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Md Zali, Mastura, Saiful Farik Mat Yatin, Mohd Razilan Abdul Kadir, Siti Noraini Mohd Tobi, Nurul Hanis Kamarudin, and Nik Nurul Emyliana Nik Ramlee. "Managing Medical Records in Specialist Medical Centres." International Journal of Engineering & Technology 7, no. 3.7 (July 4, 2018): 232. http://dx.doi.org/10.14419/ijet.v7i3.7.16358.
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A collection of facts about a patient’s life and health history of past and present illnesses and treatments is known as medical records. The health professionals were contributing to record the patient’s care. The responsibility in managing daily records that produced by each of department is by the Medical Records Department. It is a department under clinical support services with activities including managing of patient records, patient information production, management of medical reports, and hospital statistics. This article aims to discuss the challenge associated with managing medical records in the organization and how to handle and manage it with the records management as a tool to mitigate risk. Therefore, it is likely to prompt further research by addressing existing gaps towards improving service delivery that can contribute to the body of knowledge in the field of records management and archives generally.
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Stewart, D. E., and G. P. Lippert. "Psychiatric Consultation-Liaison Services to an Obstetrics and Gynecology Department." Canadian Journal of Psychiatry 33, no. 4 (May 1988): 285–89. http://dx.doi.org/10.1177/070674378803300410.
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This paper describes the psychiatric consultation-liaison services provided to an Obstetrics and Gynecology Department. Clinical services are provided both by program consultation and by individual inpatient and outpatient referral. Clinical problems in obstetrics and gynecology that result in psychiatric referral are discussed. Research interests which play an important role in the program are described. Educational activities are directed toward ward and clinic staff, undergraduate medical students, residents and the practising specialist. The combination of well articulated consumer requests, interested gynecologists and obstetricians, broadened gynecology residency training objectives, and greater involvement of consultation-liaison psychiatrists suggests a promising future for psychosomatic obstetrics and gynecology.
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REED, JAN, MARGARET COOK, GLENDA COOK, PAMELA INGLIS, and CHARLOTTE CLARKE. "Specialist services for older people: issues of negative and positive ageism." Ageing and Society 26, no. 6 (October 19, 2006): 849–65. http://dx.doi.org/10.1017/s0144686x06004855.
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This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘bottom-up’ local processes as well as ‘top-down’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.
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Tyrer, Peter. "The future of specialist community teams in the care of those with severe mental illness." Epidemiologia e Psichiatria Sociale 16, no. 3 (September 2007): 225–30. http://dx.doi.org/10.1017/s1121189x00002323.
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SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).
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Sinnarajah, Aynharan, Madalene Earp, Pin Cai, Andrew Fong, Kelly Blacklaws, Safiya Karim, Winson Y. Cheung, and Marc Kerba. "Impact of specialist palliative care delivered over three months prior to death on a colorectal cancer patient’s risk of experiencing aggressive end-of-life care." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6614. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6614.
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6614 Background: More patients are experiencing aggressive end-of-life (EOL) care. This is concerning as aggressive EOL care, on a population level, is associated with poor quality care. Specialist palliative care (PC) has been shown to help relieve EOL symptoms, improve patient quality of life, and reduce aggressive EOL care. This study aimed to estimate the impact of the timing of specialist PC, specifically PC delivered at least 3 months prior to death, on a colorectal cancer (CRC) patient’s risk experiencing aggressive care in the last 30 days of life. Methods: A population-based retrospective cohort study of adult patients who died from CRC in Alberta, Canada from 2011-2015. The Alberta Cancer Registry was used to identify the cohort, which was linked to healthcare resource use data in local, provincial, and national databases. Individuals who died < 30 days from CRC diagnosis were excluded. Patients who accessed any of the provinces specialist PC services were deemed exposed to specialist PC (includes PC consult team, intensive PC unit, palliative home care, hospice). Aggressive EOL care was defined as having experienced at least one of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any treatment in the last 14 days of life). Logistic regression was used to model factors (specialist PC timing and clinical characteristics) associated with aggressive EOL care. Results: The cohort comprised 2979 patients. Most patients received specialist PC before death (58%); 60% had ≥1 indicator of aggressive EOL care. Relative to patients who received specialist PC > 3 months before death, patients who received specialist PC < 3 months before death were 1.5 times more likely to experience aggressive EOL care (CI: 1.2-1.9). Patients who received no specialist PC were 2.1 times more likely to experience aggressive EOL care (CI: 1.7-2.8). Short disease duration ( < 1 year from diagnosis to death), younger age at death, living in a rural area, and male sex, were also associated with higher odds of experiencing aggressive EOL care. Conclusions: Specialist PC delivered > 3 months before death reduces a CRC patient’s risk of experiencing aggressive EOL care over PC delivered < 3 months before death.
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To, Teresa, Natasha Gray, Kandace Ryckman, Jingqin Zhu, Ivy Fong, and Andrea Gershon. "Sex differences in health services and medication use among older adults with asthma." ERJ Open Research 5, no. 4 (October 2019): 00242–2019. http://dx.doi.org/10.1183/23120541.00242-2019.
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Sex differences are well documented in chronic disease populations with cardiovascular disease and diabetes. Although recent research has suggested that asthma is more severe in older women compared to men, the extent of this difference remains poorly understood. The objective of this study was to compare rates of asthma-specific health services use (HSU) and medication use, between older women and men with asthma.This population-based cohort study included 209 054 individuals aged ≥66 years with asthma from health administrative data in Ontario, Canada. The primary exposure was sex. Outcomes included asthma-specific HSU (spirometry, emergency department (ED), hospitalisation, physician office and specialist visits) and medication use (asthma controller and reliever prescriptions). Negative binomial regression models adjusted for age, socioeconomic status and comorbidities were used to ascertain outcomes by sex from 2010 to 2016.Compared to men, women had lower rates of spirometry (adjusted relative rate (ARR) 0.87, 95% CI 0.85–0.89) and specialist visits for asthma (ARR 0.93, 95% CI 0.90–0.96), but higher rates of asthma-specific ED (ARR 1.43, 95% CI 1.33–1.53) and physician office visits (ARR 1.03, 95% CI 1.01–1.05). Women also had lower asthma controller (ARR 0.98, 95% CI 0.97–0.99) but higher asthma reliever (ARR 1.03, 95% CI 1.02–1.05) prescription fill rates, compared to men.These findings may indicate poorer disease control, greater asthma severity and poorer access to specialist asthma care in women.
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Smith, T., J. F. Morton, and E. Nengomasha. "Dissemination of outputs from a cluster of livestock production programme projects in Zimbabwe." Proceedings of the British Society of Animal Science 2005 (2005): 29. http://dx.doi.org/10.1017/s1752756200009406.
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During the mid to late 1990’s a cluster of Livestock Production Programme (LPP) projects, funded by the Department for International Development (DFID) was established in Zimbabwe, as a representative country of southern sub-Saharan Africa, to develop outputs to increase the livestock contribution to the alleviation of poverty. All stakeholders were involved with the projects from the planning stage and participatory on-farm research was a key feature. Several of the projects addressed one of the major constraints to livestock production in arid and semi-arid areas, dry season feeding, the animal species considered being poultry, donkeys (draught power), goats and milking cows. The benefits of these projects can only be realised through effective dissemination to relevant target groups (farmers, extension staff, which because of failing government extension services in several African countries, must include NGOs, churches and local organizations, and policy makers) and development of relevant training materials.
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Bion, Julian, Cassie Aldridge, Chris Beet, Amunpreet Boyal, Yen-Fu Chen, Michael Clancy, Alan Girling, et al. "Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study." Health Services and Delivery Research 9, no. 13 (July 2021): 1–166. http://dx.doi.org/10.3310/hsdr09130.
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Background NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’. Objectives The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness. Design This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics. Methods A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision. Results Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time. Limitations Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time. Conclusions Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care. Future work Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Wei Chern, Ang. "Healthcare Professionals’ Experiences on Interdisciplinary Collaboration in a Medical Department of a Malaysian General Hospital." Medicine & Health 16, no. 1 (June 28, 2021): 246–55. http://dx.doi.org/10.17576/mh.2021.1601.20.
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Healthcare professionals (HCPs) in all healthcare facilities including public hospitals in Malaysia need to cooperate to meet the diverse healthcare demands. To date, there has yet detailed research on this collaboration in Malaysia. This study aimed to explore interdisciplinary collaboration in the Medical Department (wards and clinics) of a state hospital. Four focus group discussions (FGDs) were held. A medical specialist, medical officer, nurse manager/charge nurse, staff nurse, senior and junior clinical pharmacists were all present at each FGD. Purposive sampling was used to recruit participants (nomination by heads of department). FGDs were performed in English, but responses in Malay were accepted and translated into English. All FGDs were audio-recorded, transcribed, and analysed thematically. In the theme of role clarity, most participants opined that the doctors led in patient management, while the nurses were in charge of monitoring, ambulating and drug administration. However, some participants were unfamiliar with the role of pharmacists. The majority believed that effective collaboration did exist, but insufficient. Weak communication skills, lack of communication, personnel and time were obstacles to effective collaboration. Regular discussions between different disciplines can encourage interprofessional collaboration. Despite doctors acknowledging pharmacists' Medication Therapy Adherence Clinic (MTAC) services, and nurses' human immunodeficiency virus (HIV) counselling and diabetic education services, some nurses and pharmacists were unaware of each other's services. To avoid conflicting tasks and human resource wastage, each HCP's services should be actively promoted among other HCPs.
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Cook, Amy. "Taking a holistic approach to acute mental health crisis." Journal of Paramedic Practice 11, no. 10 (October 2, 2019): 426–32. http://dx.doi.org/10.12968/jpar.2019.11.10.426.
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An innovative, collaborative model implemented by a UK ambulance service allows patients presenting with a mental health condition to be promptly assisted by a specialist team comprising a paramedic, mental health nurse and police officer. Initial evidence suggests that greater collaboration between emergency services and mental health trusts benefits patients and services: leading to timely assessments, reductions in patient distress levels, and decreasing emergency department overcrowding while providing substantial savings for the NHS. This article explores existing care pathways for patients experiencing acute mental health crisis. Current research from the UK is discussed, and compared with working practices of paramedics internationally. Through reflection of a case study, common difficulties faced in paramedic practice are identified. A multi-agency response to ensure the right care is provided in the right place at the right time is proposed.
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Sumar, Nureen, Madalene Earp, Desiree Hao, and Aynharan Sinnarajah. "Palliative care as a predictor of healthcare resource use at end-of-life in adult Albertan lung cancer decedents between 2008-2015: A secondary data analysis." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e24009-e24009. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24009.
