Class of 2017 Abstract / Objectives: To conduct a scoping review of studies involving healthcare professionals as study subjects and to describe the methods used, identify the topics researched, and describe the rationale and limitations of using healthcare professionals as subjects. Methods: The study was a scoping review of research utilizing health professionals as study subjects. A comprehensive literature search was conducted in several databases. Two investigators independently screened studies, collected data, and met to resolve discrepancies. Results: Sixty-five studies met the eligibility criteria. Forty-six percent of the studies evaluated cardiovascular events, 25% evaluated cancer, 9% examined ophthalmic events, 5% examined cognitive issues, and 17% miscellaneous topics. Of the 65 studies, 88% were prospective cohort studies. Questionnaires were utilized as the data collection method in 59 studies (91%). Physicians were the primary study subject in 30 studies (46%) and nurses in 20 studies (31%). No study included in the sample identified pharmacists as study subjects. A total of 41 studies (63%) did not list rationales or limitations to utilizing health professionals as subjects. Of the 24 studies that did discuss rationales and limitations, the most frequently cited advantage was reliable self-reporting (38%). The most common limitation to generalizability was high socioeconomic status. Conclusions: Questionnaires were the most common method used to collect data. Physicians were the most often studied health professional. High reliability of data reporting was a common rationale in using health professionals as subjects. The lack of studies utilizing pharmacists as subjects demonstrates an opportunity that should be further evaluated.

Transtibial amputation is a major surgical procedure where both short- and long-term perspectives are important. The surgical method can directly impact stump quality which can affect the prosthetic user’squality of life.  The aim of this scoping review is to summarize and give an overview of the research area of different incision types in relation to prosthetic rehabilitation, to help future researchers and potentially unveil areas where further research is needed. The research question: What is the data available for Different Transtibial Amputation Techniques in Prosthetic Rehabilitation, which was divided into three sub questions. The 6-step framework for scoping reviews by the Joanna Briggs Institute was used to structure the review. From a total of 736 studies screened, 28 were selected and mapped onto 12 different outcome measures. Extensive data were found regarding what amputation method has what surgical outcomes. Areas that appear to have research gaps are dressing types and contractures when contrasted with surgical methods. No study could be found regarding length of hospital stay and the Skew flap method. We conclude that there is a research gap when it comes to patient reported assessments, surveys and qualitative evaluations. / Transtibial amputation är ett större kirurgiskt ingrepp där både kort- och långsiktiga perspektiv är viktiga. Den kirurgiska metoden kan direkt påverka stumpkvalitet vilket kan vidare påverka protesanvändarens livskvalitet. Syftet med denna Scoping Review är att summera och ge en överblick över forskningsområdet inom olika typer av kirurgiska snittföringar i relation till protesrehabilitering för att hjälpa framtida forskare och eventuellt avslöja områden där vidare forskning behövs. Forskningsfrågan var: Vad finns det för data tillgänglig för olika transtibial amputationsmetoder i protesrehabilitering, vilket delades upp i tre delfrågor. Ett sex-stegs ramverk för Scoping Reviews från Joanna Briggs Institutet användes för att strukturera översikten.Av totalt 737 studier som granskades var 28 utvalda och kartlagda till 12 olika utfallsmått.  Omfattande data hittades om vilken amputationsmetod som har vilka kirurgiska resultat. Områden som verkar ha forskningsluckor är postoperativt förband och kontrakturer i kontrast till amputationsmetod. Ingen studie kunde hittas angående längden på sjukhusvistelsen med vriden sidolambå. Vi drar även slutsatsen att det finns en forskningslucka när det gäller patientrapporterade bedömningar, undersökningar och kvalitativa utvärderingar

