciplines.This article uses 'real world' examples from radiography research and scholarship to illustrate the range of currently available citation analysis tools. It explores the academic debate surrounding their strengths and limitations, and identifies the potential impact of citation analysis on the radiography research community.The article concludes that citation analysis is a valuable tool for researchers to use for personal reflection and research planning, yet there are inherent dangers if it is used inappropriately. Whilst citation analysis can give objective information regarding an individual, research group, journal or higher education institution, it should not be used as a total substitute for traditional qualitative review and peer assessment.

'I thought it was just an x-ray': a qualitative investigation of patient experiences in cardiac SPECT-CT imaging.

BACKGROUND: Patients attending for complex imaging examinations may experience anxiety and discomfort with associated poor satisfaction and reduced compliance. This may lead to poor quality imaging, repeat scans and nonattendance. Analysing and understanding patient experience to improve the quality of care is of paramount importance within the National Health Service; yet, little published evidence of patient experience research exists within nuclear medicine. This qualitative study aimed to explore the experience of patients referred for cardiac single-photon emission computed tomography-computed tomography (SPECT-CT) in two different clinical environments. METHODS AND RESULTS: Twenty-two patients (13 women, nine men; mean age 63.9 years) were interviewed before and after the procedure to determine their prior knowledge, concerns, expectations and experiences. Thematic analysis demonstrated seven recurring themes: justification, validity of patient information, fear (of their condition, of harm and of the procedure), compliance, role of significant others, mitigation of anxiety, and coping strategies. In most cases an expectation-reality divide was apparent, with the actual experiences of the procedure being in some cases a pleasant surprise, or in other cases a shock. CONCLUSION: Cardiac SPECT-CT patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. The imaging team requires an awareness of potential expectation-reality divides, even when there are no overt signs of worry and distress. Written patient information is undoubtedly helpful, but there is no substitute for ongoing and repeated explanations and reassurance by staff. These findings are likely to have implications for other complex nuclear medicine procedures, including noncardiac SPECT-CT examinations and emerging PET-CT applications.

The role of the GI radiographer: a United Kingdom perspective.

CONTEXT: Since the 1990s radiographers in the United Kingdom have expanded their role in gastrointestinal (GI) radiology, first by performing double-contrast barium enema (DCBE) examinations independently and later by interpreting and reporting the results of these exams. OBJECTIVE: This article will trace the evolution of GI radiographers in the United Kingdom, evaluate their success and explore how the U.K. experience could apply to American radiologist assistants. METHODS: The authors surveyed the professional literature to determine the historical context in which GI radiographers emerged and assess how their performance on DCBE exams compares with radiologists' performance. RESULTS: DCBE exams performed by GI radiographers have been shown to be efficient, cost effective and safe. In addition, GI radiographers have helped reduce waiting and turnaround times for DCBE exams. SUMMARY: The success of GI radiographers in the United Kingdom offers assurance that radiologist assistants can benefit American patients, radiologists and radiologic technologists.

Radiation protection of female patients of reproductive capacity: A survey of policy and practice in Norway.

The implementation of various policies related to female patients of reproductive capacity was investigated using a structured telephone interview of radiological departments in Norway. The findings suggest that 60% (n=35/58) of radiological departments have written guidelines regarding female patients of reproductive capacity. The 10-day rule is implemented for a range of examinations in 12% (n=7/58) of the radiological departments questioned, and in another 9% (n=5/58) it is only implemented for hysterosalpingography. Forty percent (n=23/58) of departments are familiar with rapid urine pregnancy tests and use them in certain circumstances. In conclusion, a lack of standardisation of approaches to radiation protection is apparent, and this raises concerns as national and international recommendations are not being correctly implemented. This may lead to confusion amongst patients and staff, and may have adverse consequences such as the accidental irradiation of the unborn child.