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e24009 Background: Early utilization of specialist palliative care (SPC) in cancer patients may reduce healthcare resource use, aggressive interventions, and costs at end-of-life. We evaluated the impact of SPC on healthcare resource utilization and aggressive interventions at end-of-life in patients who have died from lung cancer. Methods: Descriptive and multivariable logistic regression analyses were conducted on lung cancer decedents in the Calgary Zone, Alberta Health Services from 2008 to 2015. The primary exposure was timing of SPC (Early: receipt of SPC > = 90 days before death; Late: < 90 days before death; No SPC). The primary outcome was end-of-life healthcare resource use (defined as any of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any chemotherapy in the last 14 days of life) in the 30 days prior to death. Results: There were 3300 patients of which the majority (51.6%) of decedents were male. More female versus male lung cancer decedents (36.4% vs 28.7%) received early SPC. After adjusting for confounders, a strong association was found between early, late or no SPC and end-of-life healthcare resource use (ORno exposure 3.25 (95% CI 2.41-4.40) vs ORlate exposure 2.44 (95% CI 2.03-2.92) compared to those with early SPC; p < 0.001). Males had 1.53 the odds of aggressive care at end-of-life compared to females (p < 0.001). Stratified analysis by sex revealed a strong association between the absence of SPC utilization and end-of-life healthcare resource use. Young age ( < 50 at death) was a strong driver of aggressive care at end-of-life in females versus males [OR 5.44 vs 2.53]. Conclusions: Early specialist palliative care was significantly associated with less end-of-life healthcare resource use in both male and female lung cancer decedents, with less early specialist palliative care use in males. Keywords: palliative care, early palliative care, cancer, end-of-life, healthcare resource use, lung cancer.
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Menon, Anish, Farhad Fatehi, Dominique Bird, Darsy Darssan, Mohan Karunanithi, Anthony Russell, and Leonard Gray. "Rethinking Models of Outpatient Specialist Care in Type 2 Diabetes Using eHealth: Study Protocol for a Pilot Randomised Controlled Trial." International Journal of Environmental Research and Public Health 16, no. 6 (March 18, 2019): 959. http://dx.doi.org/10.3390/ijerph16060959.
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Conventional outpatient services are unlikely to meet burgeoning demand for diabetes services given increasing prevalence of diabetes, and resultant impact on the healthcare workforce and healthcare costs. Disruptive technologies (such as smartphone and wireless sensors) create an opportunity to redesign outpatient services. In collaboration, the Department of Diabetes and Endocrinology at Brisbane Princess Alexandra Hospital, the University of Queensland Centre for Health Services Research and the Australian e-Health Research Centre developed a mobile diabetes management system (MDMS) to support the management of complex outpatient type 2 diabetes mellitus (T2DM) adults. The system comprises of a mobile App, an automated text-messaging feedback and a clinician portal. Blood glucose levels (BGL) data are automatically transferred by Bluetooth-enabled glucose meter to the clinician portal via the mobile App. The primary aim of the study described here is to examine improvement in glycaemic control of a new model of care employing MDMS for patients with complex T2DM attending a tertiary level outpatient service. A two-group, 12-month, pilot pragmatic randomised control trial will recruit 44 T2DM patients. The control group will receive routine care. The intervention group will be supported by the MDMS enabling the participants to potentially better self-manage their diabetes, and the endocrinologists to remotely monitor BGL and to interact with patients through a variety of eHealth modalities. Intervention participants will be encouraged to complete relevant pathology tests, and report on current diabetes management through an online questionnaire. Using this information, the endocrinologist may choose to reschedule the appointment or substitute it with a telephone or video-consultation. This pilot study will guide the conduct of a large-scale study regarding the capacity for a new model of care. This model utilises multimodal eHealth strategies via the MDMS to primarily improve glycaemic control with secondary aims to improve patient experience, reduce reliance on physical clinics, and decrease service delivery cost.
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Fisher, Ruth Moira. "Improving post-resuscitation care after out-of-hospital cardiac arrest." Journal of Paramedic Practice 12, no. 1 (January 2, 2020): 14–21. http://dx.doi.org/10.12968/jpar.2020.12.1.14.
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Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA post-resuscitation care pathway should be developed to improve the delivery of care and survival.
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Hampton, Chelsey, Bridie Evans, Khalid Ali, Jenna Bulger, Gary Ford, Chris Moore, Alison Porter, et al. "PP085 A Scoping Review Of Emergency Assessment And Referral Of Suspected Transient Ischemic Attack." International Journal of Technology Assessment in Health Care 33, S1 (2017): 110–11. http://dx.doi.org/10.1017/s0266462317002537.
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INTRODUCTION:Patients who experience Transient Ischaemic Attack (TIA) should be assessed and treated in a specialist clinic to reduce risk of further TIA or stroke. But referrals are often delayed. We aimed to identify published studies describing pathways for emergency assessment and referral of patients with suspected TIA at first medical contact: primary care; ambulance services; and emergency department.METHODS:We conducted a scoping literature review. We searched four databases (PubMed, CINAHL, Web of Science, Scopus). We screened studies for eligibility. We extracted and analysed data to describe setting, assessment and referral processes reported in primary research on referral of suspected TIA patients directly to specialist outpatient services.RESULTS:We identified eight studies in nine papers from five countries: 1/9 randomized trial; 6/9 before-and-after designs; 2/9 descriptive account. Five pathways were used by family doctors and three by Emergency Department (ED) physicians. None were used by paramedics. Clinicians identified TIA patients using a checklist incorporating the ABCD2 tool to describe risk of further stroke, online decision support tool or clinical judgement. They referred to a specialist clinic, either directly or via a telephone helpline. Anti-platelet medication was often given, usually aspirin unless contraindicated. Some patients underwent neurological and blood tests before referral and discharge. Five studies reported reduced incident of stroke at 90 days, from 6–10 percent predicted rate to 1.2-2.1 percent actual rate. Between 44 percent and 83 percent of suspected TIA cases in these studies were directly referred to stroke clinics through the pathways.CONCLUSIONS:Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalization of TIA patients. No pathways for paramedic use were reported. Since many suspected TIA patients present to ambulance services, effective pre-hospital assessment and referral pathways are needed. We will use review results to develop a paramedic referral pathway to test in a feasibility trial.
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Cottrell, David. "Supervision." Advances in Psychiatric Treatment 5, no. 2 (March 1999): 83–88. http://dx.doi.org/10.1192/apt.5.2.83.
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Supervision is a key feature of professional development in a wide range of professions. The Royal College of Psychiatrists, in its ‘Statement on approval of training schemes for basic specialist training for the MRCPsych’ (available on request from the Postgraduate Educational Services Department of the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG) dictates that each basic specialist trainee should have a “protected hour per week” with his or her educational supervisor. This time should belong “exclusively” to the trainee and be “for the benefit of the trainee”. The Higher Specialist Training Handbook (Royal College of Psychiatrists, 1998) also emphasises the central importance of supervision as part of higher training for specialist registrars. Training consultants are expected to be “readily available” to trainees, and to provide a “regular, weekly, timetabled supervision session”. Supervision is obviously perceived by those responsible for standard-setting in psychiatry as a key activity. However, there is a marked lack of clarity as to what constitutes good and effective supervision and there are often few opportunities for learning how to supervise. Hayes (1996) writes about research supervision but his comments are equally applicable to other forms of supervision. He suggests that quality supervision, where it exists, is often by accident rather than by design. It is likely to have been acquired experientially and not without some past hurt to either supervisor or supervised or both. He argues that too much attention has been paid to the quality control of supervision and not enough to quality assurance, with insufficient attention paid to all the possible roles of a supervisor and the key personal attributes necessary to fulfil these roles.
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Stebelman, Scott, Jack Siggins, David Nutty, and Caroline Long. "Improving Library Relations with the Faculty and University Administrators: The Role of the Faculty Outreach Librarian." College & Research Libraries 60, no. 2 (March 1, 1999): 121–30. http://dx.doi.org/10.5860/crl.60.2.121.
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An academic library’s most powerful constituents are faculty and administrators. In an attempt to satisfy the needs of individual departments and faculty members, many libraries employ subject specialists. To the degree that a subject specialist is proactive, or the department is heavily dependent on the library’s services, those needs will be met. However, few libraries have developed systematic programs to reach all faculty members or to begin targeting university administrators as a special user group. The rationale for doing so is twofold: to educate them on the growing role of information technology in research and teaching, and to enhance their support for new electronic resources. At George Washington University, the position of faculty outreach librarian was created to fill such a need. This article discusses how that position evolved, the projects initiated, and the outcomes that have led to revised marketing strategies.
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Barst, Robin J., Jeffrey R. Fineman, Michael A. Gatzoulis, and Richard A. Krasuski. "Pulmonary Arterial Hypertension in Adults with Congenital Heart Disease." Advances in Pulmonary Hypertension 6, no. 3 (August 1, 2007): 142–48. http://dx.doi.org/10.21693/1933-088x-6.3.142.
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This discussion was moderated by Robyn J. Barst, MD, Professor of Pediatrics, Divisions of Pediatric Cardiology at Columbia University College of Physicians and Surgeons and Cornell Medical Center, and Director of New York Presbyterian Pulmonary Hypertension Center at Columbia University Medical Center, New York, New York. Panel members included Jeffrey R. Fineman, MD, Pediatric Critical Care Specialist and Associate Investigator of the Cardiovascular Research Institute, University of California, San Francisco; John Granton, MD, Assistant Professor of Medicine, University of Toronto, Pulmonary Arterial Hypertension Programme, University Health Network, Toronto, Ontario; Michael A. Gatzoulis, MD, PhD, Professor of Cardiology, Congenital Heart Disease, and Consultant Cardiologist and Director of the Adult Congenital Heart Centre at the Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College School of Medicine, London, UK; and Richard A. Krasuski, MD, Director of Adult Congenital Heart Disease Services, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Hampton, Chelsey, Nigel Rees, Khalid Ali, Richard Dewar, Lyn Evans, Gary Ford, Roger John, 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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McInnes, Susan, Cheryl M. Carrino, and Laura Shoemaker. "Frontline oncology care team primary palliative symptom guideline education, the oncology care model, and emergency department visits." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 143. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.143.
