Development of an ADL-practice guideline: The next step towards guidance in essential nursing care activities

Supporting and respecting care receivers in Activities of Daily Living (ADL) lies at the essence of nursing care, irrespective of diagnosis or healthcare setting. ADL-care is an intimate form of caring, and therefore close and personal to the care receiver, aiming to enhance their independence and comfort. Even though ADL-care is indispensable and highly valued by care receivers, the scientific foundation of ADL-care is weak. This leaves nursing professionals with insufficient guidance as to what constitutes quality ADL-care and what activities are necessary and effective. Therefore, we developed an ADL practice guideline according to the framework of the Dutch Institute for Health (AQUA-guideline) and AGREE II. The guideline was developed over three stages: (1) Determination of the target population and scope, (2) Analysis of problems leading to guiding questions and answering these based on literature search and consensus, (3) Testing and validation. A multidisciplinary working group determined the purpose, target group, and five clinical questions. We used literature search and consensus procedures to answer these questions in close collaboration with care receivers and professional care providers. This guideline provides guidance for nursing professionals to choose appropriate ADL-care options in five modules covering recommendations: (1) Involving care receivers in ADL-related care choices, (2) Identifying ADL-care needs, (3) Choosing effective interventions to enhance ADL-independence and comfort, (4) Supporting informal caregivers in ADL-care, and (5) Using ADL-care for early detection of health problems. These modules are considered leading for future developments in essential nursing care and will be evaluated in a pilot implementation.

Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics

There is wide variation in terminology used to refer to children living with complex needs, across clinical, research and policy settings. It is important to seek to reconcile this variation to support the effective development of programmes of care for this group of children and their families. The European Academy of Pediatrics (EAP) established a multidisciplinary Working Group on Complex Care and the initial work of this group examined how complex care is defined in the literature. A scoping review was conducted which yielded 87 papers with multiple terms found that refer to children living with complex needs. We found that elements of integrated care, an essential component of care delivery to these children, were repeatedly referred to, though it was never specifically incorporated into a term to describe complex care needs. This is essential for practice and policy, to continuously assert the need for integrated care where a complex care need exists. We propose the use of the term Complex and Integrated Care Needs as a suitable term to refer to children with varying levels of complexity who require continuity of care across a variety of health and social care settings.

British Gynaecological Cancer Society recommendations for women with gynecological cancer who received non-standard care during the COVID-19 pandemic

During the COVID-19 pandemic, pressures on clinical services required adaptation to how care was prioritised and delivered for women with gynecological cancer. This document discusses potential ‘salvage’ measures when treatment has deviated from the usual standard of care. The British Gynaecological Cancer Society convened a multidisciplinary working group to develop recommendations for the onward management and follow-up of women with gynecological cancer who have been impacted by a change in treatment during the pandemic. These recommendations are presented for each tumor type and for healthcare systems, and the impact on gynecological services are discussed. It will be important that patient concerns about the impact of COVID-19 on their cancer pathway are acknowledged and addressed for their ongoing care.

Management of a large outbreak of COVID-19 at a British Army training centre: lessons for the future

IntroductionThe COVID-19 pandemic has posed major challenges for infection control within training centres, both civilian and military. Here we present a narrative review of an outbreak that occurred at the Royal Military Academy Sandhurst (RMAS) in January–March 2021, in the context of the circulating, highly transmissible SARS-CoV-2 variant B.1.1.7.MethodsTesting for SARS-CoV-2 was performed using a combination of reverse transcriptase PCR and Lateral Flow Devices (LFDs). Testing and isolation procedures were conducted in line with a pre-established symptom stratification system. Genomic sequencing was performed on 10 sample isolates.ResultsBy the end of the outbreak, 185 cases (153 Officer Cadets, 32 permanent staff) had contracted confirmed COVID-19. This represented 15% of the total RMAS population. This resulted in 0 deaths and 0 hospitalisations, but due to necessary isolation procedures did represent an estimated 12 959 person-days of lost training. 9 of 10 (90%) of sequenced isolates had a reportable lineage. All of those reported were found to be the Alpha lineage B.1.1.7.ConclusionsWe discuss the key lessons learnt from the after-action review by the Incident Management Team. These include the importance of multidisciplinary working, the utility of sync matrices to monitor outbreaks in real time, issues around Officer Cadets reporting symptoms, timing of high-risk training activities, infrastructure and use of LFDs. COVID-19 represents a vital learning opportunity to minimise the impact of potential future pandemics, which may produce considerably higher morbidity and mortality in military populations.

Pilot Study of an Electronic Laboratory Notebook for Research and Development

The laboratory notebook is the fundamental record for research and development. The emergence of cloud-based digital tools to replace or augment the laboratory notebook has shown promise for groups that are multidisciplinary, working asynchronously, or in multiple locations. This paper details a recent pilot study conducted by Sandia National Laboratories (SNL) comparing an electronic lab notebook (ELN) with traditional paper lab notebooks (PLN), including members of SNL’s Primary Standards Laboratory (PSL). Partly motivated by a related pilot study conducted at the National Institute of Standards and Technology (NIST), the focus of the present study was on the integrability of an ELN within the unique constraints of a national lab, including security protocols that limit cloud capabilities and limited WIFI. The study used Microsoft OneNote and commercially available mobile computing hardware. The pilot included 18 participants from the PSL, biosciences, and materials science/engineering labs. In addition to OneNote, participants were provided one of two options for a computer to be used as their note taking device (including a stylus). Usability and gap analyses, as well as interviews with pilot participants were conducted by members from Sandia’s human factors group. Findings from this study indicate that ELNs may be particularly useful for teams where sharing of procedures and results is important. Participants believed that use of the ELN increased organization of their work and facilitated reporting much more than paper lab notebooks (PLNs). Other benefits included searchability and capability for access on multiple devices. Many of the identified drawbacks were specific to the unique constraints of working at a national lab, but some constraints are more general (e.g. use of ELNs in wet labs where hazardous materials may be of concern). Overall, it was found with proper training, collaboration on best practices, and technical support, that ELNs appear to be a promising tool for modernizing recording practices in research. Some examples from PSL will be highlighted, including R&D for qualifying measurement systems, calibration processes, and procedures.

