Staff experience of rapid implementation of telemedicine: informing future service redesign

2021 ◽  
Vol 27 (12) ◽  
pp. 1-10
Author(s):  
Faye Shorthouse ◽  
Nicholas Spahr ◽  
Christopher Tack
Keyword(s):  
Best Practice ◽  
Lessons Learned ◽  
Service Development ◽  
Multiple Choice Questions ◽  
Staff Members ◽  
Open Questions ◽  
Service Redesign ◽  
Remote Patient ◽  
Remote Consultations

Background/Aims In response to the COVID-19 pandemic, many services in the NHS suspended face-to-face appointments and transitioned to remote consultations. Best practice advocates for evaluation of what was implemented, and the lessons learned, to guide future service redevelopment. This evaluation explored the experienced of physiotherapy staff, aiming to inform future service development and ensure that the staff perspective is taken into account. Methods A survey was distributed to all staff involved in the initial running of the integrated musculoskeletal physiotherapy service at Guy's and St Thomas' NHS Foundation Trust. Questions consisted of Likert scales, multiple choice questions, scales of 1–100 and open questions. Overall, 22 staff members from the new remote clinic and 10 from the follow-up clinic responded. Content analysis was performed to draw themes from responses. Results Overall, 75% of responses indicated a positive experience of the implementation of telemedicine. However, improvements in training and procedural matters were highlighted as fundamental to supporting staff in these clinics. There was considerable variation between staff in the new patient clinic and those in the follow-up clinic, with the former feeling less confident about running remote patient clinics. Conclusions Remote consultations are an accepted medium for staff to deliver physiotherapy consultations. However, future development of telemedicine services must be informed by this experience and take staff experiences into consideration.

scholarly journals Delivery of the National Child Measurement Programme in England

2020 ◽  
pp. 1-21
Author(s):  
Martin Čadek ◽  
Stuart W. Flint ◽  
Ralph Tench
Keyword(s):  
Public Health ◽  
Local Government ◽  
Best Practice ◽  
Online Survey ◽  
The Other ◽  
Service Availability ◽  
Healthy Weight ◽  
Weight Category ◽  
Convenience Sampling

Abstract Objective: The National Child Measurement Programme (NCMP) is a mandatory initiative delivered in England to children in reception and year 6. To date, no research has explored the methods used to deliver the NCMP by Local Government Authorities (LGA) across England. Design: An online survey was administered between February 2018 and May 2018 to explore the delivery of the NCMP across the 152 LGAs in England and disseminated using non-probability convenience sampling. Setting: LGAs received an anonymous link to the survey. Participants: A total of 92 LGAs participated in the survey. Results: Most LGAs who responded provide result feedback (86%), a proactive follow-up (71%) and referrals to services (80%). Additionally, 65% of the authorities tailor Public Health England specimen result letters to suit their needs, and 84% provide attachments alongside. Out of 71% of LGAs who provide proactive follow-up, 19 (29%) provide the proactive follow-up only to upper weight categories, and only 4 (6 %) include Healthy Weight category with other categories in proactive follow-up. Regarding the service availability for children, out of 80% of LGAs who indicated that services are available, 32 (43%) targeted solely upper weight categories while the other 42 (57%) offered services across all weight categories. Finally, most LGAs (88%) commission providers to manage various parts of the NCMP. Conclusions: The results show that LGAs in England localise the NCMP. Further guidance regarding standards of best practice would help LGAs to find the most suitable localisation out of various options that exist across other LGAs.

scholarly journals Approaches to Anti-Ageism Interventions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 672-672
Author(s):  
Tracey Gendron ◽  
Jennifer Inker
Keyword(s):  
Social Interactions ◽  
Self Esteem ◽  
Older Individuals ◽  
Staff Members ◽  
Self Development ◽  
And Behaviors ◽  
Aging Anxiety ◽  
Negative Impacts ◽  
Systemic Nature

Abstract Ageism, a multidimensional construct, is also understood as a relational process whereby perceptions and behaviors toward older individuals by younger individuals not only damage the self-esteem of elders, but also create a hostile environment for their own future social interactions and their own future self-development as elders. Anti-ageism interventions have the hefty task of improving attitudes and behaviors toward aging within all of these contexts. This presentation will discuss findings from two different anti-ageism interventions both designed to mitigate the negative impacts of ageism. Results from a study on an intergenerational arts-based program found that after participation students demonstrated a positive change in their attitudes toward older adults. Findings from a video-based ageism intervention among a sample of 265 staff members in 15 senior living communities demonstrated decreased internalized aging anxiety as well as decreased ageist behaviors directly after the training and at three month post follow-up. Given the complex and systemic nature of ageism, diversity is necessary in scope and type of intervention in order to reach the broadest audience.

Classification of Male Breast Lesions According to the IAC Yokohama System for Reporting Breast Cytopathology

2020 ◽  
pp. 1-8
Author(s):  
Melissa Oosthuizen ◽  
Rubina Razack ◽  
Jenny Edge ◽  
Pawel Tomasz Schubert
Keyword(s):  
Predictive Value ◽  
Best Practice ◽  
Internal Audit ◽  
Needle Aspiration ◽  
Male Breast ◽  
Histopathological Diagnosis ◽  
Breast Lesions ◽  
Risk Of Malignancy ◽  
Sensitivity Specificity

<b><i>Objective:</i></b> This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast. <b><i>Study Design:</i></b> Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category. <b><i>Results:</i></b> The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests. <b><i>Conclusion:</i></b> This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one’s own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes

2021 ◽  
pp. 135910452110138
Author(s):  
Jacinta Tan ◽  
Gemma Johns
Keyword(s):  
Eating Disorders ◽  
United Kingdom ◽  
Eating Disorder ◽  
High Mortality ◽  
Best Practice ◽  
Service Development ◽  
The United Kingdom ◽  
Scottish Government ◽  
The Relationship ◽  
Service Change