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143 Background: The Oncology Care Model (OCM) is a novel 5-year quality-based Oncology payment and care delivery program established by the Centers for Medicare & Medicaid Service in 2016. OCM prioritizes high-quality, coordinated care for patients undergoing chemotherapy (chemo pts.) Participating centers provide augmented services to enhance care and meet quality goals. Challenging symptoms (sxs) are common among chemo pts and may lead to hospitalization and decreased quality of life. Specialist palliative care teams are not able to see all chemo pts with active sxs. Front line oncology care teams (FLC) need education on primary palliative sx management. Methods: Cleveland Clinic Taussig Cancer Institute is one of 181 practices voluntarily participating in OCM. Locations include main campus and 5 regional cancer offices with 100 oncologists caring for about 4,000 chemotherapy patients annually. Our OCM team engaged Oncology (Onc) and Palliative Medicine (PM) providers to standardize sx management. Education was provided to FLC of all disciplines. Electronic record analytics were used to determine emergency department (ED) utilization. Results: A multidisciplinary team of Onc and PM experts developed guidelines for 4 common sxs (chemotherapy-induced neuropathy, persistent cancer pain, nausea/vomiting and constipation. Guidelines were approved by key Onc and PM staff and made available to all providers online. There were 4 educational sessions for FLCs to all sites in 2017. Urgent sx outpatient appointment slots were created in oncology offices to address uncontrolled sx. From Dec 2017 to May 2018, ED visits for all cancer patients at main campus decreased from 500/month to 453/month (9.4%.) Reductions in ED visits were also seen at 2 hospitals adjacent to regional cancer centers (16% and 6%.) Conclusions: OCM participation provided an opportunity to improve care quality at our institution. Primary palliative sx guidelines were successfully developed by an interdisciplinary team and disseminated to FLC. Urgent sx management appointments were made available in oncology offices. These interventions coincided with a reduction in ED visits for all cancer patients.
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Chisadza, Bright, Michael J. Tumbare, Washington R. Nyabeze, and Innocent Nhapi. "Validation of local knowledge drought forecasting systems in the Limpopo River Basin in Southern Africa." Disaster Prevention and Management 23, no. 5 (October 28, 2014): 551–66. http://dx.doi.org/10.1108/dpm-02-2014-0032.
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Purpose – This research paper is informed by a study to assess performance of local knowledge drought forecasts (LKDFs) in the Mzingwane catchment which is located in the Limpopo River Basin in Zimbabwe. The purpose of this paper is to validate local traditional knowledge (LTK) indicators being applied in Mzingwane catchment and verify their accuracy and reliability in drought forecasting and early warning. Design/methodology/approach – LTK forecast data for 2012/2013 season were collected through structured questionnaires administered to 40 selected household heads and focus group discussions. Observations and key informant interviews with chiefs and the elderly (>55 years) were also used to collect additional LTK forecast data. Meteorological data on seasonal rainfall were collected from the meteorological Services Department of Zimbabwe (MSD). Two sets of comparisons were conducted namely the hind-cast comparison where the LKDF system results were evaluated against what the season turned out to be and forecast comparison where local LKDF system results were compared with downscaled meteorological forecasts. Findings – The results showed that the majority of the LTK indicators used were accurate in forecasting weather and drought conditions when compared to the observed data of what the season turned out to be. LTK forecasts were found to be more accurate than meteorological forecast at local scale. This study has shown that the reliability of LTKs is high as demonstrated by the fact that the predicted event occurs. Research limitations/implications – Further validation be carried out for a number of seasons, in order to standardise the LTK indicators per geographical area. Originality/value – The research creates platform for adoption of LTKs into formal forecasting systems. The research is useful to both meteorological researchers and resource constrained communities in Mzingwane catchment.
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Teplov, V. M., S. S. Aleksanin, E. A. Tsebrovskaya, V. V. Kolomoytsev, V. V. Burykina, A. A. Lebedeva, V. A. Belash, and S. F. Bagnenko. "New Professional Competences of Inpatient Emergency Department Staff." Disaster Medicine, no. 2 (June 2021): 59–64. http://dx.doi.org/10.33266/2070-1004-2021-2-59-64.
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The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.
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Cassel, Brian, Patrick J. Coyne, Nevena Skoro, Kathleen Kerr, and Egidio Del Fabbro. "Evaluating the impact of early versus late inpatient palliative care consultation for cancer patients." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6638. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6638.
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6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]
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Mole, Guy, Mayur Murali, Sarah Carter, David Gore, Jack Broadhurst, Tim Moore, Philip Vickers, and Andrew Miles. "A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery." British Journal of Nursing 28, no. 19 (October 24, 2019): 1134–38. http://dx.doi.org/10.12968/bjon.2019.28.19.1134.
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Introduction: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. Methods: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. Results: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. Discussion: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.
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Mole, Guy, Mayur Murali, Sarah Carter, David Gore, Jack Broadhurst, Tim Moore, Philip Vickers, and Andrew Miles. "A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery." British Journal of Nursing 28, no. 19 (October 24, 2019): 1234–38. http://dx.doi.org/10.12968/bjon.2019.28.19.1234.
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Introduction: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. Methods: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. Results: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. Discussion: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.
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Edge, Lucinda, Brian O'Rourke, Conal Cunningham, and Frances Horgan. "185 Revisiting Comprehensive Geriatric Assessment in the Emergency Department." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.108.
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Abstract Background In a large teaching hospital, a specialist interdisciplinary team identify frailty and begin comprehensive geriatric assessment of older adults in the Emergency Department (ED). This study aimed to determine the clinical utility of a range of measures: grip strength, calf circumference, frailty and functional mobility to evaluate whether they help to estimate the care pathways for patients. Objectives included: (1) To ascertain the prevalence of frailty and (2) To profile this population’s demographics, falls history, calf circumference and grip strength. Methods This was a cross-sectional study. Inclusion criteria were persons ≥ 70 who presented to ED weekdays during research hours 9:00 – 16:00, with Manchester triage score ≥ 3. Information on gait aids, social supports and falls in the past 6 months was self-reported. Grip strength was assessed using hydraulic hand-held dynamometry. Sarcopenia was measured using calf circumference as a proxy. Frailty was determined using the Clinical Frailty Scale (CFS). Functional mobility was assessed by an interdisciplinary team member. Onward referrals and admission to hospital were recorded. Data was analysed using SPSS statistics software. Results One hundred and one participants were included, 39 male (38.6%) and 62 female (61.4%), mean age 79.3 years. Thirty-five percent (n=36) were considered Frail (a CFS score of ≥5), 35.6% (n=36) lived alone, 52.5% (n=53) used a gait aid. Outcomes included admission to hospital (27.7%, n=28) and discharge with onward referral (25.7%, n=26). The most common referral was community physiotherapy (11.9%, n=12). The population identified as frail were more likely to be female (p = 0.036), to use a gait aid (p = 0.001) and to have fallen within the past 6 months (p = 0.007). Conclusion The prevalence of frailty was determined in this population and was not significantly associated with hospital admission, grip strength or calf circumference. A focus on alternative pathways to hospital admission with appropriate access to community services is recommended for individuals with frailty.
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Lisetska, I. S. "The role of the student scientific circle in the training highly qualified specialists during distance learning." Modern pediatrics. Ukraine, no. 4(116) (May 26, 2021): 82–85. http://dx.doi.org/10.15574/sp.2021.116.82.
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An important stage in the formation of the future specialist is the independent work of the applicant, in particular the involvement of the best representatives in research work. Applicants are attracted to the GDR through a student research group. The COVID-19 coronavirus pandemic and quarantine restrictions have forced almost all countries to reconsider educational strategies. Purpose — to evaluate student research group the role of the functioning in the higher medical educational institution at the Department of Pediatric Dentistry in the training of future highly qualified specialists and the peculiarities of its work during distance learning. Results. An important means of organizing the educational work of applicants for in-depth study of various aspects of pediatric dentistry is their research activities in independent work, in the process of which teachers are initiative and interested applicants who continue research within the student research group department, conducting research on selected topics. During distance learning IFNMU uses the site «Office 365 Cloud Services», which is accessible to all teachers and students. During the quarantine, student research group meetings are held in the format of online conferences in the Microsoft Teams program (previously created team with the type «Class» — student research group Department of Pediatric Dentistry, which added students of all courses of the Faculty of Dentistry and events in the program — in calendar according to the calendar-thematic plan student research group meetings, students and teachers are invited). Microsoft Teams is a teamroom for Office 365, which is a simpler version of learning management systems, but allows the learning team to communicate and share files. The program is convenient because it combines everything in a common work environment, which includes chat for discussion, file sharing and corporate programs. The student research group meeting was organized by video link. Conclusions. Thus, participation in the student research group Department of Pediatric Dentistry IFNMU gives applicants the opportunity to prepare a full-fledged scientific work that enhances the educational process, promotes their professional growth, helps to combine creativity, theoretical knowledge and practical skills. In addition, it increases the level of training of future specialists and the formation of research work skills as a component of professional training of applicants and the development of scientific potential of future scientists even during distance learning. No conflict of interest was declared by the author. Key words: research work, student research group, distance learning, applicant.
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Rogers, Emily, and Howard S. Carrier. "A qualitative investigation of patrons’ experiences with academic library research consultations." Reference Services Review 45, no. 1 (February 13, 2017): 18–37. http://dx.doi.org/10.1108/rsr-04-2016-0029.
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Purpose This paper aims to report the findings of a qualitative investigation of student patrons’ experiences with research consultations provided by reference librarians at a comprehensive university located in the southern USA during 2014. Design/methodology/approach Data were collected through recorded interviews with patrons who had recently experienced a reference consultation with one of eight professional reference librarians during a semester. The recorded data were transcribed verbatim and the transcripts subjected to content analysis. The qualitative data analysis model selected was that of a conventional, inductive content analysis. Findings One principal finding demonstrates the need for marketing of the reference consultation service; participants were surprised at the service’s availability. Other findings illustrate the value participants placed on individual attention from a librarian, perceived librarian expertise, the consultation environment and student/librarian engagement. Research limitations/implications Limitations to this study include a small participant pool of undergraduate student patrons, mainly majoring in humanities disciplines. The findings therefore are limited in the confidence with which they can be generalized to larger populations. Practical implications The reference consultation remains an integral part of the services offered by an academic library’s reference department; libraries should market consultations accordingly. Academic libraries that do not operate on a subject specialist model should consider strategies for maximizing benefit when matching available staff to consultation requests. Social implications This study provides evidence for the value of one-to-one reference service through research consultations provided to library patrons in academic libraries serving institutions of the type described in the research. Originality/value A qualitative methodology, using content analysis of lengthy interviews with participants, provides considerable insight into academic library patrons’ attitudes toward the reference consultation service.
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Torabi, Nazi. "Library School Curricula in the US Should Address Liaison Responsibilities for Students Interested in Academic Librarianship." Evidence Based Library and Information Practice 5, no. 2 (June 17, 2010): 100. http://dx.doi.org/10.18438/b8h326.
