The impact of changing the diagnostic algorithm for TB in Manicaland, Zimbabwe

SETTING: Governmental health facilities performing TB diagnostics in Manicaland, Zimbabwe.OBJECTIVE: To investigate the effect of making Xpert® MTB/RIF the primary TB diagnostic for all patients presenting with presumptive TB on 1) the number of samples investigated for TB, 2) the proportion testing TB-positive, and 3) the proportion of unsuccessful results over time.DESIGN: This retrospective study used data from GeneX-pert downloads, laboratory registers and quality assurance reports between 1 January 2017 and 31 December 2018.RESULTS: The total number of Xpert tests performed in Manicaland increased from 3,967 in the first quarter of 2017 to 7,011 in the last quarter of 2018. Mycobacterium tuberculosis DNA was detected in 4.9–8.6% of the samples investigated using Xpert, with a higher yield in 2017 than in 2018. The overall proportion of unsuccessful Xpert assays due to “no results”, errors and invalid results was 6.3%, and highly variable across sites.CONCLUSION: Roll out of more sensitive TB diagnostics does not necessarily result in an increase of microbiologically confirmed TB diagnosis. While the number of samples tested using Xpert increased, the proportion of TB-positive tests decreased. GeneXpert soft- and hardware infrastructure needs to be strengthened to reduce the rate of unsuccessful assays and therefore, costs and staff time.

Changing from telephone to videoconference for pre-treatment pharmacist consults in cancer services: Impacts to funding and time efficiency

Introduction: This study examined the reimbursement opportunity and the time efficiency of a standard care model of unscheduled telephone consults compared to scheduled videoconference consults for obtaining pre-treatment medication histories for patients with cancer. Methods: Data related to (a) the available and the claimed activity-based funding for both models and (b) the number of contacts and the duration of each contact to complete the patient’s medication history via either unscheduled telephone or scheduled videoconference consults were collected and compared. Results: Data was collected for 86 telephone and 56 videoconference consults. The actual activity-based funding claimed for telephone consults was $0, even though $86 of activity-based funding was available for each consult. This represented a $0 reimbursement for the staff time spent conducting the telephone consults, and a missed opportunity to claim $86 per consult. Activity-based funding was claimed for all but one videoconference consult with an average of $205 received per consult, when $221 per consult was available. Videoconference consults were an average of 2.3 min shorter than telephone consults. Discussion: When compared to unscheduled telephone consults, the scheduled videoconference consults represented increased reimbursement and equivalent time efficiency for the cancer pharmacist completing pre-treatment medication histories.

Library Publishing Programs at Capacity: Addressing Issues of Sustainability and Scalability

This article discusses the changes to overall goals, direction, and services that were made to two library publishing programs at University A and University B when they were no longer able to grow their programs due to an inability to hire additional staff and COVID-19-instigated staff reassignments. Description of Programs University A's publishing program grew out of its institutional repository, and, at its peak, published 7 open access journals. In addition, University A's Libraries founded a University Press in 2016, which has published 6 books as of 2021. University B's publishing program began publishing open access journals in 2008, and it has grown to include over 20 journals. Lessons Learned Both University A and University B's publishing programs have faced scalability and sustainability issues, which were further exacerbated by COVID-19. The focus of our library publishing programs, as well as many others, has been on continual growth, which is not sustainable without the ability to hire additional staff or allocate staff time differently. We argue that standardizing services as well as creating a business plan can help ensure publishing programs are sustainable and scalable. Next Steps We hope to begin a conversation among library publishers about acknowledging limits and creating achievable definitions of success outside of continual growth.

Archivists and Architects: A Case Study on Mitigating Design Cataloging Challenges through Copyright Outreach

ABSTRACT For many archives working to publish collections online, securing copyright is a time-consuming challenge. What if the labor-intensive process of copyright outreach could be designed to increase the yield of staff time and add value to collection metadata? This case study explores an effort at the Irwin S. Chanin School of Architecture Archive of The Cooper Union to combine copyright outreach with author-generated metadata in an attempt to address common architectural record cataloging challenges. Specifically, the study looks at direct correspondence with creators as an opportunity to both secure permission to publish copyrighted materials and to fill descriptive holes in subject, title, caption, image orientation, and authorized name. This article further studies the feasibility of combining two laborintensive processes, discusses a preliminary and revised workflow, and evaluates the practicality and value of corresponding with over eight hundred individuals.

Frequency of sharp wound debridement in the management of diabetes-related foot ulcers: exploring current practice

Background Conservative sharp wound debridement (CSWD) is fundamental to wound bed preparation. Evidence-based practice guidelines strongly recommend frequent CSWD of diabetes-related foot ulcers (DFU) based on expert opinion and observational studies which suggest that more frequent debridement is associated with better healing outcomes. Aim To document current practice with regards to CSWD of DFU and whether this is performed at every visit, how often and what factors determine debridement frequency. Method Survey data were collected and managed using REDCap electronic data tools, a secure, web-based application. The survey was distributed through podiatry managers and relevant clinical networks between October 2017 and February 2018. Results One hundred clinicians opened the survey and seventy-five surveys were completed by n = 53 NSW Health (Australia) employed podiatrists (representing 41% of all NSW Health podiatrists), 11 privately practicing podiatrists, and 11 nurses. Most (n = 47) worked in metropolitan areas versus regional/remote (n = 28). CSWD was the most frequently used debridement method, performed at every visit by most (84%) of podiatrists. Callus, slough and infection presence were the top 3 most important determinants of frequency, with staff time (a limiting factor) ranking 4th. Regional/remote podiatrists practiced less frequent debridement compared with those in metropolitan areas (debridement every 2 weeks or less = 71% regional podiatrists versus 45% metropolitan podiatrists) (p = 0.024). Conclusion and clinical implications CSWD was the predominant form of debridement used with debridement occurring at every treatment visit for most of the clinicians surveyed. Debridement frequency was determined by clinical wound indications and staffing resources, with regional/remote podiatrists providing debridement less often than their metropolitan colleagues.

