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Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.

The current lack of sustainable and affordable housing is a global issue which has reached a crisis point. Traditional construction approaches used to solve sustainability issues in housing are often in tension with affordability, where the achieving one of these two aims is often to the detriment to the other. The application of Design for Disassembly (DfD) in combination with Industrialised Construction (IC) can simultaneously provide environmentally and economically sustainable solutions to these ongoing housing challenges. However, the application of DfD and the planning of varying lifespans for different building components raises issues with the conventional Whole Building Life Cycle Assessment (LCA) methodology, which is used to quantify environmental impacts of the construction.This paper covers three theoretical objectives: (1) to provide an overview of DfD and IC and how these can be combined to provide resource efficient, affordable housing (2) examine how the Shearing Layers concept can extend the building lifespan and better ensure a sustainable End-of-Life, and (3) a preliminary outline proposal as to how the Whole Building LCA methodology, based on existing standards, can be adapted to align with the Shearing Layers. These objectives will be achieved through a literature review, covering the theoretical principles of DfD and the key ISO standards related to LCA. Based on the literature and applied theory, a preliminary aggregated LCA methodology is proposed that will be further developed and tested using case studies in future investigations by the author.The result of the discussion reveals potential conflict between construction in practice and applying Shearing Layers and the adapted Whole Building LCA and the need for further investigation to establish the number of years assumed for each layer of the LCA. Whilst inventory data for materials and processes follow conventional practices, it is the proposed organisation of information into layers illustrates to designers the need to design housing for disassembly to remove and replace building components.

Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform.A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation.Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role.Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.

Background Magnetic resonance (MRI) scanning of the heart is an established part of the investigation of cardiovascular conditions in children. In young children sedation is likely to be needed and multiple controlled periods of apnea are often required to allow image acquisition. Suppression of spontaneous ventilation is possible with remifentanil, however the dose required is uncertain. Aims To establish the dose of remifentanil, by infusion, required to suppress ventilation sufficiently to allow a 30 second apnea during MRI imaging of the heart. Method Patients aged 1 to 6 years were exposed to different doses of remifentanil and the success in achieving a 30 second apnea was recorded. A dose recommendation was made for each patient, informed by responses of previous patients using an adaptive Bayesian dose escalation design. Other aspects of anesthesia were standardized. A final estimate of the dose needed to achieve a successful outcome in 80% of patients (ED80) was made using logistic regression. Results 38 patients were recruited, and apnea achieved in 31 patients. The estimate of the ED80 was 0.184 µg/kg/min (95% CI 0.178-0.190). Post-hoc analysis revealed that higher doses were required in younger patients. Conclusion The ED80 for this indication was 0.184 µg/kg/min (95% CI 0.178-0.190). This is different from optimal dosing identified for other indications and dosing of remifentanil should be specific to the clinical context in which it is used.

Objective The primary aims of this study were to explore: (1) manifestations of socio-environmental models of allied health support provision in the disability sector; and (2) narrative experiences of individual allied health professionals in the disability sector. Methods A narrative qualitative study using interviews from a purposive sample of two allied health professionals working in the disability sector explored manifestations of socio-environmental models of allied health support provision and their experiences from case examples. The key informants had more than 10 years of experience in the disability support services setting. Results Seven key themes exploring manifestations of socio-environmental models of allied health professional practice in the disability sector emerged: (1) dignity of risk; (2) models of care; (3) considerations when working in the supported person’s environment; (4) goal-oriented work; (5) informed choice and informed consent; (6) reactive and flexible plans; and (7) training and education role. Conclusions Socio-environmental models of allied health support provision in the disability sector focus on empowering people with disability to achieve their goals. This may require displacement of cultural norms within the allied health professions. What is known about the topic? Socio-environmental models of allied health support provision in the disability sector focus on empowering people with disability to achieve their goals. What does this paper add? Displacement of cultural norms within the allied health professions may be needed to promote positive risk taking. Challenges for allied health professionals remain in navigating conflicting goals between clients and family members, empowering informed choice and consent, and working in uncontrolled environments. What are the implications for practitioners? Adopting training and education roles for clients, family members and carers when implementing National Disability and Insurance Scheme plans may represent one of the many pragmatic and flexible approaches to achieve people’s goals.

Background and purpose: Falls in older adults is a major issue for health care organisations. Footwear is often reported as a contributing factor to falls in older adults; however, the reporting of footwear styles that are proposed to increase falls and falls risk is confusing. Moreover, these reports have been used to inform falls guidelines and recommendations by health practitioners. A systematic review was performed to identify and synthesize the available evidence examining whether there was support of a causal or correlational relationship between different styles of footwear and falls in older adults in real-life settings.Method: The databases included in the search were Ovid MEDLINE, PubMed, Scopus and Web of Science. The inclusion criteria were papers with falls outcomes, healthy adults that were 65 years or older. The footwear styles included slippers, Oxford/lace ups, high heels, boots and sandals. The exclusion criteria were laboratory studies and papers with primary focus on gait issues that ...