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A Review of:
Attebury, R. I., & Finnell, J. (2009). What do LIS students in the United States know about liaison duties? New Library World, 110(7), 325-340.
Objectives – The two main objectives of this study were to determine the level of prevalence of liaison work in academic library job advertisements and to investigate whether the current library & information science (LIS) students are aware of liaison duties.
Design – The mixed methods used in this study are job postings analysis and online survey.
Setting – The research settings were the following:
(1) Online academic job advertisements published between November 15, 2007 and January 15, 2008 and collected from Chronicle of Higher Education’s Web site and lisjobs.com;
(2) Fifty-three electronic mail lists of ALA-accredited library schools in the US.
Subjects – The subjects of the study were 313 online academic job advertisements and 516 LIS students.
Methods – The sample size and methodology for the first part of this study were based on four previously published studies. Duplicated job postings were removed and the remaining were organized into 15 categories of access/public services, reference, instruction, bibliographer/subject specialist, combination (instruction and reference), archives/special collections, special libraries, director/dean, department head or coordinator, interlibrary loan (ILL), systems/web development, cataloguing, outreach, and acquisitions/collection-development. Only those job ads containing the term “liaison” were included in the analysis.
For the second part of the study, the authors conducted an online survey. They attempted to investigate the knowledge of LIS students on liaison librarianship, to measure the level of exposure to liaison responsibilities in their course work, and to gauge the confidence of the individual in their ability to become successful liaison librarians. The survey was distributed among 53 LIS school electronic mail lists, resulting in 516 respondents.
Main Results – The job ad analysis revealed that 29% of job postings were directly related to liaison duties. The liaison component of the positions related to access/public services, instruction, bibliographer/subject specialist, special, and outreach were the highest (50% or more). The liaison activities described in the job ads related to reference, a combination of reference and instruction, ILL, department head/coordinator, and system/Web development were also high (29% to 50%). The positions categorized as librarian, archives, director/dean, cataloguing, and collection development/acquisitions had less liaison responsibilities (
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Abdulsalam, Ahmed, and Hafiz T. A. Khan. "Hospital Services for Ill Patients in the Middle-Belt Geopolitical Zone, Nigeria: Patient’s Waiting Time and Level of Satisfaction." Illness, Crisis & Loss 28, no. 1 (January 18, 2017): 18–37. http://dx.doi.org/10.1177/1054137316689582.
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An important parameter in the assessment of quality health care lies on patient satisfaction. Despite concerted efforts to improve health-care services, patient satisfaction coupled with the quality of hospital care at disposal remain a significant challenge in Nigeria. The purpose of the study was to determine the perception on factors associated with prolonged waiting time and patient satisfaction at the outpatient department of Ibrahim Badamasi Babangida Specialist Hospital in Nigeria. A mixed-method research was utilized. Questionnaire was administered on 95 outpatients, and a focus group discussion (FGD) was held with eight participants. Statistical analysis was utilized to determine the association between dependent and independent variables. Data from FGD were analyzed with NVivo 10. The overall hospital satisfaction was found to be 75.8% among the study population. There was a significant inverse relationship between the level of satisfaction with the doctor and employment status and educational level and a significant direct relationship between the level of satisfaction with the doctor and appointment status and type of visits. The results of FGD show that patients were satisfied with the neatness of the hospital, doctor’s professionalism, and patient–doctor relationship. Dissatisfaction was with extended patient waiting time and the small size infrastructure of the hospital, inefficient handling of patient files by nurse aids, and thoroughness of the physicians. The results showed that majority of the patients were dissatisfied with the waiting time for consultation in the hospital. In other words, consultation time positively correlated with the level of patient satisfaction. To improve the overall patient satisfaction, the waiting time for consultation should be reduced significantly.
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Quilty, Simon, Danielle Valler, and John Attia. "Rural general physicians: improving access and reducing costs of health care in the bush." Australian Health Review 38, no. 4 (2014): 420. http://dx.doi.org/10.1071/ah13197.
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Objective To assess the effectiveness of the introduction of a trainee specialist physician into the workforce mix of a rural hospital in the Northern Territory. Methods A retrospective review comparing clinical and non-clinical outcomes during two corresponding 6-month periods in 2011 and 2012, before and after a FRACP Trainee in General and Acute Care Medicine commenced employment in the hospital. Results There was a significant reduction of 18% in total length of stay of admitted adult patients, with a 23% reduction of inter-hospital transfers and a 43% reduction of total aeromedical evacuations after the introduction of the trainee specialist. Although there was a 9% increase in patients presenting to the emergency department, there was a 9% reduction in total adult admissions. There was no change in the overall in-patient mortality rate; however, there was a significant change in the location of death, with an increase in patients dying in Katherine Hospital and a reciprocal decrease in death rate in those who had been transferred to Royal Darwin Hospital after the arrival of the trainee Conclusions The addition of an Advanced Trainee in General Medicine led to a significant change in the capacity of the hospital to care for unwell and complex patients. The role of the hospital in the care of dying patients was redefined and allowed many more people to pass away closer to their community and families. There were considerable savings at Katherine Hospital in terms of reduced bed pressure, reduced hospital bypass behaviour and reduced inter-hospital transfers, and these translated into significant benefits for the tertiary referral hospital in Darwin. A rural general physician can greatly value add to the capacity of a rural hospital and is a highly effective mechanism for reducing the disparities in healthcare access for rural and Indigenous patients. What is known about this topic? There is little research about the clinical and non-clinical impact of the addition of general speciality clinicians into the workforce of rural hospitals. Although there are several regional hospitals in Australia that have general specialists (i.e. emergency department physicians, general physicians and surgeons) and sub-specialists where the volume of patients is adequate to support such a workforce, there has been no published assessment of the impact of the addition of such speciality services. What does this paper add? This paper provides evidence of the cost-effectiveness of the addition of a specialist general physician to the workforce of a remote hospital servicing a large Indigenous population with very high burdens of acute and chronic illnesses in the Northern Territory. The paper demonstrates the potential to significantly add capacity to a rural or regional hospital by moving general speciality care to the hospital rather than, or in addition to, providing other methods of speciality and sub-speciality health care delivery. What are the implications for practitioners? The implications of this paper are that a significantly cost-effective means of addressing health care delivery to rural and remote populations is through the addition of appropriately trained general specialists such as emergency department physicians, general physicians and general surgeons. The implications extend to broader workforce development policies for education providers, speciality colleges and state and federal governments.
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Vakhidova, Lucia V., Elvira M. Gabitova, Lira R. Saitova, and Oksana G. Startseva. "IMPLEMENTATION OF THE TRAINING PROGRAM «PROFESSIONAL EDUCATION»: EXPERIENCE, PROBLEMS, PROSPECTS FOR DEVELOPMENT." Pedagogicheskiy Zhurnal Bashkortostana 88, no. 3 (2020): 55–67. http://dx.doi.org/10.21510/1817-3292-2020-88-3-55-67.
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The article describes the process of training future specialists under the program "Professional education", its features, conditions for implementation, aspects of further development, as well as some of the difficulties that arise during its organization. The focus of the department on how to create a new architecture of the educational process within the program "Professional education" is set by the leading principles: modularity, integrability, flexibility and dynamism, and methodological approaches - competence, activity-based, subject-oriented, environmental – were the basis for its development. As a result the authors presented a model for training a modern specialist with formed professional skills and personal and professional qualities, capable of being in demand in the labor market. The research results can be used in the educational process in the context of how to implement relevant programs in accordance with the new requirements in the educational services market. The rapid technologization of the socio-economic development of our society was reflected in the system of vocational education, designed to prepare highly qualified and competent specialists for the modern economy, science and industry. The transformation of the educational sphere is taking place under the influence of new technologies and human practices that change the social order. The determined infrastructural spheres have the greatest impact on this transformation, we are talking about "Communication Infrastructure": the sphere of information and communication technologies that affect all processes of accumulation and transmission of information; "Infrastructure of production and consumption": a financial and investment sphere, which sets the general rules for interaction in the economic and educational system. The above said made it possible to determine the further vector of educational activities of the Department of Pedagogy and Psychology of Vocational Education in training the specialists in "Professional Education" field both at the bachelor and master degrees.
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Golla, Heidrun, Gereon Fink, Roman Rolke, Stefan Lorenzl, Markus Ebke, Thomas Montag, Ralf Gold, Gereon Nelles, Carsten Eggers, and Raymond Voltz. "New Structures in Neurology: Palliative Care for Neurological Patients." Neurology International Open 01, no. 03 (June 2017): E117—E126. http://dx.doi.org/10.1055/s-0043-108438.
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AbstractAlthough patients with incurable neurological diseases suffer from a variety of distressing symptoms and may die from their neurological condition and associated complications, palliative and hospice care for these patients to date remains rare. Initial estimates indicate that on average 10% of all patients suffering from a neurological disease need palliative and hospice care. However, within German neurology departments, only few physicians (on average 1.3/department) and nurses (on average 2.2./department) are specialized in palliative and hospice care and only about 3% of patients cared for in palliative or hospice care structures suffer from neurological diseases (in contrast to the approximately 80% of patients suffering from oncological diseases). This rather low number is due to the gradual increase in the awareness of palliative and hospice care needs for neurological patients and a currently predominant supply of oncological patients in palliative and hospice care structures that are primarily aimed at these patients. Correspondingly, the special aspects of neurological patients are currently not adequately addressed in the palliative training curricula of healthcare professionals. Rather, patients with advanced neurological conditions are medically cared for by general practitioners and by the existing inpatient and outpatient neurology structures, which may also offer sub-specialty services. Consequently, adequate care for severely affected neurological patients becomes difficult as soon as these patients are hardly able to visit these structures because home-based specialist treatment is currently rendered and financed only to a limited degree. Novel yet to date rare approaches, mostly of international origin, suggest that these patients may benefit from specialized home-based services, combining neurological and palliative care expertise. At present, data that characterizes the situation of neuro-palliative care in Germany remains scarce. In addition to the already known supply gaps (e. g., low rate of neurologists trained in palliative medicine as well as of nurses working in neurology trained in palliative care, lack of consideration of the specific (care) needs of neurological patients in general and specialized palliative and hospice care structures, few available home-based outpatient specialists) research is a prerequisite to identify current gaps in palliative care of neurological patients in more detail and how these might be overcome in the future.
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Galvan, Pedro, Ronald Rivas, Benicio Grossling, Juan Portillo, Julio Mazzoleni, and Enrique Hilario. "VP28 Building A Virtual Diagnosis Network Through A Telemedicine Platform." International Journal of Technology Assessment in Health Care 35, S1 (2019): 82–83. http://dx.doi.org/10.1017/s0266462319003027.
