Allied Health Care Professionals Research Articles

Collaborative model of care between orthopaedics and allied healthcare professionals (CONNACT) in knee osteoarthritis: Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention

ObjectiveTo compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA). MethodsPragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS4) ≤ 75) were enrolled. Primary outcome was KOOS4 at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modelling were conducted. Economic evaluation through a societal approach was embedded. Results110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: -1.86 [-9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group. ConclusionCONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward. Trial RegistrationClinicaltrials.gov Identifier: NCT03809975. Registered January 18 2019. https://clinicaltrials.gov/ct2/show/NCT03809975

P035 BSR Digital resources- Spotlights and Podcasts The Story So Far

Abstract Background/Aims The British Society for Rheumatology (BSR) has an eLearning site for members. Due to increasing demand for online learning triggered in part by the COVID pandemic, a decision was made to create a BSR digital learning board and produce a broader range of content. Methods The Digital Learning Board (DLB) was formed in February 2021 consisting of trainees, nurses, Consultant Rheumatologists and Allied Healthcare Professionals from all around the 4 nations. After consultation and discussion, a decision was made to produce two main new formats of resources in addition to the online webinar series that was already established. This included Spotlights where a variety of blended learning resources including webinars, podcasts, eLearning cases and links to relevant journal articles are collated on a topic. The Talking Rheumatology Spotlight podcast series was also developed and shared on streaming platforms such as Spotify, iTunes and the eLearning website. This includes overview podcasts on topics as well as bonus case based episodes. Resources for the wider community (not limited to members) include the podcasts and ‘How to’ resources created for doctors and nurses starting work in the specialty for the first time. Numbers of podcast downloads, views on the eLearning website and quantitative and qualitative feedback is collected via eLearning website. Results The DLB have produced 30 spotlights with the most popular topics being axial spondyloarthropathy, psoriatic arthritis and Sjogren’s. The average rating for this series is 4.5/5. Examples of feedback; “all areas of great interest and very educational”“I really enjoyed the course, the fact that BSR included several podcasts allowed me to complete the course while doing my exercise. Great course really useful for my clinical practice” 28 podcasts have also been produced so far. There have been 15,500 downloads with significant international interest particularly in the US, Europe and Oceania. The most popular episodes so far have been Polymyalgia rheumatica and Sjogren's syndrome. The how to resources for trainees resource has been viewed 3,897 times by 1502 unique users, and the how to for nurses resource has been viewed 3159 times by 1360 unique .Examples of feedback from nurses “I have now been in post for 6 months and have learnt so much with this resource”“Great introductory course to Rheumatology” Conclusion Work is underway to promote the resources, seek feedback and suggestions for further topics. Many face to face education programmes including the BSR’s own are running again but research (1) and behaviour suggest blended learning is here to stay and complements in person learning well. We are exploring this area further through the development of pre course learning for our face-to-face courses. Disclosure R. Benson: None. L. Coulson: Other; Louise works for the BSR as Digital Events Manager. W.J. Gregory: Honoraria; W.G. has received honoraria for speaker and advisory board from Abbive, Novartis, Pfizer and UCB.. J. Lemon: None. Y.L. Man: None. K. Maxey: Other; Kate works for the BSR as events and education officer. D. Pilbury: None. M. Serrano: Other; Marina works for the BSR as acting Head of Education. C. Wincup: None. P.A. Watson: Other; I am employed by the British Society for Rheumatology as Digital Learning Editor (2PA per week). S. Ellis: None. E. Chibueze Mbanasor: None. M. Malik: None. B. Lakshmana Murthy: None.

Clinician Awareness of Stickler Syndromes Among Australian Allied Health Care Professionals.