Falls have a profound effect on the quality of life of older adults. As the population ages, falls are an increasing financial burden for health services worldwide. Footwear styles and particular footwear features have been implicated as a risk for falls. When recommending footwear for falls, health practitioners rely on guidelines that are based on the available evidence. There is limited robust evidence supporting footwear recommendations in falls prevention. This thesis reviewed the available evidence on footwear styles and features and provided evidence in regard to particular footwear styles commonly worn by older adults and their effect on gait parameters.

Background:Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls.Methods:A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm.Results:The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear.Conclusions:This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education. (J Am Podiatr Med Assoc 103(6): 465–470, 2013)

The Victorian Assistant Workforce Model (VAWM) enables a systematic approach for the identification and quantification of work that can be delegated from allied health professionals (AHPs) to allied health assistants (AHAs). The aim of the present study was to explore the effect of implementation of VAWM in the community and ambulatory health care setting. Data captured using mixed methods from allied health professionals working across the participating health services enabled the measurement of opportunity for workforce redesign in the community and ambulatory allied health workforce. A total of 1112 AHPs and 135 AHAs from the 27 participating organisations took part in the present study. AHPs identified that 24% of their time was spent undertaking tasks that could safely be delegated to an appropriately qualified and supervised AHA. This equates to 6837 h that could be redirected to advanced and expanded AHP practice roles or expanded patient-centred service models. The VAWM demonstrates potential for more efficient implementation of assistant workforce roles across allied health. Data outputs from implementation of the VAWM are vital in informing strategic planning and sustainability of workforce change. A more efficient and effective workforce promotes service delivery by the right person, in the right place, at the right time. What is known about this topic? There are currently workforce shortages that are predicted to grow across the allied health workforce. Ensuring that skill mix is optimal is one way to address these shortages. Matching the right task to right worker will also enable improved job satisfaction for both allied health assistants and allied health professionals. Workforce redesign efforts are more effective when there is strong data to support the redesign. What does this paper add? This paper builds on a previous paper by Somerville et al. with a case study applying the workforce redesign model to a community and ambulatory health care setting. It provides evidence that this workforce redesign model enables data to be collected to identify the opportunity for redesign in the allied health workforce in this clinical setting. What are the implications for practitioners? There are career pathways and opportunity for growth in the allied health assistant workforce in the community and ambulatory health care setting. These opportunities will need to be coupled with the development of supervision and delegation skills in the allied health professional workforce to ensure that an integrated workforce is built to provide optimal clinical care in the community and ambulatory setting.

Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls.

During half of this two-hour study, 28 individually tested subjects completed the MMPI. At the outset of the second hour, each subject photographed a frightening view, then described his or her percept of the view as a student artist made a colored chalk drawing of the perceptual experience described. Independent raters later compared the subject's color photograph of the view itself and the colored drawing of the subject's perceptual experience, and rated the extent to which the view itself had been 1) embellished, 2) diminished, and 3) transformed in the subject's perceptual experience of the view. During the conclusion of the second hour, each subject mentally envisioned a frightening image, then described the image as the student artist made a colored chalk drawing of the imaginal experience described. The independent raters, on three more scales, rated the extent to which the drawn image expressed 1) paranoid fear, 2) phobic fear, and 3) chronic fear. Subjects whose perceptual experiences of frightening views transformed the actually viewed stimuli scored significantly higher on the MMPI Schizophrenia scale. In addition, subjects whose frightening images expressed paranoid fear scored significantly higher on both the MMPI Paranoia scale and the MMPI Schizophrenia scale. Such results suggest that artists' drawings of subjects' percepts and images can, with psychological validity, serve to envision other minds.

We evaluated the correspondence between in-person- and telephone interview-derived data on affective symptoms, health-related quality of life, disability days, and medication compliance in patients with bipolar disorder. Twenty-eight outpatients with DSM-III-R-documented bipolar disorder were randomly assigned to an initial in-person or telephone interview. An average of 4.0 days later, they were reassessed by the other interview method. Results indicate good to excellent agreement between telephone and in-person interviews on measures of mania (intraclass correlation coefficient (ICC) = 0.92) and depression symptoms (ICC = 0.90), suicide risk (kappa = 0.80), and alcohol use (kappa = 0.61), scores on the Medical Outcomes Study 36-item Short-Form Health Survey (ICCs = 0.66-0.92), and medication compliance (ICCs = 0.50-0.66). Measures of bed disability days (ICC = 0.34) and restricted activity days (ICC = 0.66) showed less agreement. Telephone interviews are feasible and reliable for collecting data on psychiatric and other health-related outcomes in bipolar disorder patients.

Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls.A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm.The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear.This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education.

The US industrial base has a large set of capabilities that is sometimes difficult to track as an acquisition official. Where the Department of Commerce helps track the most important technological inputs into Army Modernization and individual companies track technological inputs into their own modernization, some of the actual capabilities to ‘modernize’ and upgrade existing electronics are hard to find or evolve rapidly. This paper describes capabilities that have proven to be valueable competencies when modernizing embedded electronics, and what tools and personnel are needed to provide an effective and efficient modernization capability. This will help the acquisition officer or procurement manager know what questions to ask and skills to demand from modernization suppliers.

Objective The aim of the present study was to identify areas where allied health assistants (AHAs) are not working to their full scope of practice in order to improve the effectiveness of the allied health workforce. Methods Qualitative data collected via focus groups identified suitable AHA tasks and a quantitative survey with allied health professionals (AHPs) measured the magnitude of work the current AHP workforce spends undertaking these tasks. Results Quantification survey results indicate that Victoria’s AHP workforce spends up to 17% of time undertaking tasks that could be delegated to an AHA who has relevant training and adequate supervision. Over half this time is spent on clinical tasks. Conclusions The skills of AHAs are not being optimally utilised. Significant opportunity exists to reform the current allied health workforce. Such reform should result in increased capacity of the workforce to meet future demands. What is known about the topic? Increasing skill shortages across Australia’s health workforce necessitates that the capabilities of all healthcare team members should be used optimally. AHA roles are an important and growing response to current health workforce needs. Increasing workforce capacity will ensure the right health workers are matched to the right task by skill, experience and expertise. What does this paper add? This paper presents a model that assists services to identify tasks suitable for delegation to an AHA by an AHP. The model is unique because it describes a process that quantifies the need for AHAs and it has been successfully implemented in rural, regional and metropolitan health services in Victoria. What are the implications for practitioners? Working collaboratively, with executive support, will lead to a sustainable and integrated approach to support workforce capacity building. Altering the skill mix of healthcare teams through increasing the role of AHAs has benefits for AHPs, patients and the healthcare system.

Low Frequency Ultrasonic Debridement (LFUD) provided by the Sonoca 185 is a new method of debriding wounds that is less traumatic, less painful and can achieve faster healing rates. It is bactericidal and enables many debridement treatments to be undertaken by a podiatrist or wound consultant in their smaller clinical setting. Due to the many properties of LFUD the clinical indications for use are vast including but not limited to chronic ulcers, diabetes foot ulcers, leg ulcers, pressure ulcers, infected ulcers and dehisced wounds. As with all treatment methods there are some contraindications to use of LFUD treatment which include but not limited to those patients with vascular abnormalities, those patients with haemorrhagic conditions, over exposed malignancies and tissue previously treated with radiation, deep x-ray or irradiation. This technology is new within Victoria and to the departments of podiatry and wound care specialists. Being so, all staff directly involved with the daily clinical use of LFUD for wound management were up skilled and had to pass competencies to use the treatment modality. In addition, clinical pathways and protocols were developed in order to ensure best patient care was practised. This presentation will give an overview of the process involved in using LFUD including (i) patient selection, (ii) clinical set up, and (iii) considerations during treatment. By discussing and evaluating clinical case studies on the use of LFUD I will further demonstrate its benefits in wounds healing and provide my opinion and experience on the ease of using this effective debriding agent.

After a sharp increase in viral hepatitis cases, mostly type B, among the 2000 employees of a general hospital during three years, we conducted an investigation which consisted of obtaining data on employee cases and surveying many current employees. Of the 38 cases, 22 occurred in non-physician, ward employees. Of 189 current ward employees, 8% had antibody to hepatitis B surface antigen (anti-HBS) and 1% had hepatitis B surface antigen (HBSAg). Hepatitis B virus (HBV) seropositivity was highest for employees who worked closely with hemodialysis and renal transplant patients and for those who claimed that their ward was understaffed. Nine of the 38 cases occurred in clinical lab workers. Of 70 current lab employees, 17% were positive for anti-HBS and none for HBSAg. HBV seropositivity was highest for those working in the chemistry section (highest there among those performing blood-gas determinations and those working with the multi-channel autoanalyzers) and those who routinely got blood on their skin and clothes at work. All seropositive employees worked routinely with blood. These data support the hypotheses that many hospital employees contract hepatitis B from exposure to HBSAg-positive patients and many clinical laboratory employees contract it from exposure to HBV-contaminated blood.