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IntroductionAdvances in information and communication technology (ICT) and health technology have enhanced healthcare for many countries around the world. The challenge for low income setting countries is to build a telemedicine platform to enhance the community hospital diagnosis response capacity. Populations living in remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. There were subsequent equity issues between urban and rural populations. In this context the virtual telediagnosis network should be directed towards developing better equity in the provision of services in remote locations without access to specialists. The usability of a telemedicine platform to enhance the virtual diagnosis network of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telemedicine platform to enhance the virtual diagnosis network of community hospitals. For this purpose, the results obtained by the virtual telediagnosis network implemented in sixty public countryside community hospitals were analyzed.ResultsA total of 427,026 remote diagnoses were performed between January 2014 and October 2018 in sixty community hospitals. Of the total, 35.76 percent (152,703) corresponded to tomography studies, 62.55 percent (267,100) to electrocardiography (EKG), 1.68 percent (7,204) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound. There were no significant differences between the remote and the face-to-face diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the sixty communities.ConclusionsThe results show that the virtual diagnosis network based on a telemedicine platform can enhance significantly the community hospital diagnostic services, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its countrywide implementation, a contextualization with the regional epidemiological profile must be performed.
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Naomi Smith, E., Emily Finch, and Colin Drummond. "Falling through the cracks’ – the role of assertive alcohol outreach teams in treating comorbid mental health problems in people with addictions." BJPsych Open 7, S1 (June 2021): S277. http://dx.doi.org/10.1192/bjo.2021.736.
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AimsInput from Assertive Alcohol Outreach Teams (AAOTs) reduces the ‘burden’ on already overstretched community mental health teams (CMHTs).AAOTs are specialist addictions services. This project focuses on an AAOT based in the London, which engages with people with severe alcohol and illicit substance misuse problems.Previous research has shown that input from AAOTs reduces hospital admissions. This project examined the impact of AAOT input on reducing the ‘burden’ on CMHTs.MethodThe full caseload of the Southwark-based AAOT was reviewed, including mental health records, general practitioner notes, hospital notes and discharge summaries. We collected data on diagnoses and previous hospital admissions. Patients were assessed to determine whether they met criteria to be open to a CMHT (the presence of complex or serious mental health problems, in addition to addictions).ResultThe caseload was made up of 39 patients, 85% of patients were deemed to meet criteria for being under the care of a CMHT. Only 15% of patients are currently under the care of a CMHT. 87% of patients had at least one comorbid psychiatric diagnosis. 72% of patients had had at least one emergency department or medical hospital admission due to mental health-related problems. 39% had previous admissions to mental health wards. 21% of patients has been admitted under Section of Mental Health Act.ConclusionThe majority of AAOT patients have severe mental health problems in addition to addictions. The patients are complex and often have a history of disengagement from standard mental health services. Formal diagnosis and treatment of comorbid mental health problems is challenging in the presence of protracted drug and alcohol misuse. AAOT input appears to address a serious ‘gap’ in supporting patients with complex mental health needs who are often ineligible for CMHT input or disengage from CMHT support.
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Menon, Vikas, Siddharth Sarkar, and Shijo Thomas. "Establishing a psychosomatic clinic in a low resource setting: Process, challenges, and opportunities." Journal of Neurosciences in Rural Practice 7, no. 01 (January 2016): 171–75. http://dx.doi.org/10.4103/0976-3147.172157.
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ABSTRACT Background: Specialty psychosomatic clinics are a felt need in low- and middle-income countries, but its benefits and challenges have not been reported so far. Aims: To describe the process, challenges, and opportunities that we encountered in setting up a specialty psychosomatic clinic at a government medical college in South India. Methods: The biweekly psychosomatic clinic was located in the Department of Psychiatry and manned by a multimodal team. Structured questionnaires were used to evaluate all patients. All psychiatric diagnoses were made as per International Classification of Diseases-10, clinical descriptions and diagnostic guidelines. Management comprised both pharmacotherapy and psychotherapeutic interventions. Results: A total of 72 patients registered for services in the 1st year of the clinic. The mean age of the sample was 36.6 years (range 14–60 years). A median of 2 years and 19 visits to various care providers had elapsed before their visit to the clinic. The index contact was a general practitioner in the majority of cases though an overwhelming majority (95.6%) had also sought specialist care. The most common diagnostic cluster was the somatoform group of disorders (50.0%). Antidepressants were the most commonly prescribed medications (70.6%). Conclusion: The specialty psychosomatic clinic provided better opportunities for a more comprehensive evaluation of people with medically unexplained symptoms and better resident training and focused inter-disciplinary research. It describes a scalable model that can be replicated in similar resource constrained settings.
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Banerjee, S. "Issues in pharmacological management of behavioural and psychological symptoms of dementia: English ministerial review of the use of antipsychotic drugs for people with dementia." European Psychiatry 26, S2 (March 2011): 2110. http://dx.doi.org/10.1016/s0924-9338(11)73813-5.
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IntroductionIn response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.Aims and methodsThe report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.ResultsThis review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.ConclusionsThe report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.
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Fowler Davis, Sally, Hilary Piercy, Sarah Pearson, Ben Thomas, and Shona Kelly. "Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners’ views." BMJ Open 8, no. 3 (March 2018): e019084. http://dx.doi.org/10.1136/bmjopen-2017-019084.
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ObjectivesTo report general practitioners’ (GPs’) views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister’s Challenge Fund (second wave) for England which aimed to extend patient access to primary care.SettingPrimary care in Sheffield, England.ParticipantsSemi-structured interviews with a purposive sample of GPs working in 24 practices across the city.ResultsFour core themes were derived: GPs’ receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload.ConclusionsThe variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.
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Ślusarz, Robert, and Karolina Filipska. "Postgraduate Education of Neurological Nurses — Preliminary Reports." Journal of Neurological and Neurosurgical Nursing 9, no. 2 (June 2020): 71–75. http://dx.doi.org/10.15225/pnn.2020.9.2.4.
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Introduction. Postgraduate education for nurses is an integral part of professional development. Currently, in accordance with the legislation in force in Poland, a neurological nurse may improve their profession as part of self-education or as part of organized forms and types of postgraduate education by undergoing various specialized training, acquiring professional skills in the narrower fields of nursing or providing specific health services. Aim. The aim of the research was to analyse the postgraduate education of neurological nurses. Material and Methods. The research was conducted on a group of 128 nurses employed in 9 neurological centres in the Kuyavian-Pomeranian Voivodeship (Bydgoszcz, Toruń, Włocławek, Grudziądz, Świecie, Lipno). Postgraduate education was assessed by means of a diagnostic survey using a questionnaire survey technique. Results. It was shown that there are statistically significant differences between the age, experience and education of the respondents and the preferred form of education (p < 0.05) and awarding educational points for training (p < 0.05). It was also found that age and seniority in the neurology department differentiated the form of financing training (p < 0.05). Additionally, seniority is a factor that significantly differentiates the thematic specificity of the training (p < 0.05). Conclusions. The most popular form of postgraduate education is specialization and a specialist course. An important form of training is also participation in a conference/symposium. The vast majority of respondents stated that their trainings are financed by their own/private funds. It was found that the respondents lacked knowledge about training specific to neurological nurses, with the simultaneous need for such training. Among the difficulties/problems related to professional development, the most frequently indicated were the lack of time for training and difficulties with its financing. Almost half of the respondents expect to receive education/credit points for education. (JNNN 2020;9(2):71–75) Key Words: neurological nursing, postgraduate education, nurses
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Llewellyn, Sue, Naomi Chambers, Sheila Ellwood, Christos Begkos, and Chris Wood. "Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy." Health Services and Delivery Research 4, no. 31 (October 2016): 1–156. http://dx.doi.org/10.3310/hsdr04310.
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BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Ruzangi, Judith, Mitch Blair, Elizabeth Cecil, Geva Greenfield, Alex Bottle, Dougal S. Hargreaves, and Sonia Saxena. "Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017." BMJ Open 10, no. 5 (May 2020): e033761. http://dx.doi.org/10.1136/bmjopen-2019-033761.
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ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.
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O’Hara, Rachel, Maxine Johnson, Enid Hirst, Andrew Weyman, Deborah Shaw, Peter Mortimer, Chris Newman, et al. "A qualitative study of decision-making and safety in ambulance service transitions." Health Services and Delivery Research 2, no. 56 (December 2014): 1–138. http://dx.doi.org/10.3310/hsdr02560.
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BackgroundDecisions made by front-line ambulance staff are often time critical and based on limited information, but wrong decisions in this context could have serious consequences for patients. There has been little research carried out in the ambulance service setting to identify areas of risk associated with decisions about patient care.AimThe aim of this study was to qualitatively examine potential system-wide influences on decision-making in the ambulance service setting and to identify useful areas for future research and intervention.MethodsWe used a multisite, multimethod qualitative approach across three ambulance service trusts. In phase 1 we carried out 16 interviews to contextualise the study and provide discussion points for phase 2. For phase 2, university and ambulance service researchers observed paramedics on 34 shifts and 10 paramedics completed ‘digital diaries’ that reported challenges to decision-making or to patient safety. Six focus groups were held, three with staff (n = 21) and three with service users (n = 23). From observation and diary data we developed a typology of decisions made at the scene. Data from these and other sources were also coded within a human factors framework and then thematically analysed to identify influences on those decisions. In phase 3, workshops were held at each site to allow participants and stakeholders (n = 45) to comment on the study findings. Participants were asked to rank influences on decisions using a ‘paired comparison’ method.ResultsInterviews provided the context for further qualitative exploration. Nine types of decision were identified from observations and digital diaries, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. A synthesis of findings from the observations, diaries and staff focus groups revealed seven overarching system influences on decision-making and potential risk factors: meeting increasing demand for emergency care; impacts of performance regime and priorities on service delivery; access to appropriate care options; disproportionate risk aversion; education, training and professional development for crews; communication and feedback to crews; and ambulance service resources. Safety culture issues were also identified. Data from the service user focus groups reflected similar issues to those identified from the staff focus groups. Service user concerns included call handling and communication, triage, patient involvement in decisions, balancing demand, resources, access to care, risk aversion, geographical location and vulnerable patients. Group discussions highlighted a lack of awareness by the public of how best to use emergency and urgent care services. Workshop attendees were satisfied that the findings reflected relevant issues. The two issues ranked highest for warranting attention were staff training and development and access to alternative care.ConclusionsMultiple qualitative methods allowed a range of perspectives to be accessed and validation of issues across perspectives. Recommendations for future research include exploring effective ways of providing access to alternative care pathways to accident and emergency, assessing public awareness and expectations of ambulance and related services, exploring safe ways of improving telephone triage decisions and assessing the effects of different staff skill levels on patient safety.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Adam, B., and R. N. Keers. "Exploration of the views of healthcare professionals working in a mental health trust in England on pharmacists as future approved clinicians: early findings." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i24. http://dx.doi.org/10.1093/ijpp/riab015.028.