Stickler Syndromes are multisystem collagenopathies affecting 1 in 7500-9000 individuals and are associated with craniofacial, ocular, auditory, and musculoskeletal complications. Prophylactic retinopexy treatment reduces the risk of retinal detachment, emphasising the need for early detection and multidisciplinary referral. This study evaluated knowledge and awareness of Stickler Syndromes among allied health professionals and their perceived needs for targeted education to improve multidisciplinary care. A cross-sectional survey was undertaken among audiologists, speech pathologists, optometrists, orthoptists, and physiotherapists in Australia. Survey questions included practitioner demographics, awareness and knowledge of Stickler Syndromes, confidence managing Stickler Syndromes, and perception of multidisciplinary care needs for Stickler Syndromes. Of 180 healthcare professions who participated (79% female; 78% aged between 25 and 44 years), 55% indicated that they had heard of Stickler Syndrome, and 14% had directly worked with patients known to have Stickler Syndromes. Practitioners who had were either optometrists, orthoptists, or audiologists. The most recognised clinical sign of Stickler Syndromes was retinal detachment (selected by 66% of optometrists and orthoptists and 16% of other professions), but only 41% of optometrists and orthoptists (27% all respondents) selected cryopexy as a potential management strategy. Vitreous anomaly was recognised as a clinical feature by 20% of all respondents. Overall, 69% of allied health professionals did not feel confident managing Stickler Syndromes, and a similar number of practitioners (69%) indicated that they were willing to attend professional development courses for complex conditions such as Stickler Syndromes. This study provides meaningful insights on awareness and knowledge of Stickler Syndromes among allied healthcare professionals. Targeted clinician education, enhanced communication between healthcare entities, and multidisciplinary care programs can significantly improve the integrated care of Stickler Syndromes leading to better patient outcomes.

Improving the efficiency of clerking patients under an acute medical admission by introducing allied healthcare professionals to the clerking process

Improving the efficiency of clerking patients under an acute medical admission by introducing allied healthcare professionals to the clerking process

Oral health experiences of people living with Parkinson's disease: a scoping review.

Background and aim Parkinson's disease is the fastest growing and second most common progressive neurodegenerative condition in the UK; poised to represent a major societal and health care challenge. The scoping review aims to provide an overview of the literature on the oral health (OH) experiences of people living with Parkinson's, identifying current research gaps and future priorities.Method Search strategies included three electronic databases, two grey literature databases, relevant organisations, specialist journals and hand searching of the reference lists. A data extraction tool was developed and piloted.Results A total of 121 items were included in the review. Four themes were identified: OH impact, education and training, service delivery and wider impacts of OH for people with Parkinson's (PwP). The majority of studies included were cross-sectional in design, describing the OH status of PwP.Conclusion The majority of research to date has focused on OH impact. Areas for future research include use of qualitative studies exploring the experiences, attitudes and priorities of PwP and their care partners. Inclusion of medical, dental and allied health care professionals, together with people with lived experience, is required to develop, implement and evaluate interventions to support OH.

Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review.

Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non-communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care-specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. DERR1-10.2196/53901.

Oral manifestations of long COVID and the views of healthcare professionals

Introduction Oral manifestations have been observed with this condition; however, little is known about their impact on the healthcare professionals routinely managing these patients.Aims To investigate the prevalence of the oral manifestations of long COVID and the healthcare professionals' views, experiences and practices for managing these conditions.Materials and methods A cross-sectional mixed-methods study, including a self-reported online questionnaire (n = 104) and healthcare professionals' (n = 7) semi-structured interviews, was conducted. Descriptive statistics and reflexive thematic analysis were used to analyse the data.Results In total, 78% of respondents reported one or more oral conditions associated with COVID-19. Changes in the sense of taste and/or smell (58%), dry mouth (48.1%) and mouth sores (45.7%) were frequently reported. Themes identified from healthcare professionals' interviews were areas for research, management and interdisciplinary collaboration.Discussion Allied healthcare professionals may assist dental professionals with managing oral manifestations of long COVID. Inadequate access to NHS dentistry is deterring patients worried about their oral symptoms and the limited oral knowledge of healthcare professionals affects their ability to manage patients.Conclusion Healthcare professionals have observed oral manifestations in individuals diagnosed with long COVID; however, further information and training on this topic would assist them with managing patients and increasing awareness among clinicians.

