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Introduction Canadian occupational therapists are employed as case managers on assertive community treatment (ACT) teams to support community living for individuals with severe and persistent mental illnesses. In this position, occupational therapists act primarily as generalists, typically attending appointments with clients, supervising medication adherence, supporting basic living needs, and managing client crises. Occupational therapists may also provide psychotherapy and coping skill groups, as well as profession-specific practices, such as skills training. Exploring how ACT occupational therapists describe their perceived ideal practice may support transformation in long-standing, occupational therapy practices on ACT teams. Method This qualitative, interpretive description study involved 11 Canadian ACT team occupational therapists in one individual, semi-structured in-depth interview using an interview guide containing open-ended questions. Interview transcripts were analyzed to identify themes pertaining to therapists’ descriptions of their perceived ideal occupational therapy practice on ACT teams. Results Three themes emerged: (a) Engaging in practice “with intention”; (b) Finding the space for occupational therapy practice; and (c) Supporting clients in their recovery to find their best occupational self. Conclusions The findings highlight practice possibilities for occupational therapist working on ACT teams and provide a foundation for advocating for better use of specific occupational therapy practices within community mental health settings.

BACKGROUND Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. PURPOSE To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. METHODS Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. RESULTS Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. CONCLUSIONS PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.

Background Physician assistants (PAs) and nurse practitioners (NPs) have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. Purpose To evaluate workforce patterns of PAs and NPs working in nephrology over the past decade. Methods Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. Results Surveys of nephrology practitioners show the evolution of the dialysis-centralized practitioner to one encompassing all aspects of nephrology: hospital, intensive care unit, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. Implications for practice Physician assistants and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.

Introduction An occupational repertoire is the array of occupations that an individual has the perceived capacity to perform at a specific point in time. The Occupational Repertoire Development Measure – Parent is a new tool that uses parent report to identify the occupations children can and do perform and their interests in and opportunities for doing them. This study aimed to test the face validity, comprehensiveness, and internal consistency of the Occupational Repertoire Development Measure – Parent as a tool to measure the occupational repertoire of children aged between 2 and 12 years. Method Twenty-nine occupational therapists completed an online questionnaire about the Occupational Repertoire Development Measure – Parent, and 27 parents completed it and then provided feedback via a structured interview. Descriptive statistics, content analysis, and the content validity index guided data analysis. Results Participants view the Occupational Repertoire Development Measure – Parent as practical, simple, and supportive of occupation-centred practice to optimize children’s development of a meaningful repertoire. Overall, self-care occupations were rated highly relevant. Lower-scoring occupations were those perceived as performed only by older children, nonessential for children with disabilities, or culturally unimportant. Conclusion Results indicate value in the further development of the Occupational Repertoire Development Measure – Parent and validate that it asks relevant questions to understand a child’s performance, engagement, and opportunities, leading to optimal repertoire development.

This article presents an unusual case of appendicitis in pregnancy complicated by the novel coronavirus (SARS-CoV-2). The novel coronavirus has affected the way medicine is practised across most parts of the world with over 160 000 000 global cases to date. Tackling management of these cases is more complex when other pathological processes are ongoing. Appendicitis is a common occurrence in pregnancy, with most obstetric centres seeing about one or two cases a year. Though maternal morbidity and mortality are relatively unimpacted by this event, fetal loss and preterm labour are common sequelae. This case involves a 35-year-old woman presenting in her third trimester with abdominal pain and who went on to be diagnosed with concurrent appendicitis and SARS-CoV-2 infection. Although spinal anaesthesia would be most appropriate as it avoids aerosol generation, general anaesthetic techniques were indicated due to thrombocytopenia in this case. She underwent a successful appendicectomy, although preterm delivery was indicated as a result of maternal and fetal concerns.

Introduction: Many models of human occupation are predicated on the notion that environments or contexts influence occupational performance and engagement. By extension, it can be considered that c...

