Conceptualizing Occupational Therapists’ Change Agent Role To Support Entry-Level Pedagogical Activities: Results From A Scoping Study

Entry-level programs are expected to support occupational therapy students in developing knowledge and skills pertaining to the change agent role. To do so, a detailed, multidimensional conceptualization of this role is necessary. To date, in the occupational therapy profession, there is no such conceptualization, which might impact educators’ ability to conduct relevant pedagogical activities. Our study aimed to explore the dimensions of the change agent role for occupational therapy practitioners. We undertook a scoping study of the scientific and grey literature up to August 31, 2018 to “map” what is known about the change agent role. We searched nine databases, including Medline and CINAHL, varying combined keywords according to the database. We also manually searched reference lists and 12 relevant websites. We examined data using thematic charts and analysis. From the 33 documents analyzed, we identified two change agent configurations: social and clinical. The social configuration operates at the macro-level (society) and is aimed at optimizing health and social justice for communities or populations. Actions include lobbying, using media, and assuming a formal duty in an advocacy group. At the micro-level (clinical setting), the intent of the clinical configuration is to inform, sustain and promote individual decision-making and protect civil rights. This involves discussions with clients to understand their values and provide information about rights and options. To play the change agent role, occupational therapy practitioners must acquire a variety of knowledge and skills. To develop their students’ ability to take on this important role, educators must tailor their pedagogical activities accordingly

Developing the Change Agent Competencies of Occupational Therapy University Students: Using a Scholarship of Teaching and Learning Approach in a Canadian Program

Canadian occupational therapy (OT) university programs must teach change agent competencies. These include promoting social justice and empowering clients, which United States occupational therapists also do. Change agent competency requirements are challenging to teach and involve multidisciplinary knowledge and non-traditional skills. As few occupational therapists feel competent to act as change agents, university programs must engage in a scholarship of teaching and learning (SoTL) approach and identify areas of improvement. The aim of this study, informed by SoTL, was to document, as described by participants, the pedagogical activities related to teaching the change agent role in an OT program in Canada and explore possible curricular improvements. Two online 90-minute focus group meetings were held: one with ten teaching team members, the other with six current and past students. Participants were questioned regarding current formal and informal curricular activities, barriers that influenced competency development, and activities that could help improve it. Data were analyzed thematically. Actual informative teaching activities, such as ethics and multicultural courses, were deemed helpful but insufficient, with only one transformative course in the curriculum. Barriers such as a rigid, biomedical-based program structure also affected competency acquisition. Solutions to improve acquisition included mentorship and recognition of relevant extracurricular projects by the programs. SoTL offers a reflective lens to learn from collective experiences. This study showed the importance of involving students and faculty in program development and delivery improvements in order to better support educators and program administrators in their mission to meet the needs of vulnerable populations

Considerations in the Use of Podcasts for Teaching and Learning in Occupational Therapy: A Scoping Study

Evidence-based practice integrates and supports the best interventions in clinical practice. However, a gap of about ten years may elapse between the production of evidence and integration of best practices in clinical settings. Some technologies, such as podcasting, have become increasingly popular and are emerging as an innovative teaching modality that can support knowledge acquisition and integration. This scoping study gathered and synthesized the information in the literature regarding the use of podcasts by occupational therapy clinicians and students as a means for teaching and learning evidence-based knowledge. A scoping study approach was used following the five stages defined by Arksey and O\u27Malley. In four databases and using 40 keywords, two team members selected and cross-checked articles. Two team members also extracted data and analyzed them in the form of descriptive statistics and salience (recurrence and importance). Of the 46 articles selected, seven broad categories of 20 important themes related to the use of podcasting were identified: facilitators and obstacles to podcast use, advantages and disadvantages of podcasts, effects of podcasts, potential utility of podcasts, and elements to consider for podcast creation. Podcasting is an innovative and appropriate modality for the retention of knowledge and the optimization of practical skills. It differs from traditional methods in its ease of access and portability. Many positive effects have been associated with its use. However, podcasts should not replace class attendance or other active learning opportunities

