Journal articles: 'Specialist Intervention'

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Edwards, Katherine, and Lawrence Impey. "Extreme preterm birth in the right place: a quality improvement project." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 4 (2019): 445–48. http://dx.doi.org/10.1136/archdischild-2019-317741.

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Extreme preterm birth is a major precursor to mortality and disability. Survival is improved in babies born in specialist centres but for multiple reasons this frequently does not occur. In the Thames Valley region of the UK in 2012–2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014–2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction. There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement. The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

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Viljoen, Adie, Rabia Chaudhry, and John Bycroft. "Renal stones." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 56, no. 1 (2018): 15–27. http://dx.doi.org/10.1177/0004563218781672.

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Renal stone disease is a worldwide problem which carries significant morbidity. It frequently requires specialist urology intervention. Patients with recurrent disease and those at high risk require specialist investigations and review. Certain cases benefit from medical and surgical intervention. In this review, we discuss the pathophysiology, risk assessment, specialist investigations and various interventions, their rationale and evidence base. This review aims to provide an update of the previous publication in 2001 in this journal on this topic.

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Stock, Nicola Marie, Fabio Zucchelli, Nichola Hudson, James D. Kiff, and Vanessa Hammond. "Promoting Psychosocial Adjustment in Individuals Born With Cleft Lip and/or Palate and Their Families: Current Clinical Practice in the United Kingdom." Cleft Palate-Craniofacial Journal 57, no. 2 (2019): 186–97. http://dx.doi.org/10.1177/1055665619868331.

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Objectives: The importance of psychosocial aspects of care has received growing recognition in recent years. However, the evidence base for psychosocial intervention remains limited. Specialist clinicians working in cleft lip and/or palate (CL/P) services hold a wealth of knowledge and experience yet to be elicited. The aims of this study were to identify common psychosocial challenges and potential risk and/or protective factors for psychosocial distress from the perspective of specialist clinicians and to establish the types of interventions currently being delivered in practice. Design: Individual interviews with 17 clinical nurse specialists and 19 specialist clinical psychologists, representing all 16 UK CL/P surgical sites. Data were analyzed using inductive content analysis. Results: Numerous psychosocial challenges affecting individuals with CL/P and their families were identified across the life span. Risk factors were predominantly contextual in nature, while protective factors appeared amenable to intervention. Participants drew upon a range of therapeutic models and approaches to guide formulation and intervention, while acknowledging the lack of evidence to support these approaches in CL/P populations specifically. Conclusions: Findings have important implications for the way in which psychosocial support for CL/P and related conditions is delivered and evaluated. A framework for the standardized assessment of holistic individual and familial well-being is proposed. Suggestions for increasing the evidence base for specific psychosocial interventions are made, including enhanced family functioning; social, emotional, and appearance concerns; treatment decision-making; and screening for psychosocial and developmental issues.

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Jordan, Rita, and Stuart Powell. "Autism: The Case for Early Specialist Intervention." Early Years 16, no. 1 (1995): 46–50. http://dx.doi.org/10.1080/0957514950160110.

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Callaghan, Sarah. "The percutaneous coronary intervention specialist nurse role." British Journal of Cardiac Nursing 6, no. 5 (2011): 252–54. http://dx.doi.org/10.12968/bjca.2011.6.5.252.

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Steen, Allison, and Jessica Bovio Franck. "Improving clinic utilization and workload capture for clinical pharmacy specialists." American Journal of Health-System Pharmacy 77, no. 7 (2020): 552–59. http://dx.doi.org/10.1093/ajhp/zxaa008.

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Abstract Purpose To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. Methods In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). Results After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. Conclusion The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators’ collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.

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Messika-Zeitoun, David, Ian G. Burwash, and Thierry Mesana. "EDUCATIONAL SERIES ON THE SPECIALIST VALVE CLINIC: Challenges in the diagnosis and management of valve disease: the case for the specialist valve clinic." Echo Research and Practice 6, no. 4 (2019): T1—T6. http://dx.doi.org/10.1530/erp-19-0041.

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Valvular heart disease (VHD) is responsible for a major societal and economic burden. Incidence and prevalence of VHD are high and increase as the population ages, creating the next epidemic. In Western countries, the etiology is mostly degenerative or functional disease and strikes an elderly population with multiple comorbidities. Epidemiological studies have shown that VHD is commonly underdiagnosed, leading to patients presenting late in their disease course, to an excess risk of mortality and morbidity and to a missed opportunity for intervention. Once diagnosed, VHD is often undertreated with patients unduly denied intervention, the only available curative treatment. This gap between current recommendations and clinical practice and the marked under-treatment is at least partially related to poor knowledge of current National and International Societies Guidelines. Development of a valvular heart team involving multidisciplinary valve specialists including clinicians, imaging specialists, interventional cardiologists and surgeons is expected to fill these gaps and to offer an integrated care addressing all issues of patient management from evaluation, risk-assessment, decision-making and performance of state-of-the-art surgical and transcatheter interventions. The valvular heart team will select the right treatment for the right patient, improving cost-effectiveness and ultimately patients’ outcomes.

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Nimalendran, M., and Giovanni Petrella. "Do ‘thinly-traded’ stocks benefit from specialist intervention?" Journal of Banking & Finance 27, no. 9 (2003): 1823–54. http://dx.doi.org/10.1016/s0378-4266(03)00103-1.

