Clinical interpretation of health and the human spirit for occupation .

In reading and contemplating Yenca\u27s (1998) article, I was immediately struck by the utility of the ideas she offers on a number of clinical fronts. We are presented with occupation-based strategies that are directly applicable to our work with patients and program development; we can make use of the language and ideas that are offered as a way to begin talking to one another (therapist to therapist) in clinical settings about occupation; and we are given the opportunity to think about the contribution, value, and efficacy of occupation and how we might convert those ideas into clinically based research actions. This last point is especially useful given Yerxa\u27s powerful view of the complex and compelling human and person issues that are looming on the horizon (achieving healthfulness, finding valued substitutes for work). In response to these person dilemmas of the future, it is exciting to consider what kinds of new treatment approaches, programming ideas, and research questions might be most appropriate for us to develop on me basis of our understanding of the importance of occupation to health

What\u27s going on here? Deconstructing the interactive encounter.

Eleanor Clarke Sagle Lectur

An emerging view of mastery, excellence, and leadership in occupational therapy practice.

The recent focus on clinical reasoning in occupational therapy, specifically on how therapists solve complex problems, has stimulated interest in how master clinicians think in practice. By gaining insight into how clinicians think and what they think about when they identify and solve problems, we may be able to identify clinical reasoning patterns and processes that occupational therapy students and novice therapists need to experience in order to progress in their practice or to emerge as leaders in their field. Observation of the way in which clinical masters and leaders view challenges and solve problems as manifested in their clinical reasoning may provide new and potential therapists with clues as to how to best bone their skills and knowledge for future success in practice. This paper describes a study that examined the relationship of mastery, excellence, and leadership in occupational therapy. Ten master clinicians were interviewed to determine the characteristics of their mastery and excellence in practice and to explore the degree to which they engaged in leadership behavior. The findings revealed that mastery, excellence, and leadership are independent of one another but that some characteristics are common to all of these phenomenas

How do we change practice when we have the evidence?

Translating research findings into practice includes myriad pragmatic realities, including understanding the suitability of the data to a particular patient group, writing new guidelines for occupational therapy practitioners, facilitating adoption of the guidelines, and instituting new patterns of care for patients. The process is more than a matter of disseminating the information to practitioners and expecting immediate change in patient treatment. Indeed, the field of implementation science is devoted to the identification of the numerous barriers and supports that constrain or expedite practice change in response to research. Moving forward and adopting evidence-based findings will require a focused understanding of the particular setting where change is warranted. Among the issues to address are the health system levels involved in change (professional, legislative, administrative, practitioner, and patient and family members), the values and beliefs of the participants, and knowledge of the communication channels that exist in the setting and how information and new ideas make their way through the setting

Promoting Environments that Measure Outcomes: Partnerships for Change

This paper describes the development of the PrEMO© (Promoting Environments that Measure Outcomes) program. PrEMO© is an innovative model promoting evidence-based practice (EBP) while developing capacity and quality of Level II fieldwork placements. The PrEMO© program is described from initiation to completion, including development of site-specific learning objectives, the twelve week schedule and the role of faculty mentorship. Occupational therapy (OT) students, and university OT program faculty including academic fieldwork coordinators, partner with fieldwork educators at the site to implement EBP using a data-driven decision making (DDDM) process to guide the development of evidence-based practices. PrEMO© appears to be a useful strategy for building Level II fieldwork capacity and enhancing student and fieldwork educators’ knowledge and skills about EBP and outcome measurement in routine OT practice

System Development from a Legal Perspective

This paper discusses the potential for legal liability when software malfunctions and causes financial loss or harm to the user. The focus is on the systems developer as opposed to the vendor, although the samelegal issues may apply to vendors as well. Various theories in the U.S. legal system may form the basis for legal action, on the part of the purchaser or ultimate user, based upon the characteristics of the individual case. The legal theories examined, for their application to malfunctioning software, are breach of contract and the tort theories of fraud and computer malpractice

The United States Responds to Spain

In the United States, spam, unsolicited bulk or commercial e-mail, is considered to be a significant problem for both consumers and Internet Service Providers. It is currently attracting a patchwork of state level legislative actions as well as proposed federal legislative initiatives. While spam engenders numerous policy concerns, two issues, the jurisdictional domain and the transfer of costs, appear to be unique to spam

Exploring the Personal Reality of Disability and Recovery: A Tool for Empowering the Rehabilitation Process

People experiencing disability and chronic disease often feel powerless, relinquishing medical control to “more knowledgeable” professionals. This article presents qualitative and quantitative results from three individual patients experiencing an emerging procedure called Recovery Preference Exploration (RPE). To inspire greater patient involvement, self-direction, and individual choice, we instructed participants to create an imagined recovery path, exposing recovery preferences while learning about clinical rehabilitation concepts. Results uncovered important values and feelings about disability, providing a richer context for patient evaluation and treatment goal modification. Applying mixed methods, RPE is presented as an explanatory process for quantifying recovery preferences in a way that stimulates rich narrative of how people see different types of disabilities. RPE shows promise for increasing depth of discussions among patients, family, and clinicians. RPE may promote greater quality of life through patient empowerment by directed learning, increased communication, and enhanced self-knowledge