Purpose: This thesis focuses on the development of occupational therapy competencies to enable executive occupational performance with school-aged children and youth. Methods: Three studies were structured according to the knowledge inquiry, synthesis, and product stages of the Knowledge To Action cycle (Graham et al., 2006). A scoping review in Phase One explored how executive functioning is described in the occupational therapy literature. In Phase Two, a qualitative study was conducted to determine how occupational therapists who have worked with children and youth perceive executive functioning to be understood and addressed. Phase Three used established competency development processes to produce an occupational therapy competency model and framework for enabling executive occupational performance. Results: Although there is little consensus on how executive functioning is understood, literature reviewed in Phase One demonstrated its pervasive effect on performance of complex, novel, and goal-directed occupations. Emerging themes suggest that assessment requires occupational, dynamic, and performance-based approaches, with interventions rooted in metacognitive frameworks. The Phase Two qualitative study suggested that, although there are challenges to being able to “see” executive functioning, it is necessary to explicitly and systematically consider executive functioning during clinical reasoning. Learning to “see” through the executive functioning lens is a complex process. The competency framework development process utilized in Phase Three yielded the Competencies in Context Model. Responding to series of contextual challenges related to system, client, and occupational therapist factors, professional assessment, intervention, iii knowledge acquisition, and knowledge translation competencies are used to organize 16 specific occupational therapy practice competencies. Conclusion: Points of tension within the literature and the field have implications for occupational therapy curricula, research, practice, and professional development. Executive functioning issues have wide reaching effects on occupational performance of children and youth that have not been adequately recognized or explored in the occupational therapy literature. The competency model and framework developed through this research make a substantive contribution to the field in beginning to redress the dearth of occupational therapy-specific models, resources, and tools designed to support occupational therapists’ acquisition or implementation of the executive functioning perspective. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-08-26 22:27:09.05

This scoping review examines the available evidence supporting accommodation use in the assessment of health professionals with disabilities in licensing contexts. While test accommodations are a protected right under antidiscrimination legislation, the peer-reviewed evidence informing their use is contested and widely dispersed. Furthermore, the ramifications of accommodation misuse are significant, including human rights violations and increased risks to patients. As such, this study addressed two research questions: 1) What is the current state of literature on accommodation use in the assessment of health professionals? and 2) What programs of research would address stakeholders’ concerns about the use of accommodations in the assessment of those professionals? Systematic searches of five prominent databases identified 15 articles for analysis. Several major themes emerged from that analysis: interpreting legislation, administration and process, relationships between education and licensure, and psychometrics and test development. Stakeholder consultation revealed that stakeholders face challenges managing accommodation requests and defining reasonable accommodations. While there is a paucity of literature on the topic overall, especially of an empirical nature, this study mapped the available evidence and laid the foundation for future studies by delineating the gaps in the scholarly literature as defined by stakeholders’ needs.

Introduction: Innovations in modern medicine have led to the development of many effective laboratory tests for diagnosis and monitoring of disease. However, research suggests that 20-50% of tests may be inappropriately ordered. Test-ordering intervention development experts i.e. those staff at individual institutions who are tasked with designing different approaches to improving test-ordering practice, often have large datasets on the test-ordering practices within their jurisdiction as part of clinical care, but often have no clear guidance on how to choose which tests are worthy of intervention. These staff can include both clinicians and knowledge translation experts working in separately or in tandem to improve test-ordering behaviours at their institutions. The overall aim of this research is to build a prioritization framework to assist healthcare organizations in deciding which tests are worth targeting for intervention. Methods: The first stage of this project was a scoping review of the literature, the purpose of which was to determine the factors and processes used by intervention developers to choose which tests to target for intervention. Identification of these articles allowed for the descriptive analysis of the factors and processes reported in making the test-ordering decisions. The second stage involved semi-structured interviews with intervention development experts and contains information on their experiences with measuring and prioritizing among factors, as well as which processes they found to be most effective in making the decision on which tests to target for intervention. Results: By exploring all relevant guideline statements and related empirical studies, we gathered a wide range of factors to consider when deciding which test(s) to target for intervention. Overall, we identified 18 factors in our review and 30 in our interviews, highlighting the potential complexity of these decisions. While our studies were not the first to demonstrate that targeting tests is complex and that many factors must go into the decision of deciding which tests to target, our work has identified the most comprehensive range of factors available. We also explored processes reported by the studies that led to these decisions. Of the nine processes identified in our review, some were identified in a majority of cases (literature review, followed by clinical standard-implicit and consensus process), and other processes far more infrequently. Our interviews with relevant stakeholders demonstrated that the interviewees used 18 unique processes to decide which tests to target for intervention and helped to prioritize among the processes that are most effective in making these decisions. Conclusion: The current work prepares the way to develop a framework designed to help intervention developers choose which tests can most efficiently result in improved test-ordering processes. After additional interviews to ensure saturation of themes, we will be able to proceed with framework development, perhaps involving a consensus process of all relevant stakeholders. We hope to widely distribute our framework to assist intervention development experts working in a wide variety of milieus to help them decide which tests are worth targeting for intervention such that their respective institutions can provide the highest quality of care to patients.