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Singh, Swaran P., and Helen L. Fisher. "A Specialist Early Intervention for First-Episode Psychosis." Psychiatric Services 55, no. 8 (2004): 942—a—943. http://dx.doi.org/10.1176/appi.ps.55.8.942-a.

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Reynolds, Nicola, Roopal Desai, Zheng Zhou, Miriam Fornells-Ambrojo, and Paul Garden. "Psychological interventions on a specialist Early Intervention Inpatient Unit: An opportunity to engage?" Early Intervention in Psychiatry 12, no. 6 (2017): 1094–99. http://dx.doi.org/10.1111/eip.12419.

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Winpenny, Eleanor M., Céline Miani, Emma Pitchforth, Sarah King, and Martin Roland. "Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface." Journal of Health Services Research & Policy 22, no. 1 (2016): 53–64. http://dx.doi.org/10.1177/1355819616648982.

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Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians’ skills through education or joint consultations with complex patients.

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Johnston, Nikki, Clare Lovell, Wai-Man Liu, Michael Chapman, and Liz Forbat. "Normalising and planning for death in residential care: findings from a qualitative focus group study of a specialist palliative care intervention." BMJ Supportive & Palliative Care 9, no. 1 (2016): e12-e12. http://dx.doi.org/10.1136/bmjspcare-2016-001127.

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BackgroundImproving access to palliative care for older adults living in residential care is recognised internationally as a pressing clinical need. The integration of specialist palliative care in residential care for older adults is not yet standard practice.ObjectiveThis study aimed to understand the experience and impact of integrating a specialist palliative care model on residents, relatives and staff.MethodsFocus groups were held with staff (n=40) and relatives (n=17). Thematic analysis was applied to the data.ResultsThree major themes were identified. The intervention led to (1) normalising death and dying in these settings, (2) timely access to a palliative care specialist who was able to prescribe anticipatory medications aiding symptom management and unnecessary hospitalisations and (3) better decision-making and planned care for residents, which meant that staff and relatives were better informed about, and prepared for, the resident's likely trajectory.ConclusionsThe intervention normalised death and dying and also underlined the important role that specialists play in providing staff education, timely access to medicines and advance care planning. The findings from our study, and the growing wealth of evidence integrating specialist palliative care in residential care for older adults, indicate a number of priorities for care providers, academics and policymakers. Further work on determining the role of primary and specialist palliative care services in residential care settings is needed to inform service delivery models.

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Kamat, Ameya, and Andrew Parker. "Optimising neurosurgical outpatient care: a paradigm shift?" Journal of Primary Health Care 7, no. 3 (2015): 198. http://dx.doi.org/10.1071/hc15198.

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INTRODUCTION: The Wellington Regional Hospital (WRH) neurosurgical service has noted a substantial increase in patient volumes over the last decade, with referrals to the neurosurgical outpatient clinic appearing to have increased even more substantially. AIM: To quantify the increase in referrals to the WRH neurosurgical outpatient service and to determine whether this has translated into an increase in the number of neurosurgical procedures performed. METHODS: All referrals to the WRH neurosurgical department from the lower North and upper South Islands of New Zealand spanning 10 years were collected. Key outcome data were the number of interventions performed. In addition to GP referrals, all specialist referrals to the WRH neurosurgical outpatient service were also analysed as a comparison. RESULTS: In total, 19 201 patients were referred to the WRH neurosurgical service over the 10 years of the study. Within this timeframe, 7105 patients were referred by GPs and 12 096 were referred by specialist teams. Only 348 patients (4.9%) referred by GPs underwent some form of therapeutic intervention, compared to 3489 patients (28.8%) referred by specialist teams. DISCUSSION: Our data shows that specialist referrals result in a proportionally greater number of therapeutic interventions than GP referrals. This is in part due to the wider array of diagnostic tests available to specialists compared to GPs. The development of relevant guidelines for primary care referral to a neurosurgical service appears warranted and could facilitate initiation of appropriate investigations in primary care. KEYWORDS: Neurosurgery; outpatients; primary health care; referrals

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Blank, Lindsay, Susan Baxter, Helen Buckley Woods, et al. "What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis." Health Services and Delivery Research 3, no. 24 (2015): 1–430. http://dx.doi.org/10.3310/hsdr03240.

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BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Classen, Sherrilene, Sandra Winter, Miriam Monahan, et al. "Driving Intervention for Returning Combat Veterans." OTJR: Occupation, Participation and Health 37, no. 2 (2016): 62–71. http://dx.doi.org/10.1177/1539449216675582.

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Increased crash incidence following deployment and veterans’ reports of driving difficulty spurred traffic safety research for this population. We conducted an interim analysis on the efficacy of a simulator-based occupational therapy driving intervention (OT-DI) compared with traffic safety education (TSE) in a randomized controlled trial. During baseline and post-testing, OT-Driver Rehabilitation Specialists and one OT-Certified Driver Rehabilitation Specialist measured driving performance errors on a DriveSafety CDS-250 high-fidelity simulator. The intervention group ( n = 13) received three OT-DI sessions addressing driving errors and visual-search retraining. The control group ( n = 13) received three TSE sessions addressing personal factors and defensive driving. Based on Wilcoxon rank-sum analysis, the OT-DI group’s errors were significantly reduced when comparing baseline with Post-Test 1 ( p < .0001) and comparing the OT-DI group with the TSE group at Post-Test 1 ( p = .01). These findings provide support for the efficacy of the OT-DI and set the stage for a future effectiveness study.