Introducao: Muitos modelos de ocupacao humana sao baseados na nocao de que ambientes ou contextos influenciam o desempenho ocupacional e o engajamento. Por extensao, pode-se considerar que os conte...

Aging of the population in the United States and increasing incidence of chronic diseases such as diabetes, hypertension, and CKD have contributed to a growing demand for healthcare services. Increasingly, healthcare organizations employ Physician Assistants (PAs) and Nurse Practitioners (NPs)

Background. Foundational to the occupational therapy profession is the belief that engagement in occupation is health promoting; however, this belief fails to account for occupational engagement that may be risky or illness producing. Consensus regarding the nature of the relationship between occupation and health has yet to be achieved. Purpose. The purpose of this study is to provide a comprehensive description of how the relationship between occupation and health and well-being is discussed within the occupational therapy and occupational science literature. Method. The methodological framework outlined by Arksey and O’Malley served as the basis for this scoping review of the occupational therapy and occupational science literature. Findings. One hundred and twelve articles were identified as meeting the criteria for inclusion. The dominant discourse portrays the relationship between occupation and health as positive. Implications. The broader literature suggests that occupational engagement can have both positive and negative effects on health and well-being. As such, the reconceptualization of the relationship between occupation and health and well-being is warranted to enable occupational therapists to practise in a more client-centred manner.

There is currently little research concerning occupations that may be detrimental rather than beneficial to health and well-being. This study used interpretative phenomenological analysis (Smith & Osborn, 2003) to explore one young man's experience of binge drinking; an occupation typically associated with varying health risks. Viewing his subjective account of binge drinking through the lens of Wilcock's (1993) theory of the human need for occupation, it could be regarded as an occupation to maintain aspects of health and well-being and therefore have some constructive elements. This study lends qualified support to Wilcock's hypothesis, suggesting that the relationship between occupation, health and well-being is far more complex than much of the earlier occupational science research proposed.

Management of patients with chronic kidney disease has evolved since the last Kidney Disease Improving Global Outcomes clinical practice guideline was published in 2012. This article reviews the most recent guidelines, common management issues in primary care, kidney risk and outcome calculators, and over-the-counter medications that may cause community-acquired acute kidney injury.

En effet, la communaute mondiale en ergotherapie peut et doit travailler en collaboration afin de promouvoir les valeurs communes sous-jacentes de la profession; par exemple, le droit de tous les individus, communautes, groupes et populations a s’engager dans des occupations signifiantes ou a l’habilitation de leur participation occupationnelle en ayant acces a des services justes et equitables et en evoluant dans des milieux justes et equitables (p. ex., Townsend et Polatajko, 2013). Pour etre indexees, ce qui est requis pour faire une demande de facteur d’impact au Journal Citation Reports, ces revues doivent demontrer que les articles qu’elles publient sont largement cites, et ce, dans des revues publiees en anglais. Toutefois, recemment, ces revues sont passees a la publication bilingue en ajoutant des manuscrits en langue anglaise et, dans certaines situations, comme pour le Brazilian Journal of Occupational Therapy (BrJOT; http://www.cadernosdeterapiaocupacional.ufscar.br), en publiant des articles dans trois langues. (Ont.), OTR, OT(C) Redactrice en chef adjointe / Coredactrice Revue canadienne d’ergotherapie Ana Ana Paula Serrata Malfitano, PhD, OT (Bresil) Redactrice en chef, Brazilian Journal of Occupational Therapy Professeure, Federal University of Sao Carlos, UFSCar, Sao Carlos, Sao Paulo, Bresil

Occupational engagement (OE) has been presented as a core construct in occupational therapy; however, its broad conceptualization and confounding definitions are problematic. Clarifying the construct of OE would help occupational therapists to explicate the nature of their practice. The purpose of this study was to explore occupational therapists’ perspectives of the construct of OE. Qualitative descriptive methodology was used to collect data using semistructured interviews with nine practicing occupational therapists in the Greater Toronto Area. Qualitative content analysis, using an inductive approach, was employed to uncover emerging categories. Participants spoke about transitioning from therapeutic engagement to OE with a client by following a client’s path of choice. The essential elements and influencers of OE were highlighted, and the relationship between OE and occupational performance was discussed. The findings provide an initial understanding of essential elements necessary to enable clients to initiate engagement in therapy and then, subsequently, in occupations of their choice.

