Towards a Model of Care for Chronic Leg Ulcer: Lessons Learned from Studies in Scotland

2001 ◽  
Vol 16 (1) ◽  
pp. 17-19 ◽  
Author(s):  
C. V. Ruckley
Keyword(s):  
General Practitioners ◽  
Clinical Skills ◽  
Care Delivery ◽  
Training Programme ◽  
Lessons Learned ◽  
Leg Ulcer ◽  
Teaching Hospitals ◽  
Nurse Training ◽  
Model Of Care ◽  
Acute Hospitals

Aim: To highlight the need for a different model of care delivery for chronic leg ulcer. Method: Analysis of data from the Scottish Leg Ulcer Trial and from surveys of leg ulcer care provision among General Practitioners, community nurses and health boards. Synthesis: General Practitioners and community nurses report serious deficiencies in education, training, protocols, equipment and support from the Acute sector. The Scottish Leg Ulcer Trial in a population of 2.65 million showed three-month healing rates of 30% with no improvement after dissemination of National (SIGN) Guidelines even when supplemented by a nationwide nurse training programme. Individual community nurses cared for an average of 1.5 ulcer patients per year. The more chronic the ulcer the poorer the healing rates. Only 17% of Scottish Teaching hospitals or District General hospitals provide a specialist led leg ulcer service. Conclusions: In the population at large, healing rates for leg ulcer are unacceptably low. Individual community nurses do not see enough leg ulcer patients to acquire or sustain the necessary clinical skills. Very few acute hospitals provide leg ulcer services. A new model of leg ulcer care is urgently required centred on multi-disciplinary teams, working in the interface between primary and secondary care, whose prime objectives should be prevention and early intervention. As an

scholarly journals Pilot study to build capacity for family medicine with abbreviated, low-cost training programme with minimal impact on patient care for a cohort of 84 general practitioners caring for Palestinian refugees in Jordan

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028240 ◽  
Author(s):  
Amjad Al Shdaifat ◽  
Therese Zink
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
General Practitioners ◽  
Clinical Skills ◽  
Low Cost ◽  
Training Programme ◽  
Ambulatory Setting ◽  
Secondary Outcome ◽  
Intervention Programme ◽  
Minimal Impact

PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are expensive and take physicians away from their clinical settings. We describe a programme created, delivered and evaluated from 2013 to 2014 in Jordan.DesignCohort study.SettingPhysicians providing primary care in the United Nations Relief and Works Agency for Palestine Refugees clinics in Jordan.ParticipantsEighty-four general practitioners (GPs) were invited to participate and completed the training and evaluation. GPs are physicians who have a license to practice medicine after completing medical school and a 1 year hospital-based rotating internship. Although GPs provide care in the ambulatory setting, their hospital-based education provides little preparation for delivering ambulatory primary care.Intervention/ProgrammeThis three-stage programme included needs assessment, didactics and on-the-job coaching. First, the learning needs and baseline knowledge of the trainees were assessed and the findings guided curriculum development. During the second stage, 48 hours of didactics covered topics such as communications skills and disease management. The third stage was delivered one on one in the trainee’s clinical setting for a 4 to 6-hour block. The first, middle and final patient interactions were evaluated.Primary and secondary outcome measuresPreknowledge and postknowledge assessments were compared. The clinical checklist, developed for the programme, assessed eight domains of clinical skills such as communication and history taking on a five-point Likert scale during the patient interaction.ResultsPreknowledge and postknowledge assessments demonstrated significantly improved scores, 46% to 81% (p<0.0001). Trainee’s clinical checklist scores improved over the assessment intervals. Satisfaction with the training was high.ConclusionThis programme is a potential model for building primary care capacity at low cost and with little impact on patient care that addresses both knowledge and clinical skills on the job.