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Foran, Sinéad, and John Sweeney. "Accessing specialist early intervention services for pre-school children." Learning Disability Practice 13, no. 2 (2010): 30–35. http://dx.doi.org/10.7748/ldp2010.03.13.2.30.c7606.

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Casiglia, Edoardo, and Valérie Tikhonoff. "Essential hypertension: the specialist as part of therapeutic intervention." Hypertension Research 41, no. 5 (2018): 323–25. http://dx.doi.org/10.1038/s41440-018-0031-7.

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Cheel, Katie. "Patient satisfaction and Clinical Nurse Specialist intervention audits 2015." European Journal of Surgical Oncology (EJSO) 43, no. 5 (2017): S19. http://dx.doi.org/10.1016/j.ejso.2017.01.082.

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Bouchet, Flavien, Vincent Le Moing, Delphine Dirand, et al. "Effectiveness and Acceptance of Multimodal Antibiotic Stewardship Program: Considering Progressive Implementation and Complementary Strategies." Antibiotics 9, no. 12 (2020): 848. http://dx.doi.org/10.3390/antibiotics9120848.

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Multiple modes of interventions are available when implementing an antibiotic stewardship program (ASP), however, their complementarity has not yet been assessed. In a 938-bed hospital, we sequentially implemented four combined modes of interventions over one year, centralized by one infectious diseases specialist (IDS): (1) on-request infectious diseases specialist consulting service (IDSCS), (2) participation in intensive care unit meetings, (3) IDS intervention triggered by microbiological laboratory meetings, and (4) IDS intervention triggered by pharmacist alert. We assessed the complementarity of the different cumulative actions through quantitative and qualitative analysis of all interventions traced in the electronic medical record. We observed a quantitative and qualitative complementarity between interventions directly correlating to a decrease in antibiotic use. Quantitatively, the number of interventions has doubled after implementation of IDS intervention triggered by pharmacist alert. Qualitatively, these kinds of interventions led mainly to de-escalation or stopping of antibiotic therapy (63%) as opposed to on-request IDSCS (32%). An overall decrease of 14.6% in antibiotic use was observed (p = 0.03). Progressive implementation of the different interventions showed a concrete complementarity of these actions. Combined actions in ASPs could lead to a significant decrease in antibiotic use, especially regarding critical antibiotic prescriptions, while being well accepted by prescribers.

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Lynn, Michaela, Bethan Goulden, Meera Parmar, et al. "Play attention! Therapeutic aspects to play in delirium prevention and management." Wellcome Open Research 5 (November 25, 2020): 277. http://dx.doi.org/10.12688/wellcomeopenres.16199.1.

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It is recognised that delirium is common among older adult inpatients and correlated with negative outcomes. The gold standard care for delirium management is achieved using multicomponent interventions. Which components work best is not yet well defined. During the COVID-19 outbreak, a paediatric ward was repurposed to treat adult patients. Paediatric nurses and play specialists remained on the ward. It was observed that the paediatric ward aesthetic and the team’s dedicated approach to cognitive stimulation and sleep promotion improved well-being among older adult patients. We propose that elements of paediatric care, primarily deployment of a play specialist, could be incorporated into a multicomponent intervention for delirium prevention and management.

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Wee, Liang En, Aidan Lyanzhiang Tan, Limin Wijaya, Maciej Piotr Chlebicki, Julian Thumboo, and Ban Hock Tan. "Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital." Tropical Medicine and Infectious Disease 4, no. 4 (2019): 137. http://dx.doi.org/10.3390/tropicalmed4040137.

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Infectious diseases (ID) specialists advise on complicated infections and are advocates for the interventions of antibiotic stewardship programs (ASP). Early referral to ID specialists has been shown to improve patient outcomes; however, not all referrals to ID specialists are made in a timely fashion. A retrospective cross-sectional study of all referrals to ID specialists in a Singaporean tertiary hospital was conducted from January 2016 to January 2018. The following quality indicators were examined: early referral to ID specialists (within 48 h of admission) and ASP intervention for inappropriate antibiotic usage, even after referral to ID specialists. Chi-square was used for univariate analysis and logistic regression for multivariate analysis. A total of 6490 referrals over the 2-year period were analysed; of those, 36.7% (2384/6490) were from surgical disciplines, 47.0% (3050/6490) were from medical disciplines, 14.2% (922/6490) from haematology/oncology and 2.1% (134/6490) were made to the transplant ID service. Haematology/oncology patients and older patients (aged ≥ 60 years) had lower odds of early referral to ID specialists but higher odds of subsequent ASP intervention for inappropriate antibiotic usage, despite prior referral to an ID specialist. Elderly patients and haematology/oncology patients can be referred to ID specialists earlier and their antimicrobial regimens further optimised, perhaps by fostering closer cooperation between ID specialists and primary physicians.

