Many self-management and support groups for medical patients target a specific medical condition or diagnosis and are often time-limited. Presented is the Medical Issues Group (MIG), which is an integration of a self-management program and a therapist-led supportive psychotherapy group. This ongoing group is open to individuals with any significant chronic medical condition. Findings from our qualitative evaluation (n = 9) revealed that this group is positively received and can provide individuals who are experiencing challenges associated with living with medical illness a forum to receive high quality social support, address feelings of social isolation and loneliness, and develop adaptive coping strategies to adjust to medical illness. The inclusive structure of the group appears to provide enhanced access to high quality support and intervention for a vulnerable population. Limitations and implications are discussed.

Healthcare is characterized by professional, organizational, and institutional boundaries. Digital health innovations can help overcome these boundaries by providing information access to all healthcare professionals. Such innovations emerge from inputs from different health professionals at different positions along the entire care process and have the potential to substantially change the way in which interprofessional tasks are performed among the involved professionals. Consequently, as less empowered professionals, physiotherapists may resist the adoption of digital health innovations in particular if the innovation is dominated by physicians, and thus the not-invented-here syndrome may become a major barrier. We aim to examine whether the origin of a digital health innovation affects German physiotherapists\' adoption decision and whether the collaboration quality and physiotherapists\' proactive job crafting behavior may help overcome adoption barriers. We applied a mixed-method sequential design with a qualitative study one in which we interviewed 20 physiotherapists to provide exploratory insights, and a quantitative study two in which we tested our proposed hypotheses with survey data including an experimental vignette from 165 physiotherapists. Physiotherapists adopt digital health innovations developed by their own professional group more likely than digital health innovations developed by physicians. Our results also confirm that physiotherapists\' job crafting behavior and the quality of the collaboration with physicians weaken the resistance against physician-driven innovations. Our study underlines (1) the need to involve allied health professionals as physiotherapists in digital health innovation development, (2) the relevance of interprofessional collaboration in daily practice and, (3) an open mind set of allied health professionals to cope with innovation adoption barriers.

BACKGROUND: Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients.
METHODS: The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy.
METHODS: These patients were diagnosed with Trousseau syndrome.
METHODS: All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined.
RESULTS: The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month.
CONCLUSIONS: Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.

The rise in child and adolescent mental health concerns has led to the need for an expanded workforce to meet the needs of our nation\'s families. Peer paraprofessionals (PPs) have proven to be impactful in the areas of adult mental health (MH) and substance use disorders, and for persons with chronic medical conditions. PPs can contribute to addressing child, adolescent, and family MH needs by being deployed in community settings and providing both emotional and tangible support to families and children. Additional use of PPs can address equity gaps in MH services by improving access to support and enhancing the cultural acceptability of MH interventions. A concentrated effort to expand and develop this workforce may help to alleviate the strain on the current MH system. The Georgetown University Infant and Early Childhood Certificate program is a paraprofessional training program that prepares community members to meet the MH needs of families with young children. The authors will describe the results of a qualitative study examining the landscape of peer paraprofessional services in DC that was conducted to support the expansion of the peer workforce to include individuals with expertise in infant and early childhood mental health.

BACKGROUND: When a new guideline is published  there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings.
METHODS: Five organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders\' identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change.
RESULTS: Therapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location.
CONCLUSIONS: The Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model.
BACKGROUND: This study does not report the results of a health care intervention on human participants.

Possession of a firearm without a certified valid license is against Nepalese law. Following a decade-long civil war, Nepal government issued stringent laws not allowing public to possess firearms without a valid reason, despite bearing a license. However, there are people who possess and use firearms for hunting purposes. The present case reports an accidental death of a teenage boy who used a musket for hunting. The present case highlights the fact that despite these stringent laws, illegal possession of arms for trophy hunting is still prevalent in rural Nepal. Furthermore, this study aims to highlight the importance of paramedics in early intervention, stabilization and transport of the sick and injured to the hospital in emergency situations. Also, recruitment of paramedics in the ambulance service might have prevented untimely death in this particular case.

Suicide is still an important issue in developed countries. The problem affects all age groups and both sexes, although usually more commonly middle-aged men. Attempted suicides committed by taking drugs ended in death are rare (regardless of gender, age, social group) except among health professionals who have easy access to medications and the knowledge of their use. This paper describes a case of a paramedic\'s suicide and discusses the literature on the issue of suicides in terms of statistics. The paramedic, who is the subject of this case story suffered from depression and alcohol dependence and committed suicide at work using the medicines available in the Medical Air Rescue service: morphine, diazepam, etomidate and rocuronium. Toxicological studies revealed that the man had also been taking sertraline, a commonly used antidepressant. The reasons for suicide among healthcare professionals are the same as for the general population; however, given the extremely high work-related stress and easy availability of drugs that can be effectively used to commit suicide, a special approach to the issue is necessary.

Announced in 1855, the Désormeaux endoscope articulated a scope expansion in medical utility of the uréthroscope initially presented to the Académie de médecine in late 1853. The former epochal term was never formally claimed, and although evidencing creative thinking by Désormeaux himself, production was a poorly acknowledged but seemingly close collaboration with two leading Parisian instrument makers: Maison Chevalier for the optical parts and Maison Charrière for the accessory catheter.

BACKGROUND: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.
OBJECTIVE: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.
METHODS: a mixed method comparative case study.
METHODS: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016).
RESULTS: 489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min).
CONCLUSIONS: This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions\' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, this case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.