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Abstract Introduction The 2007 amendment to the Mental Health Act (MHA) 1983 enabled various non-medical professionals to now qualify as approved clinicians (ACs); these included social workers, mental health and learning disability nurses, clinical psychologists and occupational therapists. [1–2] As ACs, these professionals can take on roles of clinical leadership whilst assuming responsibility for patients under the Act. Although mental health pharmacists have recognised specialist clinical roles and regularly work alongside these professionals in caring for patients, they are not presently permitted to practise as ACs. Aim This study sets out to investigate the views of healthcare professionals working in a mental health trust in England on this hitherto unexplored group of the mental health workforce as potential ACs. Methods Upon obtaining ethics approval, pharmacists, ACs and other experienced mental health professionals working in one mental health trust in England were approached via internal trust email to take part in a digitally audio recorded semi-structured interview to explore their views on pharmacists as potential ACs in future. A thematic analysis is being performed on the entire set of transcripts and an additional sentiment analysis will be applied to specific parts of the dataset. Results A total of 11 interviews were completed with 6 pharmacists, 4 medical ACs and 1 ‘other’ mental health professional thus far, with recruitment ongoing. Emerging themes included wide recognition among participants of highly valued key skills of pharmacists within mental health services provision, for instance their ability to access and appraise specialist literature as well as their analytical skills to apply expert knowledge to real-life cases. Participants identified unique challenges to pharmacists potentially becoming ACs in future, namely the traditional organisational structures whereby pharmacists are line managed and clinically supervised from within a pharmacy department which sits external to the clinical teams they typically work in, and the lack of pharmacists being fully embedded in interdisciplinary teams. Conclusion Since this is the first study of its kind to be conducted on a small cohort of participants working within one mental health trust in England, this qualitative study will likely highlight the need for further research to be carried out on the topic, such as data collection in several other NHS trusts as well as recruiting participants from the working group and other stakeholders involved in the most recent amendment of the Act. Whilst data collection and analysis are ongoing, initial findings help shed light on potential barriers and also possible solutions to these, as well as other opportunities for pharmacists wishing to assume higher leadership roles within mental health services in England. References 1. Barcham, C. Understanding The Mental Health Act Changes – Challenges And Opportunities For Doctors. BJMP. 2008;1 (2):13–17. 2. Oates, J., Brandon, T., Burrell, C., Ebrahim, S., Taylor, J. & Veitch, P. Non-medical approved clinicians: Results of a first national survey in England and Wales. International Journal of Law and Psychiatry. 2018;60:51–56.
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Temple, RM, and A. Donley. "The future hospital – implications for acute care." Acute Medicine Journal 13, no. 1 (January 1, 2014): 4–5. http://dx.doi.org/10.52964/amja.0330.
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Acute physicians are confronted daily by the relentless increase in clinical demand, inadequate continuity of care, breakdown in out of hours care and a looming crisis in the medical workforce. The scale and gravity of these factors, together with changes to patient’s needs relating to the ageing demography, were detailed in the RCP report published in September 2012 ‘Hospitals on the edge’. The top concern of RCP members and fellows was the lack of continuity of care, ahead of financial pressures and clinical staff shortages. Worryingly one in ten physicians stated they would not recommend their hospital to a family member, and a further 25% were ambivalent on this question. Concern about the provision of acute medical care is not confined to consultants and specialist registrars. Another RCP report, ‘Hospital workforce, fit for the future?’ (2013) highlighted that 37% of FT2s and CMTs considered the workload of the medical registrar on call ‘unmanageable’. The outcome of the Mid Staffs independent inquiry in February 2013 provided critical context for the launch of the Future Hospital Commission (FHC) report, which was launched seven months later in September. The report was met with an extremely positive response from patients, carers, NHS staff, healthcare leaders and politicians. Lancet Editor Richard Horton said that the Commission had ‘produced the most important statement about the future of British medicine for a generation.’ Secretary of State for Health Jeremy Hunt praised the report and its ‘buck stops here’ approach. The Daily Mirror even noted that the report was one of the few areas on which the government and the opposition could agree! ‘Future Hospital: caring for medical patients’ places the patient at the centre of healthcare. Organising healthcare delivery around the needs of the patient is at its heart and features extensively in the core principles and 50 recommendations. A series of unequivocal commitments were made to patients, on issues generating considerable patient concern: moving beds in hospital, quality of communication and arrangements to leave hospital. Patients and carers were represented in each of the Commission’s five work streams, led on the recommendations relating to building a culture of compassion and respect, and participated in launch of the report to the media. The primary focus of the FHC report is on the acute care of medical patients and the views of acute physicians were key to articulating these recommendations. However the report is clear that the solution to current acute pressures on hospitals and specifically in-patient pathways, lie across the whole health and social care system. Care must be delivered in the setting in which the patient’s clinical, care and support needs can best be met and not merely delegated to the acute hospital site. This inevitably means 7 day services in the community as well as in hospital and a consistent new level of “joined up care” with integration, collaboration and information sharing across hospital and all healthcare settings. In keeping with this the report highlights the urgent need to establish alternatives to hospital admission including the extensive use of ambulatory emergency care (AEC), the provision of secondary care services in the community and an expansion of intermediate care rehabilitation services. Many of the report’s recommendations arose from clinical staff devising innovative solutions to improve the quality of care and ameliorate clinical demand. The report showcased a range of case studies describing service developments and new patterns of care, innovations that would not have been possible without the leadership and sheer determination of physicians and their teams. Dr Jack Hawkins, Acute Physician in Nottingham Queen’s Medical Centre, described how analysis of performance data showing that 50% of acute medical patients were discharged within 15 hours, led to the starting vision for their new AEC service as “everyone is ambulatory until proven otherwise”. The case studies highlight the resources needed to implement service change and the supportive staff relationships and changes to working practices that underpin their success. The report describes the “acute care hub” as the focus of acute medical services, comprising colocation of the AMU, short stay wards, enhanced care beds and the AEC. Much of this echoes the front door configuration described by the acute medicine task force report in 2007 ‘Acute medical care: The right person, in the right setting, first time’. What the FHC adds are recommendations to co-locate AEC and a clinical co-ordination centre to provide clinicians with real time data on capacity in community-based services (rehabilitation and social services), and link to rapid access specialist clinics or community services to support pathways out of AEC and AMU. Recommendations to structure acute services to maximise continuity of care is a major theme. There should be sufficient capacity in the acute care hub to accommodate admitted patients who do not require a specialist care pathway and are likely to be discharged within 48 hours. This is supported by recommended changes to working practices of consultant led teams where they commit to two or more successive days working in the hub. This allows the consultant led team who first assess the patient in AMU to continue to manage them on the short stay ward through to their discharge – an approach familiar to acute physicians but which may be novel to GIM physicians assigned a single on call day. Striving to deliver continuity by a stable clinical team should also simplify handover, improve training, feedback and the quality and safety of the care delivered. The commission recommends designating enhanced care (level 1) and high dependency (level 2) beds in the acute care hub to improve the care of acutely ill patients requiring an increased intensity of monitoring and treatment. The RCP acute medicine taskforce made the same recommendation in 2007 but acute trusts have been slow to embed level 2 beds in particular, on AMUs. In the future hospital every effort should be made to enhance rapid access to specialist pathways that benefit patients, including entry to pathways for acute coronary disease or stroke or the frail elderly direct from the community or emergency department. Here the report is clear that the responsibility for continuity of care rests with the specialty consultant, who should review the patient on the day of admission. Patient experience should be valued as much as clinical effectiveness. Patients want “joined up care” that is tailored to their acute illness, comorbidities and requirements for social support. From a patient’s perspective, failures of information sharing between primary and secondary care, or specialist services within the same or neighbouring Trusts, are incomprehensible. The report highlights that this informatics disconnect undermines accurate clinical assessment at the time of presentation with an acute illness, when patients are most vulnerable, and this deficit will impact on patient experience, timely access to specialist staff, patient outcome and resource use. Robert Francis, in commenting on the report of the Mid Staffordshire public enquiry highlighted that the subject was ‘too important to suffer the same fate as other previous enquiries .. where after initial courtesy of welcome, implementation was slow or non existent’. The RCP shares this urgency and having accepted the recommendations of the FHC as a comprehensive ‘treatment’ for the care of patients in the future hospital, is determined that the FHC report itself will not sit on a shelf, gathering dust. The RCP is now embarking on a future hospital implementation programme. This programme gathers momentum this month with the appointment of future hospital officers and staff and the immediate priority is to identify partners to set up national development sites. The RCP is seeking enthusiastic clinical teams to investigate changes to a range of hospital and community based medical services in line with the FHC principles and to evaluate the impact on patient care. Over the next 3 years it is envisaged that the programme will also include research and new approaches to commissioning, workforce deployment, healthcare facility design and integrated working across the health economy. The evaluation of these projects, in relation to the quality and safety of patient care and patient experience, will be crucial and will be shared through the RCP and its partners. In addition, from April the RCP will publish a Future Hospital journal to help share the learning from the implementation programme and welcomes submissions of innovative best practice in acute care. The challenge now is to convert the goodwill generated by publication of the FHC principles, into an implementation programme nationally, that helps build an effective evidence base to support new ways of providing high quality, safe, patient care. Acute physicians are crucial partners in meeting this challenge.
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Ridsdale, L., P. McCrone, M. Morgan, L. Goldstein, P. Seed, and A. Noble. "Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase." Health Services and Delivery Research 1, no. 9 (October 2013): 1–128. http://dx.doi.org/10.3310/hsdr01090.
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ObjectivesTo (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.DesignNon-randomised trial with nested qualitative study.SettingThe EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.ParticipantsAdults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.InterventionIntervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.Main outcome measuresThe primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.ResultsIn the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.ConclusionsAt baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.Trial registrationCurrent Controlled Trials ISRCTN06469947.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.
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Goodyer, Ian M., Shirley Reynolds, Barbara Barrett, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Fiona Holland, et al. "Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial." Health Technology Assessment 21, no. 12 (March 2017): 1–94. http://dx.doi.org/10.3310/hta21120.