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Virani, Amin, Zach Schlei, Andrzej J. Jakubowiak, et al. "Impact of an oncology clinical pharmacist specialist in an outpatient multiple myeloma clinic." Journal of Clinical Oncology 38, no. 15_suppl (2020): e14030-e14030. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14030.

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e14030 Background: Improvements in cancer treatment, supportive care, and the approval of oral chemotherapy medications over the past decade have resulted in an increasing number of cancer patients treated in outpatient settings. Transitioning cancer treatments to the outpatient setting places greater emphasis on proper medication counseling and optimal side effect management. Current literature demonstrates improvements in medication adherence and effective cancer related symptom management with the addition of an oncology pharmacist. Historically, the University of Chicago Medical Center (UCMC) has not employed pharmacists into their ambulatory oncology clinics. UCMC is evaluating pharmacist’s roles in these clinics. Methods: The primary objective of this project is to evaluate the clinical and financial impacts of an oncology clinical pharmacist specialist in an interdisciplinary multiple myeloma (MM) clinic. This will be evaluated by monitoring the interventions made by the pharmacist in clinic through a validated scoring tool. This tool associates a value for each type of intervention made based on current literature and internal evaluations at UCMC. The oncology clinical pharmacist specialist will be available for consult by the MM clinic staff. The pharmacist may be consulted for any medication related inquiry. Based on the consult the pharmacist will categorize their interventions into twelve predefined intervention categories. Results: Study results showed the implementation of a clinical pharmacist specialist into the MM clinic over 39 clinic days resulted in 241 patient consults and 474 interventions made by the pharmacist. The most frequent interventions made by the pharmacist were medication teaching (97), dose adjustments by pharmacist (82) and medication reconciliation (63). Based on the dollar values associated with each intervention type, the value of interventions made by the pharmacist during the study period was $189,441 with a predicted annual value of $757,764. Conclusions: An clinical pharmacist specialist in the MM clinic lead to dramatic and sustainable financial and clinical impacts. Further investigation into other oncology clinics is warranted.

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Williamson, Emma, Sue K. Jones, Giulia Ferrari, Thangam Debbonaire, Gene Feder, and Marianne Hester. "Health professionals responding to men for safety (HERMES): feasibility of a general practice training intervention to improve the response to male patients who have experienced or perpetrated domestic violence and abuse." Primary Health Care Research & Development 16, no. 03 (2014): 281–88. http://dx.doi.org/10.1017/s1463423614000358.

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AimTo evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.BackgroundResearch suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services.MethodThe intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies.ResultsResults show a significant increase in clinicians’ self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians’ confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

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Plath, Debbie, Penny Crofts, and Graeme Stuart. "Engaging Families in Early Intervention for Child Conduct Concerns." Children Australia 41, no. 1 (2015): 49–58. http://dx.doi.org/10.1017/cha.2015.5.

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Early intervention programs assist families to deal with emerging child behavioural difficulties that are likely to worsen over time. Identifying families suited to an early intervention program and then generating their interest in the program can be an uncertain and complex process. This paper describes the approach to family engagement in a school-based early intervention program for children with emerging conduct problems, calledGot It!, and presents some of the findings from an external evaluation of the program conducted by the authors for New South Wales (NSW) Ministry of Health. Child behaviour screening questionnaires were completed by parents/carers and teachers, and qualitative data were gathered through interviews with parents/carers, teachers and health staff. The views of families who participated in the targeted intervention and those who were exposed only to the universal intervention were sought. Results indicate that offering the specialised group intervention in the school, in the context of universal interventions and screening, supported engagement with families of children with identified conduct problems. Many parents said they would not otherwise have sought assistance. A partnership approach between schools and specialist child and adolescent mental health services is a central feature of program delivery. Factors that contribute to an effective partnership are discussed.

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Kelly, Glenn, and Ann Parry. "Managing Challenging Behaviour of People With Acquired Brain Injury in Community Settings: The First 7 Years of a Specialist Clinical Service." Brain Impairment 9, no. 3 (2008): 293–304. http://dx.doi.org/10.1375/brim.9.3.293.

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AbstractThis article provides a review of the development and clinical practice of the ABI Behaviour Consultancy (the ‘Consultancy’), a specialist clinical service that provides outreach behaviour management support across the state of Victoria, Australia, to people with acquired brain injury (ABI) and their social network (i.e., family members, friends, support workers, and therapists). The Consultancy is a small, unique service that has developed ways of providing behaviour management strategies in community settings, despite the difficulties presented by changing and uncontrolled environments. The aim of this article is to provide a detailed account of this service. Information from the first 7 years of full operation, 1998 to 2004, is presented, during which a small number of psychologists saw more than 800 clients. A detailed description is given of behaviours referred and associated risks, assessment procedures, intervention approaches, and research activity. A variety of key service aspects are detailed, including the qualifications required of specialised staff, the service funding levels, and funding and service issues. These detailed accounts of service delivery are placed in the context of several major themes: specialist versus generalist services, the deployment of targeted interventions throughout the lifespan of a brain-injured individual, the role of specialist behaviour management services in the continuum of brain-injury support services, and broader equity issues.

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Hampton, Chelsey, Nigel Rees, Khalid Ali, et al. "VP88 Transient Ischaemic Attack Referral (TIER) Intervention Development." International Journal of Technology Assessment in Health Care 33, S1 (2017): 189–90. http://dx.doi.org/10.1017/s0266462317003555.