Post-quake call for action: developing core competencies matrix for Syrian health workers in emergency time

BackgroundThe recent earthquake in Syria has caused widespread devastation, leading to extensive damage and loss of life. Considering the diverse range of disasters and conflicts that have affected Syrian society, health workers must possess essential competencies to effectively manage various types of disasters, including earthquakes. Therefore, this study was undertaken to identify the specific competencies required by Syrian health workers to respond efficiently and effectively to earthquakes.MethodsAn exploratory qualitative study was conducted at the Medical Education Program MEP of the Syrian Virtual University SVU. Nine members of the research team of the MEP, who represent various health specializations in medicine, dentistry, nursing, and pharmacy, accepted to take part in this study. Among these, three members have been actively involved in providing health care in hospitals and the field during the Syrian earthquake on 6 February 2023. The Delphi process was adopted to identify competencies. Health workers involved in earthquake response were categorized into nine groups including medical doctors, dentists, pharmacists, nurses, psychological support professionals, medical students, allied healthcare professionals, on-site disaster teams, and managers. The final list was accepted if it achieved more than 80% agreement among the participants in the first, second, and final rounds.ResultsThe study identified 74 competencies (12 knowledge items, 35 skills, and 27 attitudes) essential for health workers to respond effectively to earthquakes. They are categorized into five domains: "Preparing the team for the rescue process during and, after earthquakes, Implementation of the rescue process, Education and psychological support, Research, and development".ConclusionA list of earthquake competencies was identified for health workers. It is hoped that this list will enhance a country’s resilience and will enable decision–makers to support health workers in acquiring these competencies within a very strained health system in Syria and other countries.

Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients.

The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.

The Impact of a Virtual Platform to Reduce Hematology-Oncology Educational Disparities Amongst Healthcare Professionals in Lower Socioeconomic Regions Globally

Introduction: Studies have shown that lower socioeconomic (LS) areas are associated with increased disparities in healthcare access and outcomes leading to increased cancer mortality. While delayed diagnosis, suboptimal access, infrastructural challenges, and finances have contributed to these inequities, access to the latest medical knowledge and advancements has been cited as an equally important contributor responsible for cancer treatment outcomes. In response, MedNews Week (MNW), a free, digital platform was developed to provide global oncology education through its programming featuring Keynote presentations from the field's global leaders. To effectively reach a wider audience of healthcare professionals (HCP), MNW formed a strategic alliance with VuMedi- a global video education platform for physicians. The primary objective of this study was to evaluate the impact of MNW's hematology-oncology programming on VuMedi's educational platform for HCP. Methods: Between September 2022 and July 2023, MNW featured 11 prominent global hematology-oncology leaders in leukemia (mean H-index = 67.82), and their Keynote presentations were prominently presented on VuMedi. This study assessed viewership, global reach, page views, tumor subtype views, unique visits, and audience occupation demographics. In conjunction with VuMedi, a descriptive analysis and mixed-methods approach were utilized to evaluate the level of engagement with the content. Results: Over this 11-month period, MNW demonstrated increased linear growth with programming generating 4,387,213 total page views and 138,288 impressions (Figure 1 a, b). The platform drew 1,750,161 new visitors and 44,982 new registrants during this time ( Figure 1a). The Leukemia Channel and Video pages demonstrated linear growth over this time with 139 channel and 891 total video page views (Figure 2 c-e). The listed videos had 746 starts with a total playing time of 8,610 minutes (Figure 1 a, g). The audience was comprised primarily of surgeons (78.57%) compared to allied healthcare professionals (14.29%) from 22 countries- 12 of which are from LS areas, including Nigeria, Sudan, Georgia, and Bangladesh, and 10 of which are from high socioeconomic areas ( Figure 1 a & h). Conclusions: MNW has demonstrated an ability to attract and retain a diverse and expanding audience of physicians globally, particularly in lower-resource areas. Despite previously identified barriers such as limited internet access and high costs hindering access to quality medical information, MNW has exhibited consistent growth and success, particularly in regions facing these challenges. By hosting Keynote presentations from global leaders to HCP, MNW provides an effective and pragmatic solution to address educational disparities, while impacting hematology-oncology education in leukemia on a global scale.