Causes and the way of treatment of patients with chronic leg ulcers

Phlebologie ◽  
2009 ◽  
Vol 38 (05) ◽  
pp. 211-218 ◽  
Author(s):  
C. Wax ◽  
A. Körber ◽  
J. Dissemond ◽  
J. Klode
Keyword(s):  
Treatment Period ◽  
General Practitioners ◽  
Peripheral Arterial Occlusive Disease ◽  
Mean Value ◽  
Arterial Occlusive Disease ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Patient Will ◽  
Peripheral Arterial ◽  
Chronic Leg Ulcers

SummaryChronic leg ulcer may have various causes, which are currently not centrally recorded in Germany. It is also unclear who treats patients with chronic leg ulcers in Germany and how the basic implementation of diagnosis and treatment of these patients looks like. Patients, methods: Therefore, we started a survey of 1000 general practitioners and practising specialists in dermatology, surgery and phlebology in five different regions of Germany. We carried out the genesis of a total of 6275 patients from 62 different practising therapists, 33 specialists in dermatology, surgery or phlebology and 29 general practitioners. Results: In 66.1% of all patients we found a venous leg ulcer, in 9.1% a leg ulcer from peripheral arterial occlusive disease, and in 8.5% a mixture of both. Thus there suffered a total of 83.8% of patients on chronic venous insufficiency or peripheral arterial occlusive disease as a major factor in the genesis of the chronic leg ulcer. However, even the rarely diagnosed entities such as exogenous factors, vasculitis, pyoderma gangrenosum or infectious diseases are occur in summation in 16.2% of all patients and should therefore be known and excluded. In addition, the treatment periods and referral routes of patients with chronic leg ulcer should be identified. The analysis showed that the vast majority (86.8%) of patients with chronic ulcers who were investigated by us is treated by specialists. The treatment duration of general practitioners is 6.3 weeks (mean value) before the patient will be referred to a specialist. This treatment period is significantly shorter compared to the treatment period of the specialists, who treat their patients 14.1 weeks (mean value) before the patient will be referred to another specialist or to a clinic. Conclusion: Our results show the current aspects of aetiology and the way of treatment of patients with chronic leg ulcers in Germany.

Setting up a successful nurse-led intravitreal injections service: pearls from Swindon

2020 ◽  
Vol 29 (20) ◽  
pp. 1178-1185
Author(s):  
Hani Hasan ◽  
Sunil Mamtora ◽  
Nimish Shah
Keyword(s):  
Nurse Practitioners ◽  
Positive Impact ◽  
Training Model ◽  
Training Programme ◽  
Intravitreal Injections ◽  
Nurse Training ◽  
Financial Benefits ◽  
Hands On ◽  
Number Of Injections

The demand for performing intravitreal injections has increased in recent years, prompting the need for more nurse training in their administration. The Great Western Hospitals NHS Trust in Swindon has developed a structured nurse training programme and now has 8 independent nurse injectors trained to undertake injections independently; nurse practitioners now contribute upwards of 85% of the total number of injections. The authors have also demonstrated the financial benefits of using injection assistant devices and shown the positive impact such devices have on training. In September 2019, the authors organised the first course to offer nurses and doctors hands-on experience in administering injections, using the Swindon training model to provide participants with a structured approach to learn how to perform intravitreal injections safely. Nurses made up 96% of participants; the remainder were doctors and managers; 6% had never performed an intravitreal injection; of units where they had, disposable drapes and a speculum were used in 71% of these. The number of injections performed per session at participants' units at the time they attended the course was: 17 or more injections=46%, 13–14=39%, and 11–12=15%. The course was rated 8.9/10 overall for content, with 85% very likely to recommend it to colleagues. All participants indicated that using the Swindon model made them feel confident to deliver injections safely. The authors demonstrated that using a structured training protocol and intravitreal assistant device improves the quality of nurse training and increases confidence in administering intravitreal injections.

Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

2021 ◽  
pp. 104973232199864
Author(s):  
Nabil Natafgi ◽  
Olayinka Ladeji ◽  
Yoon Duk Hong ◽  
Jacqueline Caldwell ◽  
C. Daniel Mullins
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Lessons Learned ◽  
Community Members ◽  
Community Based ◽  
Care Community ◽  
Care Experience ◽  
National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

scholarly journals Risk and the Republican National Convention: Application of the Novel COVID-19 Operational Risk Assessment

2021 ◽  
pp. 1-6
Author(s):  
David Callaway ◽  
Jeff Runge ◽  
Lucia Mullen ◽  
Lisa Rentz ◽  
Kevin Staley ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Care Delivery ◽  
The United States ◽  
Lessons Learned ◽  
World Health ◽  
Local Health ◽  
Mass Gathering ◽  
Wide Range ◽  
National Convention

