Athletic Trainer\u27s Perceptions of and Experiences With Professional Development Approaches for Enhancing Clinical Documentation

Context Little is known about how athletic trainers (ATs) learn clinical documentation, but previous studies have identified that ATs have a need for more educational resources specific to documentation. Objective To obtain ATs\u27 perspectives on learning clinical documentation. Design Qualitative study. Setting Web-based audio interviews. Patients or Other Participants Twenty-nine ATs who completed 2 different continuing education (CE) clinical documentation modules. Participants averaged 36.2 ± 9.0 years of age and included 16 women and 13 men representing 21 US states and 8 clinical practice settings. Data Collection and Analysis Participants were recruited from a group of ATs who completed 1 of 2 web-based CE clinical documentation modules. Within 3 weeks of completing the educational modules, participants were interviewed regarding their perceptions of how they learn clinical documentation, including their experiences completing the modules. Using the Consensual Qualitative Research approach, 3 researchers and 1 internal auditor inductively analyzed the data during 5 rounds of consensus coding. Trustworthiness measures included multianalyst triangulation, data source triangulation, and peer review. Results Two themes emerged from the data, including (1) mechanisms of learning documentation and (2) benefits of the educational modules. Athletic trainers primarily learn documentation through professional education and workforce training, but training appears to be inconsistent. Participants perceived that both educational modules were effective at increasing their knowledge and confidence related to learning documentation. The CE modules incited a growth mindset and intention to change behavior. Conclusions Athletic trainers are satisfied with web-based CE learning experiences specific to clinical documentation and may benefit from more CE offered in these formats. Educators are encouraged to integrate clinical documentation principles throughout the curriculum during both didactic and clinical education. Workforce training is also valuable for improving knowledge and skills related to clinical documentation, and employers should onboard and support ATs as they start new positions

Supporting Students after a Concussion: School Administrators’ Perspectives

Students with a concussion may experience challenges when returning to school and completing schoolwork. Therefore, students may require temporary academic support throughout the recovery process. The purpose of this study was to examine school administrators’ perceptions of the return to school process and provision of academic adjustments (AA) after concussion. Online surveys were analyzed using a series of descriptive, chi-square, and Mann Whitney tests. School administrators strongly agreed a concussion can affect school performance and were supportive of providing AA for symptomatic students. More school administrators with access to an athletic trainer and who completed concussion training had an established team to monitor concussions and reported students had received AA after concussion. To better prepare school professionals and enhance the support for students after a concussion, school administrators can develop a school-based concussion team, organize in-service training on concussion, and identify pertinent school and district-based resources to facilitate this care

Defining Athletic Training in the Military Setting: A Survey Investigation Into Professional Characteristics, Preparation, and Barriers in Clinical Practice

Context: The skill sets of athletic trainers (ATs) provide a unique contribution to the US military\u27s optimization of physical readiness, and these positions are becoming more prevalent. However, knowledge regarding the job characteristics of, and ATs\u27 preparation for, employment in a military setting is limited. Objective: To assess the position and clinician characteristics of ATs working with military members and document their perceptions of working in the military setting. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: A total of 53 ATs who currently or formerly worked in the military setting. Data Collection and Analysis: A Web-based survey with closed- and open-ended questions was distributed via e-mail and social media. Closed-ended data were analyzed via descriptive statistics, and open-ended questions were evaluated for common themes using thematic analysis. Results: Respondents were primarily males (n = 31, 58.5%), had a master\u27s degree (n = 42, 79.2%), and were not current or former service members (n = 46, 86.8%). Positions were primarily full time (n = 50, 94.3%), contracted with an independent company (n = 27, 50.9%), and within the Army (n = 24, 45.3%). The ATs were highly satisfied with their workload and ability to apply their skill set. Qualitative analysis revealed 3 themes: (1) the context of clinical practice in the military (eg, rewarding, job scope, military environment), (2) the importance of clinical and interpersonal skills, and (3) the existence of multiple barriers (eg, hiring, military culture, lack of recognition). Conclusions: Overall, ATs working in the military setting were well-qualified practitioners who were very satisfied with their current positions, yet they also reported barriers, such as working within the military culture and lack of recognition of their skill set. Although ATs indicated a neutral belief that professional degree preparation was sufficient for this clinical practice setting, the qualitative themes provided additional career-preparation advice for individuals interested in this setting

Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer

Context: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. Objective: To examine ATs’ perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). Main Outcome Measure(s): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals’ familiarity with ATs’ responsibilities were independent variables. Results: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio ¼ 1.5; 95% confidence interval ¼1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs’ communication with school professionals was their perception of school professionals’ understanding of ATs’ roles. Conclusions: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes’ physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes

Athletic Trainers’ Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network

Context:  For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs\u27 perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation. Objective:  To explore ATs\u27 perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system in the secondary school setting. Design:  Qualitative study. Setting:  Individual telephone interviews. Patients or Other Participants:  We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting. Data Collection and Analysis:  We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis. Results:  Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of additional personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting. Conclusions:  Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized

Athletic Trainers\u27 Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network

Context:  Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs\u27 reasons for documenting patient care and mechanics of completing documentation tasks. Objective:  To understand ATs\u27 perceptions about reasons for and the mechanics of patient care documentation. Design:  Qualitative study. Setting:  Individual telephone interviews with Athletic Training Practice-Based Research Network members. Patients or Other Participants:  Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states. Data Collection and Analysis:  We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking. Results:  Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently. Conclusions:  Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively

Replication of vertebrate mitochondrial DNA entails transient ribonucleotide incorporation throughout the lagging strand

Using two-dimensional agarose gel electrophoresis, we show that mitochondrial DNA (mtDNA) replication of birds and mammals frequently entails ribonucleotide incorporation throughout the lagging strand (RITOLS). Based on a combination of two-dimensional agarose gel electrophoretic analysis and mapping of 5′ ends of DNA, initiation of RITOLS replication occurs in the major non-coding region of vertebrate mtDNA and is effectively unidirectional. In some cases, conversion of nascent RNA strands to DNA starts at defined loci, the most prominent of which maps, in mammalian mtDNA, in the vicinity of the site known as the light-strand origin