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INTRODUCTION:Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.METHODS:We conducted three interrelated activities to produce the TIER intervention: •Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use•Scoping review of literature describing prehospital care of patients with TIA•Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.RESULTS:The panel used results to define the TIER intervention, to include: 1.Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic2.Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic3.Referral process via ambulance control room4.Training package for paramedics5.Agreement with TIA clinic service provider including rapid review of referred patientsCONCLUSIONS:We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.

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Gafoor, Rafael, Dorothea Nitsch, Paul McCrone, et al. "Effect of early intervention on 5-year outcome in non-affective psychosis." British Journal of Psychiatry 196, no. 5 (2010): 372–76. http://dx.doi.org/10.1192/bjp.bp.109.066050.

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BackgroundEarly specialised care may improve short-term outcome in first-episode non-affective psychosis, but it is unclear if these benefits endure.AimsTo assess the long-term effect of early intervention in psychosis.MethodIndividuals with first-episode psychosis were randomised to specialised care or care as usual (trial number: ISRCTN73679874). Outcome after 5 years was assessed by case-note review.ResultsThere were no significant differences in the admission rate (coefficient 0.096, 95% CI −0.550 to 0.742, P = 0.770) or the mean number of bed days (coefficient 6.344, 95% CI −46 to 58.7, P = 0.810).ConclusionsThese findings that specialist intervention did not markedly improved outcome at 5 years accord with those from a larger OPUS study. The sample size of this study was small and these results should be generalised with caution. More research is needed.

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Awcock, Claire, and Nicola Habgood. "Early Intervention Project: Evaluation of Wilstaar, Hanen and Specialist Playgroup." International Journal of Language & Communication Disorders 33, S1 (1998): 500–505. http://dx.doi.org/10.3109/13682829809179475.

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Palmer, Nicholas D., Barbara Appleton, and Erwin A. Rodrigues. "Specialist Nurse-Led Intervention in Outpatients with Congestive Heart Failure." Disease Management & Health Outcomes 11, no. 11 (2003): 693–98. http://dx.doi.org/10.2165/00115677-200311110-00001.

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Krall, Charlotte M., and Mary Renck Jalongo. "Creating a Caring Community in ClassroomsAdvice from an Intervention Specialist." Childhood Education 75, no. 2 (1998): 83–89. http://dx.doi.org/10.1080/00094056.1999.10521988.

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Leary, A. "ES26.01 The Impact of Specialist Nursing Intervention in Lung Cancer." Journal of Thoracic Oncology 14, no. 10 (2019): S74. http://dx.doi.org/10.1016/j.jtho.2019.08.179.

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Larson, Jim, and R. T. Busse. "Specialist-level preparation in school violence and youth gang intervention." Psychology in the Schools 35, no. 4 (1998): 373–79. http://dx.doi.org/10.1002/(sici)1520-6807(199810)35:4<373::aid-pits8>3.0.co;2-w.

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Hancock, Patricia. "Emotional abuse treatment and prevention, a specialist health visitor's intervention." Child Abuse Review 7, no. 1 (1998): 58–62. http://dx.doi.org/10.1002/(sici)1099-0852(199801/02)7:1<58::aid-car359>3.0.co;2-e.

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Blue, L., E. Lang, J. J. V. McMurray, et al. "Randomised controlled trial of specialist nurse intervention in heart failure." BMJ 323, no. 7315 (2001): 715–18. http://dx.doi.org/10.1136/bmj.323.7315.715.

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Martin, Angel. "A Clinical Nurse Specialist Intervention to Improve Maternal-Infant Bonding." Clinical Nurse Specialist 23, no. 2 (2009): 96. http://dx.doi.org/10.1097/01.nur.0000325401.85363.f5.

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Free, Robert C., Matthew Richardson, Camilla Pillay, et al. "Specialist pneumonia intervention nurse service improves pneumonia care and outcome." BMJ Open Respiratory Research 8, no. 1 (2021): e000863. http://dx.doi.org/10.1136/bmjresp-2020-000863.

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BackgroundA specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011–2013) and after (2014–2016) service implementation.ResultsThe SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014–2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70–0.85), p<0.0001) and in-hospital (OR=0.66 (0.60–0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53–0.67), p<0.0001). There was no change in length of stay (median 6 days).ConclusionImplementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

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Weiland, Anne, Annette H. Blankenstein, Jan L. Van Saase, et al. "Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial." International Journal of Person Centered Medicine 6, no. 1 (2016): 50–60. http://dx.doi.org/10.5750/ijpcm.v6i1.490.