Abstract The United States Centers for Disease Control and Prevention and the World Health Organization broadly categorize mass gathering events as high risk for amplification of coronavirus disease 2019 (COVID-19) spread in a community due to the nature of respiratory diseases and the transmission dynamics. However, various measures and modifications can be put in place to limit or reduce the risk of further spread of COVID-19 for the mass gathering. During this pandemic, the Johns Hopkins University Center for Health Security produced a risk assessment and mitigation tool for decision-makers to assess SARS-CoV-2 transmission risks that may arise as organizations and businesses hold mass gatherings or increase business operations: The JHU Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19 (Toolkit). This article describes the deployment of a data-informed, risk-reduction strategy that protects local communities, preserves local health-care capacity, and supports democratic processes through the safe execution of the Republican National Convention in Charlotte, North Carolina. The successful use of the Toolkit and the lessons learned from this experience are applicable in a wide range of public health settings, including school reopening, expansion of public services, and even resumption of health-care delivery.

The role of paediatricians in specialist nurse training: a community child health example

2021 ◽  
pp. edpract-2020-320797
Author(s):  
Cliona Ni Bhrolchain
Keyword(s):  
Child Health ◽  
Training Programme ◽  
Formal Training ◽  
Nurse Training ◽  
Training Curriculum ◽  
Clinical Specialty ◽  
Specialist Nurse ◽  
Training Programmes ◽  
Nursing Roles

Specialist and advanced nursing roles have started to emerge in paediatrics and paediatricians may be asked to support nurses through their training. While there are specific training programmes for some areas of practice eg, neonatology, there are currently no programmes for others. Paediatricians may therefore find themselves being asked to train nurse specialists outside a formal training programme, or to provide the clinical specialty component linked to a generic MSc course, where the paediatrician may be required to devise a training curriculum specific to their area of practice. Using, neonatology, there are currently no programmes for others. Paediatricians may therefore find themselves being asked to train nurse specialists outside a formal training programme, or to provide the clinical specialty component linked to a generic MSc course, where the paediatrician may be required to devise a training curriculum specific to their area of practice. Using community child health as an example, this paper outlines how paediatricians might approach this, based on the experience of the author. However, the principles outlined can apply to any area of paediatrics.

Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review

2021 ◽  
pp. jim-2021-002056
Author(s):  
Peter Thomas Leistikow ◽  
Vidhi Patel ◽  
Christian Nouryan ◽  
Joseph Steven Cervia
Keyword(s):  
Young Adults ◽  
North America ◽  
Care Delivery ◽  
Linkage To Care ◽  
Adolescents And Young Adults ◽  
Hiv Screening ◽  
Model Of Care ◽  
Delivery Model ◽  
Care Delivery Model ◽  
The World

HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people’s acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13–17, 18–24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.

A Blueprint for the Conduct of Large, Multi-Site Trials in Telemedicine (Preprint)

2021 ◽  
Author(s):  
Patricia Commiskey ◽  
April W Armstrong ◽  
Tumaini Rucker Coker ◽  
Earl Ray Dorsey ◽  
John Fortney ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Stroke Care ◽  
Lessons Learned ◽  
Patient Centered ◽  
Implementation Challenges ◽  
Home Based ◽  
Family Based ◽  
Key Aspects

BACKGROUND Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes, despite the wide variability in results. OBJECTIVE Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. METHODS This viewpoint presents relevant challenges and solutions for conducting multi-site telemedicine trials using seven ongoing and completed studies funded by the Patient Centered Outcomes Research Institute (PCORI) portfolio of large multi-site trials to highlight the challenges in implementing telemedicine trials. RESULTS Implementation challenges related to clinical, informatics, regulatory, legal, quality and billing were identified and described. CONCLUSIONS Lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multi-site telemedicine trials. CLINICALTRIAL NCT02358135: Improving Specialty-Care Delivery in Chronic Skin Diseases (PI: AWArmstrong) NCT02396576: Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas (PI: TRCoker) NCT02038959: Connect.Parkinson (PI: RDorsey) NCT04000971: C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Care) Stroke Care Trial (PI: KGaines) NCT03694431: Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal) Trial (PI: HNguyen, KMularski) NCT04153864: SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatments) Trial (PI: DRSingla) NCT03985800: Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease (IBD) and Behavioral Health Conditions Trial (PI: ESzigethy)

Sign in / Sign up

Export Citation Format

Share Document