My thesis examines the interprofessional collaboration between school-based educators and health professionals (HPs). Four research questions guided the study: 1) What is the current state of literature on interprofessional collaborations between school-based educators and HPs? 2) Based on the existing literature, how are school-based educators and HPs collaborating interprofessionally? 3) Based on the existing literature, what are the outcome(s) or impact(s) of interprofessional collaborations between school-based educators and HPs? and 4) Based on the current state of the literature, what areas are important to consider for future research on interprofessional collaborations between school-based educators and HPs? It is important for both school-based educators and HPs alike to consider answers to these questions as it can refine and strengthen their current and future practices in an effort to ultimately create a successful working and learning environment for themselves and for their students and patients. Systematic searches of four databases yielded 46 articles for inclusion, data extraction, and analysis. Through a thematic analysis of the literature, I found the following two overarching themes that govern the implementation of interprofessional collaboration: 1) time and 2) funding. In addition to these themes, I extracted two major themes and one minor theme from the literature that can guide current and future interprofessional collaborative practices. These themes included 1) pre-service training whereby a) everyone is involved, b) there is a mutual understanding between and of educators and HPs, c) both educators and HPs feel valued in their positions for their work, d) there is less sophisticated profession-specific jargon which can in turn open further dialogue between both teams of professionals, and e) a journal or frequent log can be kept to track the successes and challenges of and suggestions for the collaborative efforts as well as of student satisfaction; and 2) in-service training whereby a) educators and HPs are able to maintain consistency in their roles and responsibilities as well as for students educationally, and b) provide continued support for all. I discuss methods of how this interprofessional collaboration could be implemented, noting a) proximity (i.e., how closely, in what ways, and how frequently educators and HPs work together) and b) frequent meetings as essential to successful interprofessional collaboration. Finally, a minor theme emerged from the literature with suggestions for current and ongoing implementation of interprofessional collaboration which suggested a) increased and stronger liaison in schools and b) frequent meetings to establish and build upon a foundation that will foster further interprofessional collaboration. This review of the available literature on this topic, especially of the literature empirical in nature, worked to map key concepts, evidence, and main sources of information as well as synthesize a myriad of information (Arksey and O’Malley, 2005), fill a visible gap in the area of interprofessional collaboration among school-based educators and HPs specifically, and provide avenues for further study and practical application.

Background: Construct validity refers to the degree to which tests that claim to measure a “construct” (i.e., an inferred concept that is intangible regarding an individual’s health or internal state such as a disease, or postulated attribute) are truly reflective of that specific construct. It is suggested that construct validity is an important concept in preclinical research, as it may help reduce misinterpretations of study results allowing for better ability to predict the success of clinical translation of preclinical studies. However, there is a lack of empirical evidence to confirm its impact on preclinical research efficacy. Objectives: (I) Conduct a scoping review of the construct validity literature as it relates to the design of in vivo animal studies. (II) Conduct an overview of systematics reviews evaluating the application and reporting of construct validity within systematic reviews of in vivo animal studies. Methods: For the scoping review, we searched Embase, MEDLINE, and Google Scholar. Eligibility criteria was intentionally broad as we included any article that mentioned construct validity in preclinical in vivo research. Further review of citations was performed on eligible studies that provided substantial discussion on construct validity. For the overview, we searched MEDLINE, Embase, and TOXLINE for systematic reviews of preclinical in vivo interventions. The outcomes of interest were the prevalence of systematic reviews that mentioned construct validity and the prevalence of reviews that assessed construct validity. Results: The literature searches for the scoping and overview yielded 3657 and 2356 articles, respectively. After screening 372 and 444 met inclusion criteria for the scoping and overview. Six codes were generated (theory; mechanism; matches the human condition; measures what it reports to; experimental conditions; and outcomes) from the content analysis for the definition of construct validity. Of the 444 systematic reviews, seven mentioned construct validity, but only three used the term construct validity directly. None of the systematic reviews assessed construct validity. Discussion/Conclusion: Construct validity was not defined uniformly among studies suggesting it is not clearly understood. There was limited reporting on construct validity in systematic reviews and entirely no assessment of it; this may reflect a lack of awareness of this concept. Future research should aim to find a consensus on the definition of construct validity in order to develop tools and frameworks to help researchers assess construct validity.