Kidneys in a Box (KIB) was developed to identify the effect of a performance improvement CME (PI-CME) project on the management of patients with diabetes who are at risk for chronic kidney disease (CKD). The program provided nonnephrology practitioners with research-based interventions known to slow CKD progression.PAs were given the KIB tool kit, which described the scope of CKD identified high-risk diagnoses such as diabetes, and listed six modifiable risk factors that have been shown to slow progression of diabetic kidney disease when implemented. The PAs self-selected the factor(s) and evaluated 10 charts of patients diagnosed with diabetes before implementing the modifications. After implementing changes for a minimum of 12 weeks, the PAs again self-selected 10 different charts and evaluated the extent of the intervention application. A preintervention/postintervention assessment and demographic sheet were then submitted to the American Academy of Nephrology PAs for CME credit.302 PAs completed the program in the first 24 months, with full data available for 213 PAs. Statistically significant improvement was shown in five of the six areas: CKD staging, urine albumin-creatinine ratio (UACR), statin use, over-the-counter (OTC) yellow alert medications, and A1C. Improvement in smoking cessation interventions did not reach statistical significance.Known interventions to slow progression of diabetic kidney disease can be effective if implemented in early stages of the disease. KIB demonstrates that education focused on the nonnephrology PA can be effective in slowing CKD progression.

Acute kidney injury (AKI) complicates up to 20% of all hospital admissions. Responding to the increase in admissions, complications, mortality, morbidity, and cost of AKI, Kidney Disease: Improving Global Outcomes convened an expert panel to study the issue, review the literature, and publish guidelines to evaluate and treat patients with AKI in the acute setting. This article reviews those guidelines.

OBJECTIVE. The aim of this scoping review was to describe the characteristics and features of substance abuse interventions for women in North America and discuss the findings from an occupational perspective. METHOD. A scoping review was conducted to examine North American peer-reviewed literature published between 2001 and 2014. Four databases were searched using terms related to intervention, substance abuse, and women only. Descriptive statistics of categorical groupings were used to describe the data sources and characteristics and features of the interventions. RESULTS. Forty-two articles met the inclusion criteria, with the majority citing a harm-reduction approach and using multifaceted interventions with various targets for change. CONCLUSION. Substance abuse interventions for women are typically multifaceted and follow a harm-reduction philosophy. Further research into the efficacy of interventions that more specifically target occupation beyond substance use is needed.

Background. Many health professionals, including occupational therapists, have difficulty utilizing research findings in daily practice. Purpose. To determine if an online action research project could enhance research use among occupational therapists working in similar practice areas. Methods. Four groups of 12–14 occupational therapists met online for approximately one year. They discussed barriers and facilitators to research utilization, defined practice questions, and attempted to search for, synthesize and apply relevant research findings. Online communications and post-group interviews were thematically analyzed. Results. Only half of the participants who began the project were still online with the research project at completion. These participants believed that their involvement in the group led to increased personal awareness, motivation and confidence regarding the use of research evidence in practice and knowledge to be used in practice. Time to review, critique and synthesize research evidence continued to be a major barrier to enhanced research utilization. Practice Implications. Online meetings designed to enhance research use among occupational therapists appear to hold some promise, but refinements are needed to ensure their ultimate success.

A case involving a woman with normal sonographic findings at genetic amniocentesis who had a ruptured cornual ectopic pregnancy at 19 weeks gestation is discussed.