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BackgroundAlthough there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.ObjectiveTo determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.DesignObserver-blind, parallel-group, pragmatic superiority randomised controlled trial.SettingA total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.ParticipantsAdolescents aged 11–17 years withDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.InterventionsIn total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.Main outcome measuresMean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.ResultsThere were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104;p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126;p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.ConclusionsThe three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.LimitationsNeither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.Trial registrationCurrent Controlled Trials ISRCTN83033550.FundingThis project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit toThe Lancet.
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Rasmussen, Karsten Boye. "Digital curation after digital extraction for data sharing." IASSIST Quarterly 42, no. 3 (December 11, 2018): 1–2. http://dx.doi.org/10.29173/iq944.
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Welcome to the third issue of volume 42 of the IASSIST Quarterly (IQ 42:3, 2018).
The IASSIST Quarterly presents in this issue three papers from geographically widespread countries. We call IASSIST ‘International’, so I am happy to present papers from three continents in this issue with papers from Zimbabwe, Italy and Canada.
The paper 'The State of Preparedness for Digital Curation and Preservation: A Case Study of a Developing Country Academic Library' is by Phillip Ndhlovu, who works as the institutional repository librarian and liaison librarian, and Thomas Matingwina, who is a lecturer at the Department of Library and Information Service at the National University of Science and Technology (NUST) in Bulawayo, Zimbabwe. Modern day libraries have vast amounts of digital content and the authors noted that because these collections require very different management than the traditional paper-based materials, the new materials’ longevity is endangered. Their study assessed the state of preparedness of the NUST Library for digital curation and preservation, including the assessment of awareness, competencies, technology infrastructure, digital disaster preparedness, and challenges to digital curation and preservation. They found a lack of policies, lack of expertise by library staff, and lack of funding.
You might conclude that investigating your own organization and reaching the very well known conclusion that 'we need more money!' is not so surprising. However, you have to take note that the Jeff Rothenberg statement from 1995 that 'Digital information lasts forever – or five years, whichever comes first' has not yet sunk in with politicians and administrators, who will immediately associate the term 'digital' with 'saving money'. This study shows them why this is not a valid connotation. It is a study of a single institution, and as the authors note it cannot be generalized even to other academic libraries in Zimbabwe. However, other libraries - also outside Zimbabwe - have here a good guide for making their own assessment of the digital preparedness of their institution.
The second paper was - as was the paper above - presented at the IASSIST conference in 2018 and is also about the transition from media known for thousands of years to new media and digital forms. Peter Peller presented the paper 'From Paper Map to Geospatial Vector Layer: Demystifying the Process'. He is the Director of the Spatial and Numeric Data Services unit at Libraries and Cultural Resources at the University of Calgary in Canada.
The conversion of raster images of maps to vector data is analogous to OCR technologies extracting words from scanned print documents. Thereby the map information becomes more accessible, and usable in geographic information systems (GIS). An illustrative example is that historical geospatial information can be overlaid in Google Earth. The description of the entire process incorporates examples of the various techniques, including different types of editing. Furthermore, descriptions of the software used in selected studies are listed in the appendix. It is mentioned that 'paper texture and ink spread' can be responsible for introducing noise and errors, so remember to keep the old maps. This is because what is considered noise in one context might become the subject for interesting future research. In addition the software for extracting information will most certainly improve.
For once both the author and we at IASSIST Quarterly have been quite fast. The data for the third paper was collected in late 2017 and the results are presented here only a year later. In October 2017 a message appeared on the IASSIST mail list with the start of the sentence 'I would share the data but...' It quickly generated many ways of completing that sentence. Flavio Bonifacio - who works at Metis Ricerche srl in Torino, Italy - quickly launched a questionnaire sent to members of the mail list and to others from similar communities of interested individuals. The questionnaire was an extension of an earlier one concerning scientists' reuse and sharing of data. The paper includes many tabulations and models showing the background as well as the data sharing attitudes found in the survey. A respondent typology is developed based upon the level of propensity for sharing data and the level of experiencing problems in data sharing into a 2-by-2 table consisting of 'irreducible reluctant', 'reducible reluctant', 'problematic follower', and 'premium follower'.
In the Nordic countries we tend to have the impression that certain services are publicly available and for free. This impression is plainly superficial because we Nordic people also know very well that 'there is no such thing as a free lunch'! All services must be paid for in one way or another. If you have many services that carry no direct cost, it is probably because you - and others - paid for them beforehand through taxation. Because of cuts in the public economy one of the things Flavio Bonifacio wanted to investigate was the question 'Is there a market for selling data-sharing services?' The results imply that 'reducible reluctants' can be a target for services that reduce the problems of that group.
Submissions of papers for the IASSIST Quarterly are always very welcome. We welcome input from IASSIST conferences or other conferences and workshops, from local presentations or papers especially written for the IQ. When you are preparing such a presentation, give a thought to turning your one-time presentation into a lasting contribution. Doing that after the event also gives you the opportunity of improving your work after feedback. We encourage you to login or create an author login to https://www.iassistquarterly.com (our Open Journal System application). We permit authors 'deep links' into the IQ as well as deposition of the paper in your local repository. Chairing a conference session with the purpose of aggregating and integrating papers for a special issue IQ is also much appreciated as the information reaches many more people than the limited number of session participants and will be readily available on the IASSIST Quarterly website at https://www.iassistquarterly.com. Authors are very welcome to take a look at the instructions and layout:
https://www.iassistquarterly.com/index.php/iassist/about/submissions
Authors can also contact me directly via e-mail: kbr@sam.sdu.dk. Should you be interested in compiling a special issue for the IQ as guest editor(s) I will also be delighted to hear from you.
Karsten Boye Rasmussen - November 2018
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Lensen, S., K. Hammarberg, A. Polyakov, J. Wilkinson, S. Whyte, M. Peate, and M. Hickey. "How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients." Human Reproduction 36, no. 7 (May 4, 2021): 1854–61. http://dx.doi.org/10.1093/humrep/deab098.
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Abstract STUDY QUESTION What is the prevalence and pattern of IVF add-on use in Australia? SUMMARY ANSWER Among women having IVF in the last 3 years, 82% had used one or more IVF add-on, most commonly acupuncture, preimplantation genetic testing for aneuploidy and Chinese herbal medicine. WHAT IS KNOWN ALREADY IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, but usually used in attempts to improve the probability of conception and live birth. The use of IVF add-ons is believed to be widespread; however, there is little information about the prevalence and patterns of use in different settings. STUDY DESIGN, SIZE, DURATION An online survey was distributed via social media to women in Australia who had undergone IVF since 2017. Women were excluded if they were gestational surrogates, used a surrogate, or underwent ovarian stimulation for oocyte donation or elective oocyte cryopreservation only. The survey was open from 21 June to 14 July 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey questions included demographics, IVF and medical history, and use of IVF add-ons including details of the type of add-on, costs and information sources used. Participants were also asked about the relative importance of evidence regarding safety and effectiveness, factors considered in decision-making and decision regret. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1590 eligible responses were analysed. Overall, 82% of women had used one or more add-ons and these usually incurred an additional cost (72%). Around half (54%) had learned about add-ons from their fertility specialist, and most reported that the decision to use add-ons was equally shared with the specialist. Women placed a high level of importance on scientific evidence for safety and efficacy, and half (49%) assumed that add-ons were known to be safe. Most women experienced some regret at the decision to use IVF add-ons (66%), and this was more severe among women whose IVF was unsuccessful (83%) and who believed that the specialist had a larger contribution to the decision to use add-ons (75%). LIMITATIONS, REASONS FOR CAUTION This retrospective survey relied on patient recall. Some aspects were particularly prone to bias such as contributions to decision-making. This approach to capturing IVF add-on use may yield different results to data collected directly from IVF clinics or from fertility specialists. WIDER IMPLICATIONS OF THE FINDINGS There is a very high prevalence of IVF add-on use in Australia which may be generalisable to other settings with similar models of IVF provision. Although women placed high importance on scientific evidence to support add-ons, most add-ons do not have robust evidence of safety and effectiveness. This suggests that IVF patients are not adequately informed about the risks and benefits of IVF add-ons, or are not aware of the paucity of evidence to support their use. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by a McKenzie Postdoctoral Fellowship Grant (University of Melbourne), a Department of Obstetrics and Gynaecology Innovation Grant (University of Melbourne) and an NHMRC Investigator Grant (APP1195189). A.P. declares that he provides fertility services at Melbourne IVF (part of Virtus Health). J.W. reports grants from Wellcome Trust, during the conduct of the study, and that publishing benefits his career. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A
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Alfarra, Najwa. "Perception of Healthcare Providers in Agile Environment Imposed by the COVID-19." Clinical Research and Clinical Trials 3, no. 4 (April 30, 2021): 01–06. http://dx.doi.org/10.31579/2693-4779/027.
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BACKGROUND Nearly nine months have passed since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which caused the rapidly spreading Coronavirus Disease 2019 (COVID-19) pandemic. In Saudi Arabia, unprecedented precautionary strict measures were applied to prevent virus entry to the country or to mitigate its impact when it arrives. The physical rehabilitation is the 3rd largest profession in the area of healthcare and is the most representative profession in the area of rehabilitation in Saudi Arabia. Physical rehabilitation services provide the development, maintenance, and recovery of people’s movement and functional ability, improving their quality of life. In this way, many hospitalized patients in the acute phase of COVID-19, as well as chronic patients, need physical rehabilitation services. This study aimed to determine the number of therapists/ clinicians who interrupted their services because of the COVID-19 pandemic and to verify the procedures adopted by the therapists/clinicians to continue serving and supporting their patients. METHODS The sample comprised 46 therapists/clinicians who worked in King Faisal Specialist Hospital and Research Center (KFSH&RC), 19 (41.4%) males and 27 (58.6%) females. The measurement instrument was an on-line survey questionnaire applied mid-July to mid-August 2020 through email. The questionnaires consisted of four primary sections. The first section gathered information on respondents' sociodemographic characteristics. The second section assessed respondents ' years of professional experience and area of specialty. The third section assessed respondents ' work load on daily bases pre/post COVID-19 crisis. The final section of the questionnaire assessed the benefits and barriers of telehealth, therapist opinion about how was the department/organization handled this pandemic issue, and to add their recommendation to improve the service. RESULTS Out of the 46 therapists/clinicians, 37 (80.4%) interrupted their work activities because of the pandemic and 9 (19.6%) continue with the existing daily practice. The number of patients seen/day before pandemic decreased compare to pre pandemic by21.7%, in arrange of 15 patients/day to zero patient/day by 26.1%, that led to change the way of therapists daily practice such as seven therapists shifted their clinics to virtual clinics, and almost most of the therapists (n= 32) continue working in inpatient ward, taking in their considerations the main measures that was adopted by the organization, when they deal with the direct patient contact which included: hand washing, mask use, material disinfection and gloves. The three administrative respondents work on quality issues, managerial guidelines and research. While the four orthotics/ prosthetics clinicians shifted their work to fabricate medical supportive devices to be used for the patients. Seven therapists shift their clinics to virtual visits, and they found it very convenient to the patients. CONCLUSIONS Our result revealed that most of the therapists/clinicians interrupted their regular work , impact number patient seen per day and face-to-face practices because of the COVID-19 pandemic, due to several reason such as spread of infection and the patients are afraid to come and they cancelled their appointment, however, half of the respondents continue with their existing work and taking into their considerations the measured that were adapted by the organization, the others who did not follow up their patients’ treatment in person, most of them adapted to monitor their patients from a distance by using virtual visits.