Acting as a Change Agent

Background: Acting as a change agent (CA) is a key role for Health and Social Services (HSS) professionals. It involves working collaboratively with actors across and outside the HSS system and influencing decision-makers. However, this role requires specific skills that HSS professionals generally feel that they have not mastered. The overarching goal of this research partnership is to explore the development of CA skills by HSS professionals using a customized training program. Methods/Design: Through a research partnership, 128 HSS professionals will receive 7 hours of training using a professional co-development approach and a checklist. The immediate and medium-term effects of the training on their skills development will be evaluated with a self-administered questionnaire before and immediately following the training and again nine months later. The data will be analyzed using descriptive and inferential statistics. Discussion: This study will shed light on the effects of a customized training program on CA skills development. It will also have three main benefits: (1) development of an easy-to-reuse CA training program and checklist; (2) partner’s ownership of these products through close involvement; and (3) development of a sustainable partnership between a team of researchers and a recognized organization with an extensive HSS network

Author Correction: Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial (Nature Medicine, (2021), 27, 11, (2012-2024), 10.1038/s41591-021-01488-2)

In the version of this Article initially published, there was an omission in the member list for the CONCOR-1 Study Group. Valérie Arsenault (Héma-Québec, Montreal, Quebec, Canada) has now been included in the CONCOR-1 Study Group in the online version of the article

Integrated immunovirological profiling validates plasma SARS-CoV-2 RNA as an early predictor of COVID-19 mortality.

peer reviewedDespite advances in COVID-19 management, identifying patients evolving toward death remains challenging. To identify early predictors of mortality within 60 days of symptom onset (DSO), we performed immunovirological assessments on plasma from 279 individuals. On samples collected at DSO11 in a discovery cohort, high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA (vRNA), low receptor binding domain–specific immunoglobulin G and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers were strongly associated with mortality, including in patients on mechanical ventilation. A three-variable model of vRNA, with predefined adjustment by age and sex, robustly identified patients with fatal outcome (adjusted hazard ratio for log-transformed vRNA = 3.5). This model remained robust in independent validation and confirmation cohorts. Since plasma vRNA’s predictive accuracy was maintained at earlier time points, its quantitation can help us understand disease heterogeneity and identify patients who may benefit from new therapies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Fear of Reprisal and Change Agency in the Public Health and Social Service System: Protocol for a Sequential Mixed Methods Study

Background Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, that is, within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. Objective The overall aim is to gain a better understanding of the complex dynamic process leading to clinical professionals’ and managers’ fear of reprisal in their change agent actions and senior administrators’ and managers’ determination of wrongdoing. The objectives are (1) to estimate the prevalence of fear of reprisal among clinical professionals and managers; (2) to identify the factors involved in (a) the emergence of this fear among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; (3) to describe the process of emergence of (a) the fear of reprisal among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; and (4) to document the legal and ethical issues associated with the factors identified (objective 2) and the processes described (objective 3). Methods Based on the Exit, Voice, Loyalty, Neglect model, a 3-part sequential mixed methods design will include (1) a web-based survey (objective 1), (2) a qualitative grounded theory design (objectives 2 and 3), and (3) legal and ethical analysis (objective 4). Survey: 77,794 clinical professionals or clinical managers working in the Québec public HSS system will be contacted via email. Data will be analyzed using descriptive statistics. Grounded theory design: for each of the 3 types of participants (clinical professionals, clinical managers, and senior administrators and managers), a theoretical sample of 15 to 30 people will be selected via various strategies. Data will be independently analyzed using constant comparison process. Legal and ethical analysis: situations described by participants will be analyzed using, respectively, applicable legislation and jurisprudence and 2 ethical models. Results This ongoing study began in June 2022 and is scheduled for completion by March 2027. Conclusions Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities for serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. International Registered Report Identifier (IRRID)PRR1-10.2196/4840

Long-term orogenic-scale paleofluid system across the Tuscan Nappe - Umbria-Marche Apennine Ridge (northern Apennines, Italy) as revealed by mesostructural and isotopic analyses of stylolite-vein networks

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