Background: Diabetes and eating disorders are frequently comorbid. This particular comorbidity is not only often poorly recognised, but is difficult to treat and has a high mortality. Method: In this article, we will briefly review the relationship between diabetes and eating disorders. We will review the current NICE and other guidance and reports concerning both diabetes and eating disorders in the United Kingdom. We will then describe the recommendations of the 2018 Welsh Government Eating Disorder Service Review and the 2021 the Scottish Government Eating Disorder Service Review regarding diabetes and eating disorders, which will lead to service change. Conclusions: We conclude that this is a relatively underdeveloped but important area where there needs to be further service development and more collaboration between diabetes and eating disorder services.

scholarly journals Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Samantha Chakraborty ◽  
Bianca Brijnath ◽  
Jacinta Dermentzis ◽  
Danielle Mazza
Keyword(s):  
Qualitative Research ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
International Guideline ◽  
Novel Approach ◽  
Clinical Questions ◽  
Key Questions

Abstract Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

Chemical Deliquification of Unconventional Gas Wells

2014 ◽  
Author(s):  
K.. Francis-LaCroix ◽  
D.. Seetaram
Keyword(s):  
Natural Gas ◽  
Best Practice ◽  
Oil And Gas ◽  
Large Deviation ◽  
Cost Effective ◽  
Gas Production ◽  
Lessons Learned ◽  
Offshore Platforms ◽  
Gas Wells ◽  
Current Production

Abstract Trinidad and Tobago offshore platforms have been producing oil and natural gas for over a century. Current production of over 1500 Bcf of natural gas per year (Administration, 2013) is due to extensive reserves in oil and gas. More than eighteen of these wells are high-producing wells, producing in excess of 150 MMcf per day. Due to their large production rates, these wells utilize unconventionally large tubulars 5- and 7-in. Furthermore, as is inherent with producing gas, there are many challenges with the production. One major challenge occurs when wells become liquid loaded. As gas wells age, they produce more liquids, namely brine and condensate. Depending on flow conditions, the produced liquids can accumulate and induce a hydrostatic head pressure that is too high to be overcome by the flowing gas rates. Applying surfactants that generate foam can facilitate the unloading of these wells and restore gas production. Although the foaming process is very cost effective, its application to high-producing gas wells in Trinidad has always been problematic for the following reasons: Some of these producers are horizontal wells, or wells with large deviation angles.They were completed without pre-installed capillary strings.They are completed with large tubing diameters (5.75 in., 7 in.). Recognizing that the above three factors posed challenges to successful foam applications, major emphasis and research was directed toward this endeavor to realize the buried revenue, i.e., the recovery of the well's potential to produce natural gas. This research can also lead to the application of learnings from the first success to develop treatment for additional wells, which translates to a revenue boost to the client and the Trinidad economy. Successful treatments can also be used as correlations to establish an industry best practice for the treatment of similarly completed wells. This paper will highlight the successes realized from the treatment of three wells. It will also highlight the anomalies encountered during the treatment process, as well as the lessons learned from this treatment.

Perceptions of barriers to patient financial hardship screening differ by provider role within gynecologic oncology outpatient care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 317-317
Author(s):  
Jhalak Dholakia ◽  
Maria Pisu ◽  
Warner King Huh ◽  
Margaret Irene Liang
Keyword(s):  
Nurse Practitioners ◽  
Gynecologic Oncology ◽  
Financial Hardship ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patient Centered ◽  
Staff Members ◽  
Care Plans ◽  
Patient Barriers

317 Background: Although approximately half of patients with gynecologic malignancy experience financial hardship (FH) during treatment, best practices to identify and assist patients with FH are lacking. To develop such practices, we assessed oncology provider and staff perspectives about FH screening and provision of assistance. Methods: An anonymous survey was conducted electronically within the Gynecologic Oncology outpatient office at a Comprehensive Cancer Center. Potential barriers to patient FH screening and follow-up were assessed within 2 domains: 1) logistic barriers to incorporating FH screening and follow-up into outpatient workflow and 2) perceived patient barriers to FH screening. Responses were elicited on a 5-point Likert scale from ‘very’ to ‘not at all’ significant and dichotomized into significant and not significant barriers. Results: Of 43 providers approached, 37 responded (86% response rate) of which 14 were physicians (MD)/nurse practitioners (NP) and 23 were other staff members (i.e., clinical and research nurses, social workers, pharmacists, care coordinators, lay navigators, and financial counselors). Altogether, 38% worked in their current position for >5 years (n=14), 11% for 3-5 years (n=4), and 51% for <3 years (n=19). For logistic barriers to implementing FH screening and follow-up, the most frequently reported significant barriers included lack of personnel training (69%) and lack of available staff (62%), training regarding follow-up (72%), and case tracking infrastructure (67%). The most frequent significant perceived patient barriers were lack of knowledge of whom to contact (72%), concerns about impact on treatment if FH needs were identified (72%), and lack of patient readiness to discuss financial needs (62%.) Compared to MD/NP, staff members more often indicated the following as significant barriers: difficulty incorporating FH screening into initial visit workflow (31 % vs. 57%, p=0.03), overstretched personnel (29% vs 73%, p=0.005), and patient concerns about influence on treatment (62% vs 86%, p=0.01). Conclusions: Care team members identified barriers to patient FH screening across logistic and patient-centered domains, although MD/NP less so than other staff possibly reflecting different exposures to patient financial needs during clinical encounters or burden of workflow. Implementation of universal FH screening, dedicated personnel, convenient tracking mechanisms, and multi-disciplinary provider and staff training may improve recognition of patient FH and facilitate its integration into oncology care plans.

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