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Objectives: Medically unexplained physical symptoms (MUPS) burden patients in their well-being and functioning and have a prevalence of approximately 25-50% in primary and specialist care. Medical specialists often find patients with unexplained symptoms difficult to deal with, whereas patients are not always understood. We report effects on patient outcomes of an evidence-based MUPS-focused communication training for medical specialists.Methods: In a multi-center randomized controlled trial medical specialists and residents allocated to the intervention received a 14-hour MUPS-focused communication training. They practiced a patient-centered approach, including multi-factorial symptom exploration and explanation of MUPS with perpetuating factors. To study intervention effects, each doctor had to include three MUPS patients before and three after the intervention and to ask them to complete questionnaires at baseline and at 3 and 6 months follow-up. The questionnaires included illness worries (Whitely Index), symptom severity (Visual Analogue Scale), distress, depression, anxiety and somatization (4DSQ) and daily functioning (SF-36).Results: A sufficient number of 123 medical specialists and residents participated in the study. They included 478 MUPS patients. Out of them, 297 patients filled out questionnaires at baseline, 165 patients at 3-months follow-up and 71 patients at 6-months follow-up. Recruitment of patients was lower than expected and patients’ non-response to baseline and follow-up questionnaires was higher than estimated. No significant effects were found on patient outcomes.Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered. New research with special attention to patient recruitment and retention is needed to answer this question.

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Plotnikoff, Ronald C., Fiona G. Stacey, Anna K. Jansson, et al. "Does Patient Preference for Mode of Intervention Delivery Impact Intervention Efficacy and Attrition?" American Journal of Health Promotion 34, no. 1 (2019): 63–66. http://dx.doi.org/10.1177/0890117119871002.

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Purpose: To explore whether there was a difference in objectively measured physical activity and study participation between people who received their preferred study group allocation (matched) and those who did not receive their preferred study group (mismatched). Design: Secondary data from the NewCOACH randomized controlled trial. Setting: Insufficiently active patients in the primary care settings in Sydney and Newcastle, Australia. Participants: One hundred seventy-two adults aged 20 to 81 years. Intervention: Participants indicated their intervention preference at baseline for (1) five face-to-face visits with an exercise specialist, (2) one face-to-face visit and 4 telephone follow-ups with an exercise specialist, (3) written material, or (4) slight-to-no preference. Participants were then allocated to an intervention group and categorized as either “matched” or “mismatched” based on their indications. Participants who reported a slight-to-no preference was categorized as “matched.” Measures: Daily step count as measured by pedometers and study participation. Analysis: Mean differences between groups in daily step count at 3 and 12 months (multiple linear regression models) and study participation at baseline, 3 months, and 12 months (χ2 tests). Results: Preference for an intervention group prior to randomization did not significantly (all P’s > .05 using 95% confidence interval) impact step counts (differences of <600 steps/day between groups) or study participation. Conclusion: Future research should continue to address whether the strength of preferences influence study outcome and participation and whether the study preferences change over time.

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Heward, Elliot, Syed F. Hashmi, Ignacio Malagon, Rajesh Shah, Julian Barker, and Kandadai S. Rammohan. "The role of thoracic surgery in extracorporeal membrane oxygenation services." Asian Cardiovascular and Thoracic Annals 26, no. 3 (2018): 183–87. http://dx.doi.org/10.1177/0218492318760710.

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Background Recent evidence surrounding the use of venovenous extracorporeal membrane oxygenation in treating acute respiratory failure has led to the expansion of extracorporeal membrane oxygenation services worldwide. The high rate of complications related to venovenous extracorporeal membrane oxygenation often requires intervention by specialist thoracic surgeons. This study aimed to investigate the role of specialist thoracic surgeons within the multidisciplinary team managing these high-risk patients. Methods We retrospectively reviewed 90 patients who received venovenous extracorporeal membrane oxygenation at our tertiary referral center between December 2011 and May 2015. Four patients who underwent lung transplantation were excluded. Results We found that 29.1% (25/86) of patients on venovenous extracorporeal membrane oxygenation had undergone a thoracic intervention. A total of 82 interventions were performed: 11 thoracotomies, 49 chest drains, 13 rigid bronchoscopies, 4 flexible bronchoscopies, 4 temporary endobronchial blockers, and 1 sternotomy. Of the 11 thoracotomies, 3 were reexplorations. Survival to discharge for patients who underwent thoracic surgical interventions was 72% (18/25). Conclusions Our experience has demonstrated that a large proportion of patients receiving venovenous extracorporeal membrane oxygenation require a thoracic intervention, many of which are major intraoperative procedures. Patients on venovenous extracorporeal membrane oxygenation have benefited from rapid on-site access to thoracic surgical services to manage these challenging life-threatening complications.

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D’Allio, Giorgio, Fernando Rutto, Michela Coppi, and Luca Guidi. "Livello di dipendenza dai Servizi Territoriali e costi relativi al trattamento della schizofrenia." Farmeconomia. Health economics and therapeutic pathways 6, no. 4 (2005): 301–4. http://dx.doi.org/10.7175/fe.v6i4.844.

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The present study was designed to evaluate the level of dependence from Mental Health Care Department, in Casale Monferrato, of three groups of psychotic patients treated with olanzapine (31), risperidone (30) or typical neuroleptics (31). The observation was retrospective, lasting one year (2003-2004), and collected data relative to health care resources as specialist visits, home interventions operated by nurses or physicians, drug administration, rehabilitation, psychotherapy, hospitalizations. The data collected allowed to evidentiate substantial differences among olanzapine and risperidone treated patients, usually younger, versus typical treated patients, usually older and more chronic. In general, atypical treated patients, evidentiate a reduction of home nurse intervention in respect to typical treated patients while olanzapine shows a trend in hospitalization and specialist visits reduction versus risperidone. Total health care costs are not significantly different among the three groups but evidentiate interventions more oriented to rehabilitation in the group treated with olanzapine while risperidone treated patients needed a major number of hospitalizations. Typical treated patients requested, instead, an high number of home intervention due to their chronic conditions and cognitive imparement.