Is Scotland's new GP contract addressing the inverse care law?

Scotland, like many countries around the world, has wide health inequalities resulting, in part, from the longstanding 'inverse care law', in which a mismatch between patient needs and provision of care in general practice in deprived areas results in poorer care and worse patient outcomes compared with affluent areas. In early 2018, Scotland embarked on a new GP contract, a stated aim of which was to reduce healthcare inequalities. National data on avoidable mortality showed a 4.8 (2019) and 4.9 (2021)-fold higher rate in the most deprived compared with the most affluent decile of the population. However, the distribution of whole-time equivalent (WTE) general practice clinicians per 10,000 patients, including GPs, and practice-employed practice nurses and other allied healthcare professionals, showed the opposite trend in both 2019 and 2022, with fewer WTE clinicians of all types in GP practices in deprived areas compared with affluent areas. These findings suggest that radical change is needed to reverse the inverse care law in Scotland.

A61A comprehensive training programme for Medical Support Workers at a large teaching hospital

The Medical Support Worker (MSW) programme enables International Medical Graduates (IMG) and refugee doctors to support clinical teams, whilst General Medical Council registration is gained [1]. North Bristol NHS Trust, a large teaching hospital in South-West England, has designed and implemented a novel training programme for a second cohort of 30 MSWs. A comprehensive learning needs assessment informed the content of the programme. Learning needs were identified from two probing questionnaires and reflective pieces, completed by 22, 27 and 29 MSWs respectively; alongside Health Education England and General Medical Council guidance [2, 3]. Four principal areas were identified- (1) Communication, (2) Portfolio Development, (3) Career Development, (4) Preparation for work in the NHS. A subsequent teaching programme consisted of simulation, human factors, communication and ethics training, alongside community theatre delivered communication skills, interview preparation practice, portfolio training sessions and a specifically tailored lecture series. The programme was evaluated using two delayed surveys, formed largely of Likert scale questions, completed by 25 and 17 MSWs. Communication, social skills or cultural change were highlighted as the biggest challenges by 64% MSWs. Only 48% of MSWs felt confident working in the NHS. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives was low (0-35%). 75% requested teaching in assessing acutely unwell patients and decision-making. 60% wanted to improve teamworking skills. : Confidence working within the NHS rose from 48% to 92%. 100% of MSWs reported that the teaching programme helped them prepare for work as doctors in the NHS. There was a greater understanding of the structure and function of the NHS, the role of allied healthcare professionals, plus the portfolio and professional development requirements of doctors (92%). 100% of MSWs felt their communication skills had improved. 87.5% reported increased confidence with informal conversation and 100% reported increased confidence in voicing opinions and raising concerns. Additionally, 100% of MSWs reported increased confidence recognizing and assessing acutely unwell patients. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives improved (60-88%). This well-received, novel programme addresses some of the unique learning needs of MSWs and helps them prepare for work as doctors in the NHS. Collaborations with other trusts are taking place to establish whether the programme could be adapted for IMGs more broadly. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Direct costs of rheumatoid arthritis multidisciplinary care in Ireland