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Kulkarni, Roshni, Laura Carlson, Rebecca A. Malouin, Marcia L. Bird, Colleen Vallad-Hix, Michelle Witkop, Ajovi Scott-Emuakpor, Renuka Gera, and Steve Gualdoni. "Telehematology: Expanding Comprehensive Care for Pediatric Patients with Blood Disorders through Telemedicine at Several Delivery Sites (Medical Homes, Hospital Clinics, Home Setting and Hemophilia Treatment Centers (HTC)) and with Interdisciplinary Providers." Blood 126, no. 23 (December 3, 2015): 5576. http://dx.doi.org/10.1182/blood.v126.23.5576.5576.
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Abstract Background: Telemedicine (TM) is the exchange of medical information from one site to another via electronic communications to improve patients' health status and access to care. We used telemedicine to provide comprehensive hematology services to patients with blood disorders at a variety of sites that included medical homes, hospital specialty clinics, HTC, patients home and teleconsultation with out of state HTC, all located at a distance from the Michigan State University Center for Bleeding and Clotting Disorders (MSU CBCD). The goals were to increase access to family centered and culturally competent specialty care and increase the numbers of patients with blood/bleeding/clotting disorder that were timely and accurately diagnosed, managed and referred for specialty care. Objectives: 1) To understand the feasibility of telemedicine between specialists and a variety of remote sites for children with bleeding/blood disorders 2) To assess the acceptability by patients, families, primary care physicians, remote site staff, specialist physicians, and specialist staff and 3) To assess the cost of telemedicine visits versus traditional visits from the societal perspective 4) To provide education and resources to distant providers. Methods: Telemedicine sites were 1) two medical homes-one at a pediatrician's office, Upper Great Lakes Family Health Center (UGLFHC)/Portage Health in Houghton MI and the other at a family medicine office, Iron Mountain/Iron River Upper Peninsula, MI 2) specialty clinics at Marquette General Hospital, Marquette MI 3) Hemophilia Treatment Centers (HTC) at Traverse City MI and Rush University IL 4) and a patient's home in MI. PolycomTM and/or VidyoTM systems were used to deliver HIPAA (Health Insurance Portability and Accountability Act) regulated bidirectional videoconferencing technology. Records of patient visits seen by local providers and via TM by MSU CBCD pediatric hematologists, nurse and social worker were obtained. Data included patient diagnosis, distance traveled, estimated time and travel costs saved, and education of distance provider. Measurable objectives included feasibility, acceptability. Technology issues were addressed. Site visits with Portage and Iron River Health Department were conducted to discuss local barriers and needs. Results: Beginning 1998, a total of 68 patients, ages 2 weeks to 17 years and their families were seen by TM at various sites. There were 97 TM visits and frequency of clinics varied monthly to as needed. Average distance travelled by patients to local clinics ranged from 12 - 70 miles (range 2-170 miles). In addition to coagulation disorders (hemophilia, von Willebrands disease, factor deficiencies, patients with bleeding symptoms such as epistaxis, menorrhagia etc.), other diagnosis such as cytopenias, spherocytosis, hemoglobinopathies, lymphadenopathy, Hereditary Hemorrhagic Telangiectasia, Ehlers Danlos Syndrome, and pediatric oncology patients in follow-up phase were also seen and in some cases family members tested. Physician and staff were educated regarding disease management; guidelines and educational materials shared. Estimated costs per patients to fly or drive to MSUCBCD were $999 ($579 -$1275) and $1653 ($1405-1887) respectively compared to obtaining care locally $87.6 ($73-117) via TM. This resulted in cost savings per patient of $911.4 and $1565.7 for driving and flying respectively. The MSU CBCD team also incurred significant cost savings by avoiding travel/lodging costs. Interviews with staff and physicians resulted in improvement in TM acceptance and delivery. A majority of laboratory testing were send-outs and local testing for platelet function defects were not available. Technology issues addressed included adjustments in bandwidth, firewall and network settings. It was feasible to do consultations with out-of-state HTCs as well as follow patients at home. Conclusion: Besides improving access to specialty care, TM with remote areas is feasible and acceptable in a variety of settings with considerable time and cost savings for both patients as well as the specialty care treatment team. Our study is in accordance with the American Academy of Pediatrics recent policy statement (Pediatrics 2015;136:202-209) recommending that TM services be coordinated through the medical homes thereby involving local primary care providers. Disclosures Kulkarni: Biogen: Research Funding, Speakers Bureau; Baxter: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees; Kedrion: Membership on an entity's Board of Directors or advisory committees; BPL: Membership on an entity's Board of Directors or advisory committees. Witkop:Pfizer: Other: Advisory Board, Research Funding; Baxter Bioscience: Other: Advisory Board; Novo Nordisk: Other: Advisory Board, Speakers Bureau.
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Perez, Jesus, Debra A. Russo, Jan Stochl, Gillian F. Shelley, Carolyn M. Crane, Michelle Painter, James B. Kirkbride, Tim J. Croudace, and Peter B. Jones. "Understanding causes of and developing effective interventions for schizophrenia and other psychoses." Programme Grants for Applied Research 4, no. 2 (March 2016): 1–184. http://dx.doi.org/10.3310/pgfar04020.
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BackgroundEarly-intervention services (EISs) offer prompt and effective care to individuals with first-episode psychosis (FEP) and detect people at high risk (HR) of developing it.AimsWe aimed to educate general practitioners about psychosis and guide their referrals to specialist care; investigate determinants of the transition of HR to FEP; and predict numbers of new cases to guide policy and service planning.Incidence of psychosis in socially and ethnically diverse settingsWe studied the incidence of new referrals for psychosis in a well-established EIS called CAMEO [seewww.cameo.nhs.uk(accessed 18 January 2016)] and built on other epidemiological studies. The overall incidence of FEP was 45.1 per 100,000 person-years [95% confidence interval (CI) 40.8 to 49.9 per 100,000 person-years]. This was two to three times higher than the incidence predicated by the UK Department of Health. We found considerable psychosis morbidity in diverse, rural communities.Development of a population-level prediction tool for the incidence of FEPWe developed and validated a population-level prediction tool, PsyMaptic, capable of accurately estimating the expected incidence of psychosis [seewww.psymaptic.org/(accessed 18 January 2016)].The Liaison with Education and General practiceS (LEGS) trial to detect HRWe tested a theory-based intervention to improve detection and referral of HR individuals in a cluster randomised controlled trial involving primary care practices in Cambridgeshire and Peterborough. Consenting practices were randomly allocated to (1) low-intensity liaison with secondary care, a postal campaign to help with the identification and referral of individuals with early signs of psychosis, or (2) the high-intensity theory-based intervention, which, in addition to the postal campaign, included a specialist mental health professional to liaise with each practice. Practices that did not consent to be randomised included a practice-as-usual (PAU) group. The approaches were implemented over 2 years for each practice between April 2010 and October 2013. New referrals were stratified into those who met criteria for HR/FEP (together: psychosis true positives) and those who did not fulfil such criteria (false positives). The primary outcome was the number of HR referrals per practice. Referrals from PAU practices were also analysed. We quantified the cost-effectiveness of the interventions and PAU using the incremental cost per additional true positive identified. Of 104 eligible practices, 54 consented to be randomised. Twenty-eight practices were randomised to low-intensity liaison and 26 practices were randomised to the high-intensity intervention. Two high-intensity practices withdrew. High-intensity practices referred more HR [incidence rate ratio (IRR) 2.2, 95% CI 0.9 to 5.1;p = 0.08], FEP (IRR 1.9, 95% CI 1.05 to 3.4;p = 0.04) and true-positive (IRR 2.0, 95% CI 1.1 to 3.6;p = 0.02) cases. High-intensity practices also referred more false-positive cases (IRR 2.6, 95% CI 1.3 to 5.0;p = 0.005); most (68%) of these were referred on to appropriate services. The total costs per true-positive referral in high-intensity practices were lower than those in low-intensity or PAU practices. Increasing the resources aimed at managing the primary–secondary care interface provided clinical and economic value.The Prospective Analysis of At-risk mental states and Transitions into psycHosis (PAATH) studyWe aimed to identify the proportion of individuals at HR who make the transition into FEP and to elucidate the common characteristics that can help identify them. Sixty help-seeking HR individuals aged 16–35 years were stratified into those who met the criteria for HR/FEP (true positives) according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) and those who did not (false positives). HR participants were followed up over 2 years using a comprehensive interview schedule. A random sample of 60 healthy volunteers (HVs) matched for age (16–35 years), sex and geographical area underwent the same battery of questionnaires. Only 5% of our HR sample transitioned to a structured clinical diagnosis of psychosis over 2 years. HR individuals had a higher prevalence of moderate or severe depression, anxiety and suicidality than HVs. In fact, psychometric analyses in other population samples indicate that psychotic experiences measure the severe end of a common mental distress factor, consistent with these results. HR individuals also experienced significantly more traumatic events than HVs, but equivalent distress. Almost half of HR individuals had at least one Schneiderian first-rank symptom traditionally considered indicative of schizophrenia and 21.6% had more than one. HR individuals had very poor global functioning and low quality of life.ConclusionsThis National Institute for Health Research programme developed our understanding of the social epidemiology of psychosis. A new theory-based intervention doubled the identification of HR and FEP in primary care and was cost-effective. The HR mental state has much in common with depression and anxiety; very few people transitioned to full psychosis over 2 years, in line with other recent evidence. This new understanding will help people at HR receive appropriate services focused on their current mental state.Trial registrationThe primary LEGS trial is registered as ISRCTN70185866 and UKCRN ID 7036. The PAATH study is registered as UKCRN ID 7798.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.