Case Management Consultant to Attorneys in Litigated Cases.

ABSTRACT: Rehabilitation nurses possess knowledge and skills that are ideally suited to a variety of roles. This article informs rehabilitation nurses about opportunities to work in private case management for medical-legal cases. A brief overview of the process of litigation gives nurses the context in which case management interventions are needed. Case examples illustrate the services that nurses provide to attorneys and their clients that help obtain needed care and aid in progressing litigation to resolution.

Integrating training in evidence-based medicine and shared decision-making: a qualitative study of junior doctors and consultants.

BACKGROUND: In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors' attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors' EBM-SDM learning and practice; and to examine how supervising consultants' attitudes and authority impact on junior doctors' opportunities for EBM-SDM learning and practice. METHODS: We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors' EBM-SDM learning and practice. RESULTS: Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors. CONCLUSIONS: These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

BACKGROUND: Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. MATERIAL: To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. METHODS: Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. RESULTS: Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. CONCLUSIONS: The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

Measuring job stress of dental workers in China during the COVID-19 pandemic: reliability and validity of the hospital consultants' job stress questionnaire.

BACKGROUND: The Hospital Consultants' Job Stress Questionnaire (HCJSQ) has been widely used to assess sources and levels of job stress. However, its reliability and validity among Chinese dental workers have not been extensively studied. The objective of this study was to assess the reliability and validity of the HCJSQ specifically in Chinese dental workers. METHODS: The HCJSQ was used to explore the sources and the global ratings of job stress among Chinese dental workers. To assess the reliability and validity of the HCJSQ, various statistical measures were employed, including Cronbach's alpha coefficient, Spearman-Brown coefficient, Spearman correlation coefficient, exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity. RESULTS: Of the participants, 526 (17.4%) reported high levels of stress, while 1,246 (41.3%) and 1,248 (41.3%) reported moderate and low levels of stress, respectively. The Cronbach's alpha coefficient for the modified HCJSQ was 0.903, and the Spearman-Brown coefficient was 0.904. Spearman correlation coefficient between individuals' items and the total score ranged from 0.438 to 0.785 (p < 0.05). Exploratory factor analysis revealed that three factors accounted for 60.243% of the total variance. Confirmatory factor analysis demonstrated factor loadings between 0.624 and 0.834 on the specified items. The fit indices of the confirmatory factor analysis indicated good model fit, with a Root Mean Square Error of Approximation of 0.064, Normative Fit Index of 0.937, Comparative Fit Index of 0.952, Incremental Fit Index of 0.952, Tucker-Lewis index of 0.941, and Goodness of Fit Index of 0.944. Additionally, the convergent validity and discriminant validity showed a good fit for the three-factor model. CONCLUSION: The results of this study confirm that Chinese dental workers experience high levels of stress, and the three-factor model of the HCJSQ proves to be a suitable instrument for evaluating the sources and levels of job stress among Chinese dental workers. Therefore, it is imperative that relevant entities such as hospitals, medical associations, and government take appropriate measures to address the existing situation.

Bernard Geoffrey Norman Smith (1938-2016).

Bernard Smith was one of the most significant specialists in restorative dentistry of his generation. He was an inspiring undergraduate and postgraduate teacher, a noted international lecturer and a house-builder. Bernard was president of the British Society for Restorative Dentistry and first chairman of the Association of Consultants and Specialists in Restorative Dentistry.

Franz Alfred (1880-1962) and Georg Frederich (1921-2010) Kantorowicz.

George Kantorowicz was a senior lecturer/consultant in conservative dentistry at the Royal Dental Hospital who provided ground-breaking treatment for cleft palate children at Great Ormond Street Hospital. His father, Alfred, was a Jewish professor, dean at Bonn Dental School and a world-famous advocate of mobile dental surgeries and prevention for children's dental health, until the Nazis put him in a concentration camp. After important interventions, he became director of Istanbul Dental Institute.

Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis.

BACKGROUND: Regional anaesthesia plays an important role in perioperative care, but gaps in proficiency persist among consultants and specialists. This study aimed to assess confidence levels in performing Plan A blocks among this cohort and to examine the barriers and facilitators influencing regional anaesthesia education. METHODS: Utilising a mixed-methods design, we performed a quantitative survey to gauge self-reported confidence in performing Plan A blocks, coupled with qualitative interviews to explore the complexities of educational barriers and facilitators. UK consultant and specialist anaesthetists were included in the study. RESULTS: A total of 369 survey responses were analysed. Only 22% of survey respondents expressed confidence in performing all Plan A blocks. Specialists (odds ratio [OR] 0.391, 95% confidence interval [CI] 0.179-0.855, P=0.016) and those in their roles for >10 yr (OR 0.551, 95% CI 0.327-0.927, P = 0.024) reported lower confidence levels. A purposive sample was selected for interviews, and data saturation was reached at 31 interviews. Peer-led learning emerged as the most effective learning modality for consultants and specialists. Barriers to regional anaesthesia education included apprehensions regarding complications, self-perceived incompetence, lack of continuing professional development time, insufficient support from the multidisciplinary team, and a lack of inclusivity within the regional anaesthesia community. Organisational culture had a substantial impact, with the presence of local regional anaesthesia champions emerging as a key facilitator. CONCLUSIONS: This study highlights persistent perceived deficiencies in regional anaesthesia skills among consultants and specialists. We identified multiple barriers and facilitators, providing insights for targeted interventions aimed at improving regional anaesthesia education in this group.

The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II).

The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).

State School Nurse Consultants Issue RN Action Agendas.

The National Association of State School Nurse Consultants (NASSNC) recently issued two action agendas for school nurses. The first action agenda promotes school nurses using their credentials in all communications, documenting their expertise and asserting their legal authority to practice professional nursing. The focus is on the baccalaureate-prepared registered nurse (RN) being the entry level preparation for school nursing. The second action agenda suggests school nurses can increase school administrator support by explaining their specialty practice and offers several marketing strategies. School nurses are invited to access the RN Action Agendas at the NASSNC website link provided.