Abstract Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining a chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary and secondary care within the Health Service Executive in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member of the primary (N = 21) and secondary care (N = 13) RA pathway. Overall cost of each patient type was calculated using time-driven activity-based costing along with medication and clinic running costs. Treating newly diagnosed RA patients costs second highest in primary (€337.39/year) and highest in secondary care (€922.32/year). While patients with advanced RA were most expensive to treat in primary (€469.18/year) and least costly in secondary care (€615.70/year). In primary care occupational therapists were the most expensive allied health care professionals (HCPs) at €1.19/min, followed by physiotherapists at €1.17/min. GP secretaries were the least costly at €0.30/min. In secondary care, consultant rheumatologists and phlebotomists were most and least costly respectively at €3.10 and €0.60/min/patient. Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more (€8718.98/year) than Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) (€120.87/year). In terms of personnel cost newly diagnosed patients and patients with advanced RA are expensive to treat as these require more time with the HCPs. Being referred to departments outside of rheumatology such as orthopaedics, advanced RA patients cost less in secondary care. The difference between whether a patient was on a csDMARD or bDMARD had the biggest influence on total, overall costs amongst the RA patient. Key messages • The study provides a breakdown of costs of RA multidisciplinary care in Ireland, facilitating understanding cost drivers and potential areas for cost-savings. • The study advances the understanding of RA management in HSE Ireland.

Student-Athletes' Deteriorating Mental Health During COVID-19: Recommendations on Proactive Strategies for Addressing Unique Mental Health Needs.

High school and college student-athletes face unique stressors that can negatively impact their mental health, which were exacerbated by the COVID-19 pandemic. Although mental health issues are prevalent in athletic communities, there often remains stigma around mental health and reluctance to seek psychological support. Physical injury can be the cause or the result of the psychological struggles that athletes face-holistic care for the adolescent athlete population must incorporate both elements. Pediatric psychologists, allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes themselves all play an active role in shaping the mental health of student-athletes and are therefore responsible for creating a culture that prioritizes mental and physical wellness. This paper aims to provide clear recommendations for the various stakeholders on how to address the unique mental health needs of student-athletes. The recommendations presented are based on a review of existing literature in the field and on-the-ground experience working with student-athletes during the COVID-19 pandemic. There are several key interventions highlighted in this paper, including changing the athletic community's culture to prioritize the holistic well-being of athletes, as well as proactively offering mental health education, resources, and programming for student-athletes, with a particular emphasis on health equity to meet the needs of students most at risk. Commitment from pediatric psychologists and allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes will maximize the likelihood of improving student-athletes' psychological well-being.

321 The barriers and enablers to an effective integrated care programme for older persons: a qualitative study

Abstract Background In line with Slaintecare goals, the Integrated Care Programme for Older Persons (ICPOP) South Lee Hub, Cork, was developed to provide onsite access to geriatrician and specialist nurse-led clinics, allied healthcare professionals, and an outreach service. ICPOP aims to avoid unnecessary hospital admissions and maximise collaboration between primary and secondary healthcare teams locally. An effective interface between primary and secondary care is, therefore, fundamental to the functioning of ICPOP. However, no research to date has examined this interface from the perspective of the clinical staff in the hubs and primary care providers in the community. This study aims to explore the barriers and enablers to the effective functioning of an ICPOP service from the perspective of both Primary Care Team (PCT) members and the ICPOP hub team. Methods Semi-structured interviews were conducted with healthcare professionals working in the ICPOP service in Cork and in primary care. All interviews were analysed thematically by two independent researchers. Results 29 semi-structured interviews were conducted; 14 with members of the ICPOP team and 15 with GP’s and members of the PCT in the ICPOP catchment area. The challenges of communicating patient information both into and out of the ICPOP hub was highlighted by both primary and secondary care teams. The GPs and other members of the PCT felt ‘on the outside’ with all the contextual knowledge of the individual patient but without a clear understanding of the functioning of the ICPOP hub. Conversely, the clinical team in the ICPOP hub found it challenging to retrieve the contextual knowledge of the patient and were challenged by administrative frustrations. Conclusion In the context of a newly emerging ICPOP service, it is essential that collaboration between primary care and the clinical hub is maximised, to provide optimal patient care.

Prevention of contamination after endotracheal intubation using a dedicated sleeve.