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Tilley, Barbara C., Arch G. Mainous, Daniel W. Smith, et al. "Design of a cluster-randomized minority recruitment trial: RECRUIT." Clinical Trials 14, no. 3 (2017): 286–98. http://dx.doi.org/10.1177/1740774517690146.

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Background: Racial/ethnic minority groups remain underrepresented in clinical trials. Many strategies to increase minority recruitment focus on minority communities and emphasize common diseases such as hypertension. Scant literature focuses on minority recruitment to trials of less common conditions, often conducted in specialty clinics and dependent on physician referrals. We identified trust/mistrust of specialist physician investigators and institutions conducting medical research and consequent participant reluctance to participate in clinical trials as key-shared barriers across racial/ethnic groups. We developed a trust-based continuous quality improvement intervention to build trust between specialist physician investigators and community minority-serving physicians and ultimately potential trial participants. To avoid the inherent biases of non-randomized studies, we evaluated the intervention in the national Randomized Recruitment Intervention Trial (RECRUIT). This report presents the design of RECRUIT. Specialty clinic follow-up continues through April 2017. Methods: We hypothesized that specialist physician investigators and coordinators trained in the trust-based continuous quality improvement intervention would enroll a greater proportion of minority participants in their specialty clinics than specialist physician investigators in control specialty clinics. Specialty clinic was the unit of randomization. Using continuous quality improvement, the specialist physician investigators and coordinators tailored recruitment approaches to their specialty clinic characteristics and populations. Primary analyses were adjusted for clustering by specialty clinic within parent trial and matching covariates. Results: RECRUIT was implemented in four multi-site clinical trials (parent trials) supported by three National Institutes of Health institutes and included 50 associated specialty clinics from these parent trials. Using current data, we have 88% power or greater to detect a 0.15 or greater difference from the currently observed control proportion adjusting for clustering. We detected no differences in baseline matching criteria between intervention and control specialty clinics (all p values > 0.17). Conclusion: RECRUIT was the first multi-site randomized control trial to examine the effectiveness of a trust-based continuous quality improvement intervention to increase minority recruitment into clinical trials. RECRUIT’s innovations included its focus on building trust between specialist investigators and minority-serving physicians, the use of continuous quality improvement to tailor the intervention to each specialty clinic’s specific racial/ethnic populations and barriers to minority recruitment, and the use of specialty clinics from more than one parent multi-site trial to increase generalizability. The effectiveness of the RECRUIT intervention will be determined after the completion of trial data collection and planned analyses.

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Ramadhan, Indah, Budi Keliat, and Ice Wardani. "Assertive training and family psychological education therapy on adolescents self-esteem in prevention of drug use in boarding school." International Journal of Advanced Nursing Studies 7, no. 1 (2018): 17. http://dx.doi.org/10.14419/ijans.v7i1.8598.

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Adolescents are prone to use drugs when they have low self-esteem. Assertiveness training and family psychological education therapies are mental health nursing specialist interventions that are expected to increase adolescent self esteem so that adolescent has ability to prevent drug use. This study aims to determine the effect of assertiveness training and family psychological education therapy on adolescent self-esteem in the prevention of drug use in boarding schools. The research design was a quasi-experimental pre-post test with a control group. Sixty four adolescent students at the boarding school were selected using purposive sampling technique and cluster random sampling. The intervention group 1 only received general nursing intervention and the intervention group 2 received general nursing intervention, assertiveness training, and family psychological education therapy. The results showed that the self-esteem of adolescent students increased significantly after receiving nursing intervention and in the high self-esteem category (p = 0.017), after assertiveness training and family psychological education therapy, adolescent self-esteem in the intervention group 2 increased greater than only general nursing intervention ( P = 0, 000) with the high self-esteem category. There is the influence of assertiveness training and family psychological education therapy on adolescent self-esteem in prevention of drugs uses in a boarding school. Community health center is recommended to do nursing care in school through school health unit program either by primary care nurse or nurse specialist of mental health nursing.

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Lin, Michael Y., Tiffany Wiksten, Alexander Tomich, Mary K. Hayden, and John Segreti. "974. Impact of Mandatory Infectious Disease (ID) Specialist Approval on Hospital-Onset Clostridium difficile (HO-CDI) Testing and Infection Rates: Results of a Pilot Study." Open Forum Infectious Diseases 5, suppl_1 (2018): S38—S39. http://dx.doi.org/10.1093/ofid/ofy209.090.