Is there a role for an embedded knowledge specialist in an organisation like an Academic Health Science Network? A retrospect of a one year pilot

Health Education England advocates for the introduction of more embedded knowledge specialist roles within healthcare organisations to save healthcare staff time ensuring that evidence from research, examples of good practice and learning from staff know-how and organisational knowledge are used to inform policy and practice. In 2020, a pilot was established to explore how a knowledge specialist role could bring benefits to the specialist business of an Academic Health Science Network in the South West of England. Using the structure of a retrospective learning after technique, this paper explores the rationale for the pilot, considers what was actually achieved despite the COVID-19 pandemic and examines reasons for successes and disappointments. Four key lessons are gathered that can be applied by anyone introducing a new knowledge management or embedded knowledge specialist service. The study concludes by outlining the unique contribution that an embedded knowledge specialist brings to the team to produce a tailored knowledge management service that saves staff time, keeps staff informed and connected while evolving to meet the ever changing priorities of complex healthcare organisations.

Support and Resistance

Gaining and maintaining support for the change process must occur throughout the initiative, with a particular emphasis on supporting staff who are involved and, as part of that, dealing with any of their concerns or resistance to the change process. A great deal of attention needs to be paid to developing, and then maintaining, support from staff and other stakeholders for the process. This includes identifying and dealing with resistance, especially by understanding the sources of resistance and proactively addressing them, for example, by providing training and other necessary resources. It is important that adequate resources in terms of staff time and any necessary financial and technological support are made available. Widespread participation of staff in the change process will be a potent source of support. Care should be taken not to “overtax” staff by requiring too much of their time for change activities.

Comparing Technology-Based Reading Intervention Programs in Rural Settings

An ever-growing call for the use of evidence-based practice has come up against the logistical hurdles of a lack of resources and expertise, particularly in rural schools that work with historically underserved students. Although integrated learning systems (ILSs)—stable and likely requiring fewer resources than personnel—do not offer a complete solution to this problem, they may serve as a useful resource, particularly for milder literacy deficits. And yet, there is a surprising lack of empirical research on their effectiveness, particularly contemporary programs. This study examines the effectiveness and efficiency of two popular ILSs, Lexia and iStation, both of which use a blended model of computer and traditionally delivered instruction, and compares them against business-as-usual (BAU) conditions across a variety of outcomes. Results suggest both programs resulted in meaningful growth across an academic year of implementation, although generally no more so than that observed in the BAU condition. However, Lexia yielded the highest level of instructional efficiency. That is, despite comparable growth across conditions, Lexia required less staff time to implement per student participant.

Clinic time required to manage remote monitoring of cardiac implantable electronic devices: impact of outsourcing initial data review and triage

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Remote monitoring is guideline-recommended to manage cardiac implantable electronic device (CIED) patients. With the continuous growth of implanted patients, clinic workload to review transmissions is increasing. Outsourcing initial data review and triage to an external monitoring center could be a valuable option for more efficient allocation of staff time, as high-skilled healthcare professionals can focus on patients in need rather than non-actionable data. Purpose The objective was to estimate the potential clinic staff time saved when outsourcing part of remote transmission review. Methods A previous time and motion evaluation described workflow tasks and time required for remote transmission review (4 EU sites, 674 observations). From real-world experience with a third-party monitoring service, the steps that can be outsourced were determined considering existing clinic-driven protocols for triage and transmission escalation. Staff time required with and without the monitoring service was thus modeled and compared. Results Outsourcing to an external monitoring center can reduce clinic staff time between 77.4% and 84.7% depending on device type. Absolute time savings range from 32.7 to 82.6 hours per year per 100 patients for therapeutic devices, and 301.3 hours for insertable cardiac monitor (ICM) patients, due to the higher frequency of transmissions in diagnostic devices. Conclusion Time to review remote transmissions can become overwhelming for clinics as growing CIED population often outpaces available staffing resources. Outsourcing initial review and triage to an external monitoring center (ensuring quality and regulatory compliance) can be an efficient option to save dedicated staff and facility time for other crucial healthcare activities. Clinic Staff Time Savings Per YearPacemakerICDCRTICMTRANSMISSIONS PER PATIENT PER YEARGreen (no further review required when outsourcing)3.04.35.020.8Yellow/Red (medical action/decision required)0.60.80.93.8ANNUAL STAFF TIME PER PATIENT, minutesNo outsourcing25.346.658.5219.7Outsourcing to monitoring center5.77.78.938.9ANNUAL STAFF TIME PER 100 PATIENTS, hoursNo outsourcing42.277.697.4366.2Outsourcing to monitoring center9.612.914.964.8TIME SAVED PER 100 PATIENTS, hours (%)32.7 (77.4%)64.7 (83.4%)82.6 (84.7%)301.3 (82.3%)Abstract Figure. Outsourcing Remote Transmission Review