Contamination of work surfaces by used laryngoscopes after endotracheal intubation is a serious infection control concern but no strategies are available to address it. We assessed if contamination of the surfaces after endotracheal intubation would be reduced when providers used a dedicated, self-erected, disposable plastic sleeve (BladePouch) to store the used laryngoscope as compared to using single gloves or double gloves and sheathing the laryngoscope with the outer gloves. Twenty participants were recruited including attending physicians, trainees and allied health care professionals. They performed endotracheal intubation on a mannequin with oral cavity coated with a dye and stored the used laryngoscope blade using single gloves, double gloves or BladePouch. Each participant used both direct and video laryngoscopes. Following intubation, dye contamination of gloves, gown and work surface was evaluated. There was no difference in the contamination of gloves or gowns between the single gloves, double gloves or BladePouch groups. However, work surface contamination was significantly reduced when using BladePouch compared to single or double gloves (13% vs. 100% vs. 80% respectively, P<0.001). The odds of work surface contamination were significantly lower with BladePouch vs. single or double gloves, even when adjusted for intubation device, role and experience of participants with an adjusted odds ratio of 0.0054 (95% confidence interval: 0.0009-0.0314), P<0.001. In conjunction with standard precautions, the use of a dedicated plastic sleeve to store contaminated laryngoscope blade after endotracheal intubation may reduce the work surface contamination, independent of intubation device, role and experience of providers.

Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals

BackgroundHereditary transthyretin-mediated amyloidosis is a rare, progressive and potentially life-limiting multisystem disease, affecting every aspect of a patient’s life.ObjectivesThis online international Delphi survey aimed to evolve clinical−patient-led practical guidance, to...

Exploring Caesarean Birth 5: Psychosocial Issues Associated with Caesarean Birth

Psychosocial issues can present at any time in the weeks and months after caesarean birth. Birth trauma can cause debilitating post-traumatic stress disorder (PTSD). Midwives should be alert to the early warning signs of risks of mental, emotional and spiritual issues that impact on the birthing person. Appropriate referrals should be made to allied healthcare professionals for assessment and management.

Managing the Risk of Lung Toxicity with Trastuzumab Deruxtecan (T-DXd): A Canadian Perspective.

Ongoing advances in precision cancer therapy have increased the number of molecularly targeted and immuno-oncology agents for a variety of cancers, many of which have been associated with a risk of pulmonary complications, among the most concerning being drug-induced interstitial lung disease/pneumonitis (DI-ILD). As the number of patients undergoing treatment with novel anticancer agents continues to grow, DI-ILD is expected to become an increasingly significant clinical challenge. Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate targeting human epidermal growth factor receptor 2 that is gaining widespread use in the metastatic breast cancer setting and is undergoing exploration for other oncologic indications. ILD/pneumonitis is an adverse event of special interest associated with T-DXd, which has potentially fatal consequences if left untreated and allowed to progress. When identified in the asymptomatic stage (grade 1), T-DXd-related ILD can be monitored and treated effectively with the possibility of treatment continuation. Delayed diagnosis and/or treatment, however, results in progression to grade 2 or higher toxicity and necessitates immediate and permanent discontinuation of this active agent. Strategies are, therefore, needed to optimize careful monitoring during treatment to ensure patient safety and optimize outcomes. Several guidance documents have been developed regarding strategies for the early identification and management of T-DXd-related ILD, although none have been within the context of the Canadian health care environment. A Canadian multidisciplinary steering committee was, therefore, convened to evaluate existing recommendations and adapt them for application in Canada. A multidisciplinary approach involving collaboration among medical oncologists, radiologists, respirologists, and allied health care professionals is needed to ensure the proactive identification and management of T-DXd-related ILD and DI-ILD associated with other agents with a similar toxicity profile.

Report from the 24th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Colorectal Cancer, Richmond, British Columbia, 28-29, October 2022.

The 24th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Richmond, British Columbia, on 28-29 October 2022. The WCGCCC is an interactive multidisciplinary conference attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals such as dieticians, nurses and a genetic counsellor participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.