Perceptionsavvikelser är vanliga hos personer med autism och kan utlösa problemskapade beteenden, stress och obehag. Påverkas förmågan att utföra aktiviteter kan detta ge negativa konsekvenser på människans välbefinnande och hälsa. En scoping review genomfördes i syfte att utforska om och på vilket sätt bearbetning av sinnesintryck påverkar utförande av vardagliga aktiviteter hos barn och ungdomar med autism. Tjugoen artiklar inkluderades i studien. Resultatet presenteras i tre kategorier: Autismens inverkan vid bearbetning av sinnesintryck; Kontextens betydelse i bearbetning av sinnesintryck; Bearbetning av sinnesintryck påverkar aktivitetsutförandet. Som konklusion påverkar avvikande bearbetning av sinnesintryck beteende, aktivitetsutförande och tolkning av omgivningen vilket bör belysas tidigt i den arbetsterapeutiska bedömningen och vid insatser.

Introduction: Improvements in the delivery of intensive care have led to a growing number of children with chronic medical conditions at significant risk of recurrent and prolonged critical illness. These patients are increasingly described as having pediatric chronic critical illness (CCI). To date, pediatric CCI is without an accepted consensus case definition. Objective: To evaluate how pediatric CCI has been defined in the current literature, including the concept of prolonged PICU admission, and describe the methodologies used to develop any existing definitions. Secondary aims included describing patient characteristics and outcomes evaluated in included studies. Methods: We searched four electronic databases for studies evaluating children identified with “CCI.” We also searched for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. We developed a hybrid crowdsourcing and machine-learning (ML) methodology to complete citation screening. Screening and data abstraction were performed by two reviewers, independently and in duplicate. We completed data abstraction including details of population definitions, demographic and clinical characteristics of children with CCI, and outcomes evaluated. Results: Twenty-eight reviewers from 11 countries performed citation screening, with a mean sensitivity of 92%. Of 24,729 unique citations assessed for eligibility, 453 full-texts were reviewed and 67 studies were included. Of these, 12 studies (18%) defined CCI, most commonly by a prolonged PICU length of stay (LOS), either in isolation or in addition related to medical complexity patient characteristics and/or readmissions rate. The concept of prolonged PICU admission was defined in an additional 55 (82%) studies by a median of 14 days (range, 1 day-6 weeks). Conclusion: To our knowledge, this scoping review provides the most comprehensive epidemiologic evidence addressing pediatric CCI. Our results suggest a uniform consensus definition is needed in order to advance this emerging and important area of pediatric critical care research. / Thesis / Master of Science (MSc)

Background: Internationally educated nurses (IENs) have become a significant source of nursing supply as a result of nursing workforce shortages, the aging population and patient acuity. However, IENs face substantial delays and barriers obtaining licensure and employment equivalent to their skills and experience. When IENs are unable to practice their profession, they experience a considerable loss of professional identity, earning potential and financial stability. The purpose of this scoping review was to identify and map key themes in the existing literature on the barriers and strategies to timely nursing registration for IENs. Methods: Arksey and O’Malley’s methodological framework was used for this study. Seven electronic databases were searched along with several grey literature sources in order to capture articles that discussed barriers and strategies to timely nursing registration for IENs. A numerical and thematic analysis was conducted to explore the scope of the literature and to present the findings. Results: After full-text screening, 38 pieces of relevant literature were selected for inclusion in the review. The majority (53%) were studies and most (42%) were qualitative. Seven key themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. Conclusion: While some IENs are able to successfully navigate the process for obtaining nursing licensure, it is clear that many IENs face obstacles at every step of the process and some never become registered as nurses. Further research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this scoping review have significant implications for nurse staffing and policies and practices to improve the strength, stability, and diversity of the nursing workforce. / Thesis / Master of Science in Nursing (MSN) / This study explores the literature on internationally educated nurses (IENs) and the difficulties they face, as well as the strategies they use to obtain nursing registration. Arksey and O’Malley’s framework was used to guide this scoping review. Seven databases were searched along with many grey literature sources in order to find articles on barriers and strategies to nursing registration for IENs. A numerical and thematic analysis was conducted to present the findings. Seven main themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. More research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this study are important for nurse staffing and policies and practices to improve the stability and diversity of the nursing workforce.