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This study examined the effects of school administrative support on teaching practice research programs using the importance–performance analysis (IPA) model. Teachers’ emotions, the importance they attributed to certain elements of the administrative services, and their satisfaction with the service quality of the administrative system were explored. To satisfy teachers’ needs and improve the service quality of administrative support, gaps in service quality between expectations and reality need to be identified. Participants were full-time teachers who had applied for teaching practice research programs at a university in Taiwan. A questionnaire on satisfaction with administrative support was developed and distributed to 102 teachers, 86 of whom returned valid responses. The results were analyzed using a paired t-test, regression analysis, and IPA. The teachers were most concerned about briefings regarding the application process and the administrative services the received, and they were most satisfied with these administrative services (t = 4.595, p < 0.001). Administrative service was the main factor contributing to teachers’ satisfaction. Seminars or workshops on writing and consultation for budgeting were the top priorities to improve the administrative support system. Suggestions for enhancing school administrative services based on these results are also provided.

IntroductionThe latest NICE guidelines for chronic HF, published in 2018, provided updated recommendations on best practice for the diagnosis and management of HF. How far does current service provision meet guideline recommendations and how do services compare across the UK? We carried out a survey to determine the different models of HF services across the UK, to characterise current service provision and understand how HF is currently managed.MethodsData were collected from HF services across the UK via postal survey or telephone interview between February and May 2018. Questions included in the survey were refined after 11 pilot interviews with lead HF nurses conducted between December 2017 and January 2018.ResultsOne hundred HF services completed the survey: 56 HF nurses and 44 HF cardiologists provided data for 67 trusts and 1 social enterprise in England, and 5 health boards in Scotland, 4 in Wales and 2 in Northern Ireland. The average population size served by an HF service was ∼600,000 people (range 22,000 to 3.5 million), with ∼1600 HF patients under their care (range 60–20,000) and ∼480 new HF patients (range 12–2000) referred into the service in the last 12 months. Most services saw patients in both hospital and the community (66%), while fewer saw only hospital (18%) or community (16%) patients. Care in the community was provided by the majority of services for HFrEF (95%) and for end-of-life care, post-MI HF and HFmrEF (∼80% each), while only 53% of services saw patients with HFpEF in the community. The number of HF nurses varied widely between HF services: 1–2 nurses (26%); 3–4 (22%); 5–6 (24%) and ≥7 (28%). Almost one quarter of HF services (24%) had no administrative support, while 15% did not have a consultant with an interest in HF in their area. Only 1 in 4 services (27%) had a pharmacist, while even fewer had a mental health professional (14%) working within their team.ConclusionHF service provision across the UK is highly variable. Around 1 in 7 services did not have a consultant or a lead physician with an interest in HF, highlighting a deficit between NICE guideline recommendations and clinical practice. The lack of administrative support in a quarter of HF services is of concern considering the large number of patients these services support. Resourcing issues may account for the type of patients HF services see, as considerably fewer services offer care in the community to patients with HFpEF compared with other types of HF.FundingThis study was supported by Novartis. Writing assistance was provided by Hollie Robinson, PhD, of Complete HealthVizion, funded by Novartis.Conflict of InterestEmployee of Novartis

Background: Surgical program directors (PDs) have been identified as being at high risk for emotional exhaustion and burnout. Consequent PD turnover and discontinuity in leadership can affect faculty and trainee success and well-being and the stability of residency programs. Prior studies have documented factors contributing to nonsurgical PD burnout; however, rates of early attrition and contributing factors in surgical PDs have not been investigated. This study examined factors affecting surgical PD satisfaction, stressors and areas where institutions can improve PD support. Methods: A national cross-sectional study of PDs was performed across all accredited surgical subspecialties. Domains assessed via a web-based survey included PD demographic characteristics and compensation, availability of administrative support for programs, satisfaction with the PD role and factors contributing to PD challenges and burnout. Results: Sixty percent of eligible surgical PDs (81/134) responded to the survey from 12 surgical specialties. Substantial heterogeneity was seen in tenure, compensation models and administrative support. All respondents exceeded their protected time for the PD position, and 66% received less than 0.8 full-time equivalent of administrative support. One-third of respondents (36%) were satisfied with their overall compensation for the position, while 43% were unhappy with compensatory models. Most respondents (70%) enjoyed the PD role, specifically relationships with trainees and the ability to shape the education of future surgeons. Stressors included insufficient administrative support, especially around resident remediation, and inadequate compensation, with 37% of PDs considering leaving the post prematurely. Conclusion: The majority of surgical PDs enjoy the role. However, intersecting factors such as disproportionate time demands, lack of administrative support and inadequate compensation for the role contribute to substantial stress and risk of early attrition. Systematic culture change to support PDs via better defined structural processes and sufficient resources is needed to keep these educators engaged and improve both PDs and trainees experiences.

Black faculty members are often expected to engage in diversity initiatives, a drain on their time and resources known as the “minority tax.” But taxes can be reformed, and several strategies could help reduce the negative sequelae of the minority tax.

Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans. [PUBLICATION ABSTRACT]

Patients with late‐stage Kellgren‐Lawrence knee osteoarthritis received a single intra‐articular injection of 1, 10, or 50 million bone marrow mesenchymal stromal cells (BM‐MSCs) in a phase I/IIa trial to assess safety and efficacy using a broad toolset of analytical methods. Besides safety, outcomes included patient‐reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); contrast‐enhanced magnetic resonance imaging (MRI) for cartilage morphology (Whole Organ MRI Scores [WORMS]), collagen content (T2 scores), and synovitis; and inflammation and cartilage turnover biomarkers, all over 12 months. BM‐MSCs were characterized by a panel of anti‐inflammatory markers to predict clinical efficacy. There were no serious adverse events, although four patients had minor, transient adverse events. There were significant overall improvements in KOOS pain, symptoms, quality of life, and WOMAC stiffness relative to baseline; the 50 million dose achieved clinically relevant improvements across most PROMs. WORMS and T2 scores did not change relative to baseline. However, cartilage catabolic biomarkers and MRI synovitis were significantly lower at higher doses. Pro‐inflammatory monocytes/macrophages and interleukin 12 levels decreased in the synovial fluid after MSC injection. The panel of BM‐MSC anti‐inflammatory markers was strongly predictive of PROMs over 12 months. Autologous BM‐MSCs are safe and result in significant improvements in PROMs at 12 months. Our analytical tools provide important insights into BM‐MSC dosing and BM‐MSC reduction of synovial inflammation and cartilage degradation and provide a highly predictive donor selection criterion that will be critical in translating MSC therapy for osteoarthritis. Stem Cells Translational Medicine 2019;8:746&757 Through anti‐inflammatory effects, bone‐marrow‐derived mesenchymal stromal cells decrease pain and improve function in patients with knee osteoarthritis.

IntroductionWe established an early diagnostic service with Cytosponge to triage patients for Barrett’s surveillance and symptomatic acid reflux. It Aims to address COVID delays, identify disease, and establish a new sustainable service for earlier diagnosis. We now have the largest single site experience of Cytosponge in the UK. We report on the challenges establishing a new service and adopting new technology during uncertain times, and outcomes from the first 1000 procedures.MethodsThe service started November 2020. We trained 2 nurse endoscopists, 2 Band 6 nurses in Cytosponge delivery and follow up. There is administrative support and 2 consultant gastroenterologists lead the service. 2 patient cohorts:- Barrett’s oesophagus on surveillance and patients with symptomatic acid reflux. Consultant led triage from waiting list, Barrett’s surveillance and routine reflux referrals with screening telephone triage by nurse to confirm suitability. Cytosponge was delivered by nurses and a patient satisfaction survey completed. Cytology was analysed by Cyted and results relayed <4 weeks. Clinical decision making was pathway led.TFF3+ was used as marker for intestinal metaplasia, p53+ve and atypia for potential dysplasia. Patients were fast tracked to gastroscopy (atypia or p53+), routine gastroscopy (New TFF3+/persistent symptoms) ongoing Barrett’s surveillance (according to risk factors) or discharged with advice and safety netting (Short segment Barrett’s with -ve TFF3, uncomplicated reflux with -veTFF3) Patients were also referred to pH Manometry.Results1000 patients agreed to Cytosponge. Adequate samples were reported in 91.2%. No adverse events. 12% reflux patients had +veTFF3, 5.6% confirmed new Barrett’s. We identified 8.8% suspected dysplasia in Barrett’s surveillance and in 0.9% reflux patients. Furthermore 11.5% have been discharged from surveillance and 72% with reflux to their GP. Those needing gastroscopy for persistent symptoms are reported elsewhere. The patient experience survey reports clear preference for Cytosponge over gastroscopy. Cytosponge has lower carbon footprint and prevented unnecessary gastroscopy in 670 patients. Challenges include ensuring financial stability and job security, encouraging new referral patterns and overcoming scepticism for change, improving success rates and adequacy of samples, securing sufficient administrative support and sufficient clinical lead time. There have been pathway changes as knowledge accrues.ConclusionWe report on the largest single site series of Cytosponge and challenges establishing a new service. Our patients have welcomed Cytosponge and benefited from a speedier streamlined pathway and detection of early pathology.

Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefits provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefits. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fiscal sustainability. Japan's strategy for long-term care could offer lessons for other nations. [PUBLICATION ABSTRACT]

ContextAthletic trainers are employed in various settings, which may utilize one of three organizational infrastructure models: 1) sport/athletic model, 2) medical model, and 3) academic model. These different settings and organizational infrastructure models may result in varying levels of organizational-professional conflict (OPC). However, how OPC may differ across infrastructure models and practice settings is not known.ObjectiveExamine the prevalence of OPC among athletic trainers in various organizational infrastructures and explore athletic trainers' perceptions of OPC, including its precipitating and mitigating factors.DesignSequential explanatory Mixed-Methods with equal emphasis on quantitative and qualitative components.SettingCollegiate and secondary school institutionsPatients or Other Participants594 athletic trainers from collegiate and secondary schools.Data Collection and AnalysisWe conducted a national, cross-sectional survey using a validated scale to assess OPC. We then followed the quantitative survey with individual interviews. Trustworthiness was established with multiple analyst triangulation and peer debriefing.ResultsAthletic trainers experienced low to moderate degrees of OPC with no differences across practice settings or infrastructure models. Poor communication, others' unfamiliarity with the athletic trainers' scope of practice, and lack of medical knowledge were precipitating factors for organizational-professional conflict. Organizational relationships founded on trust and respect for one another; administrative support in that athletic trainers were listened to, decisions were endorsed, and appropriate resources provided; and autonomy given to the AT were key components to preventing organizational-professional conflict.ConclusionMost athletic trainers experienced primarily low to moderate organizational-professional conflict. However, organizational-professional conflict continues to permeate professional practice, to some extent, in collegiate and secondary school settings, regardless of the infrastructure model used. The findings of this study highlight the role of administrative support that allows for autonomous AT practice as well as effective communication that is direct, open, and professional to decrease organizational-professional conflict.