Improving referrals to survivorship: A patient-driven initiative.

44 Background: Patients often feel lost in the transition from cancer patient to survivor. As cancer treatment improves, the number of survivors in the US is expected to approach 22 million by the year 2029. Smaller increases in the MD workforce coupled with long-term effects of new treatments necessitate the creation survivorship clinics led by advanced practice providers (APP) who are disease-specialized and specifically trained to manage unique survivor needs. Although the institutions Survivorship program was established more than a decade ago, the average referral rate to the program is only 30%. Given the high levels of patient satisfaction with the program, we sought to understand and address clinician awareness and referral obstacles. Methods: Based on patient input, members of our Patient & Family Advisory Council for Quality (PFACQ) put forth a proposal aimed at increasing referrals to the Survivorship program. A multidisciplinary working group comprising patients, clinicians, administrators and process engineers was assembled. Process Improvement training was conducted, and a primary goal was developed: increase Survivorship referrals by 25%. Central to the approach was engagement with referring physicians and APPs on a service-by-service basis. A four-question survey was developed to address timing of initial discussion, challenges to referring, knowledge of visit elements, and materials needed to support referrals. A customized ‘roadshow’ presentation was created and delivered by a PFACQ member at a faculty meeting. Highlights included: the importance of Survivorship care to patients and details of the visit, survey responses, and additional faculty discussion and input. Results: Four roadshows were completed from August 2020-June 2021: Gynecologic Surgery, Endocrine, Breast Medicine and Lymphoma. Based on survey responses and dialogue with providers, new material to support patient discussions and education have been developed: a patient-facing brochure, clinician- & patient-facing video, and clinician talking points. Methods to facilitate identifying eligible patients were also discussed, as well as automatic referrals to Survivorship for selected services. Data reveal a significant increase in referral rates from GYN and Endocrine services (follow up > 6 months) of 63% and 228%, respectively. (Breast Medicine and Lymphoma with shorter follow up will be reported.) Engagement with other services is underway. Conclusions: Results have exceeded the goal of increasing referral rates to the program. This process suggests that ongoing engagement with referring clinicians is essential to achieving and maintaining higher referral rates. The patient voice throughout this process has been a powerful tool in raising clinician awareness of their experiences and expectations for comprehensive follow up care, which can be delivered on a greater scale by survivorship providers.

A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator

Objective: The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks. Methods: The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk. Results: In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD. Conclusion: ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.

The Impact of COVID-19 Outbreak on Syncope Units Activities in Italy: A Report from the Italian Multidisciplinary Working Group on Syncope (GIMSI)

The aim of our study was to evaluate the impact of the COVID-19 outbreak on Syncope Units (SUs) Activities in Italy. Methods: Data about types of SU activities and admissions were obtained from 10 SUs throughout Italy, certified by the Italian Multidisciplinary Working Group on Syncope (GIMSI), from 10 March 2020 to 31 December 2020 and compared with the same time frame in 2019. Results: A remarkable reduction in overall non-invasive diagnostic tests (−67%; p < 0.001) and cardiac invasive procedure. Elective cardiac pacing procedures disclosed a significant decrease (−62.7%; p < 0.001); conversely, the decrease of urgent procedures was not significant (−50%; p = 0.08). There was a significantly increased rate of patients who underwent both telemedicine follow-up visits (+225%, p < 0.001) and cardiac implantable electronic devices (CIEDs) remote monitoring follow-up visits (+100%; p < 0.001). Conclusion: The COVID-19 outbreak was associated with a remarkable decrease in all clinical activities of Syncope Units in Italy, including both non-invasive tests and cardiac invasive procedures; conversely, a significant increase in telehealth activities was shown.

Editorial: Introducing the IMPACT Journal and its First Issue

Welcome to this, the first issue of the International Modern Perspectives on Academia and Community Today (IMPACT) Journal. In creating this Journal and producing this first issue we have proven that multidisciplinary working is possible. Moreover, we have shown that as academics, we have the power to challenge the norms and work in innovative ways within the contexts of our institutions. Thinking and working in innovative ways reflects on our practices as we reimagine our work and role in working with the community. Through the creation of a multidisciplinary Journal, we intend to provide a platform that will not only host approaches used in various disciplines but will also act as a merging point by putting forward perspectives from the communities alongside academic work. In doing so, we hope to promote new forms of dialogue, which have the potential to generate new research directions, and help cement the notion that academia and community are intertwined rather than separate entities within the social relations. The purpose of academic practice is to serve the needs of the community as both members of the community and academics who adopt an advocacy standpoint. Therefore, we hope that through the collaborative working practices underpinning this initiative we can achieve our aim to promote community involvement and engagement and meaningful contribution in the short and long term.