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Abstract Background The 2017 IDSA C. difficile guidelines recommend the use of nucleic acid amplification testing alone for detection of HO-CDI if appropriate stool specimens are collected (e.g., patients not receiving laxatives and ≥3 unformed stools in 24 hours). The potential role of ID specialists in enforcing appropriate C. difficile testing is unclear. Methods At a single academic hospital, we performed a pilot study of an ID specialist-led approval process for C. difficile testing. During the baseline period (January 2016 and November 2017), HO-CDI testing appropriateness was enforced using a computerized decision support tool that discouraged inappropriate testing based on detected laxative use and stool frequency criteria; however, clinicians frequently ignored the computer alerts. During the intervention period (December 2017 and March 2018), all HO-CDI testing on hospital day 4 or later triggered a computer alert requesting mandatory testing approval by an ID specialist. Approvals were provided via telephone consultation 7 days a week between 8 a.m. and 5 p.m. (in both periods, CDI testing was not performed overnight). We analyzed differences HO-CDI testing and infection rates (defined by CDC’s LabID event) per 10,000 patient days using Poisson models. We also analyzed the number of approval pager calls, rates of C. difficile testing approval, and time burden. Results Two infectious diseases specialists (M.Y.L.; J.S.) primarily answered C. difficile pager approval requests; the remainder of approvals were provided by ID specialists already consulted on the patients. During the intervention period, ordering providers made 159 calls to the approval pager; 119 (75%) received approval. HO-CDI testing and infection rates declined between the baseline and intervention periods (figure). There was a mean of 1.3 pager approval requests per day (range, 0–4) with an average of 3 minutes of time spent per request. Conclusion An ID specialist-led C. difficile testing approval process was feasible and associated with a significant decrease in HO-CDI testing and infection rates, due to enforcement of appropriate testing. ID specialists can provide a key role in enforcing appropriate C. difficile testing, but more experience is needed with respect to sustainability. Disclosures M. Y. Lin, Stryker (Sage Products): Research support in the form of contributed product, Research support. OpGen, Inc: Research support in the form of contributed products, Research support. CareFusion Foundation (now BD): Grant Investigator, Research grant.

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Brown, A., A. Gouldstone, E. Fox, et al. "Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme." BMJ Open 5, no. 4 (2015): e007217-e007217. http://dx.doi.org/10.1136/bmjopen-2014-007217.

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Yin, Hua, Ling Yang, and Qiao Ye. "A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease (COPD)." Frontiers of Nursing 5, no. 2 (2018): 147–56. http://dx.doi.org/10.2478/fon-2018-0019.

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Abstract Objective This review aimed to examine the effectiveness of clinical nurse specialist (CNS) interventions in patients with chronic obstructive pulmonary disease (COPD). COPD significantly affects people’s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective. Methods A narrative analysis of the data was performed for the eligible studies. Four databases were chosen: CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Results A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS’s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality of life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD. Conclusions The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.

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Evan, Edmond, Mehta Arpan, Taylor Alison, and Jacob John. "THUR 075 Evaluating a personal information pack in epilepsy." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (2018): A8.3—A8. http://dx.doi.org/10.1136/jnnp-2018-abn.30.

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A mainstay of epilepsy management is patient education and engagement. Previous educational interventions have varied greatly in number of sessions, teaching methodology and cost. This study assessed the impact of a low-cost intervention consisting of a personal information pack.MethodsForty-six consecutive patients with an existing epilepsy diagnosis attending clinic at MKUH NHS Trust were enrolled and pack provided. A baseline questionnaire assessed patient understanding and service utilisation (GP, A and E, specialist nurse). The questionnaire was repeated 3 months later. Patient engagement with the pack was assessed (completeness of information in pack, patient rating of usefulness).ResultsFourteen patients were lost to follow-up - thirty-two completed the second interview. There was a trend towards reduced service utilisation. Specialist nurse visits were significantly reduced (2.75 visits/year pre-intervention vs 1.11 post-intervention, p=0.01). Patient understanding was not significantly changed. Patient rating of usefulness was positive (2.4/3 on Likert scale). Two thirds of patients had not filled out the pack or added basic details only.DiscussionThis simple, low cost intervention may reduce some types of service utilisation and be found helpful by patients. A planned redesign involves the provision of a low-effort pre-filled information card together with the larger pack.

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Drigas, Athanasios, Georgia Kokkalia, Alexandra Economou, and Petros Roussos. "Intervention and Diagnostic Tools in Preschool Education." International Journal of Emerging Technologies in Learning (iJET) 12, no. 11 (2017): 185. http://dx.doi.org/10.3991/ijet.v12i11.7155.

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A representative study of some of the most important intervention, assessment and diagnostic tools of the preschool education is presented. Additionally, a list of some of the most well known intervention and diagnostic tools that are used for the Greek preschoolers by specialist is examined briefly. The importance of their use and the domains that are examined by these tools are investigated thoroughly.

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Burke, Katie, Helen Penston, and Jillian Riley. "An audit of specialist nurse pharmacological intervention in chronic heart failure." British Journal of Cardiac Nursing 3, no. 7 (2008): 301–8. http://dx.doi.org/10.12968/bjca.2008.3.7.30504.

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Barros, J., F. Renosto, R. Silva, et al. "N824 Impact of educational intervention on inflammatory bowel disease nurse specialist." Journal of Crohn's and Colitis 11, suppl_1 (2017): S501. http://dx.doi.org/10.1093/ecco-jcc/jjx002.948.

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St-Louis, Lyne, and Diane Brault. "A Clinical Nurse Specialist Intervention to Facilitate Safe Transfer From ICU." Clinical Nurse Specialist 25, no. 6 (2011): 321–26. http://dx.doi.org/10.1097/nur.0b013e318233eaab.

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Journal articles on the topic 'Specialist Intervention'

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