Aspects Of Patient Care Research Articles

Impact of COVID-19 on rheumatology practice in the UK-a pan-regional rheumatology survey.

The COVID-19 pandemic has disrupted healthcare services and rheumatology staff were redeployed to the frontline. The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the provision of rheumatology services as viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was sent to 804 clinicians including consultant rheumatologists, speciality trainees, nurse specialists, and allied health professionals in 4 regions of the UK to evaluate personal effects of COVID-19 and redeployment, impact on current out-patient clinic activity, immunosuppressive drug use, and future rheumatology care. Response rate was 21%. One-fifth of the responders reported that their rheumatology departments were functioning less than 50% capacity during the pandemic. Two-third of responders felt anxious about the ill-effects of COVID-19 on their health and well-being, and one-third of them were redeployed. During the peak of the pandemic, 75% of clinicians stopped intravenous biologics. Although access to video consultation was available for up to three-fourths of the clinicians, the majority (90%) used this modality in less than 1 in 4 consultations. This survey highlights rheumatologists’ perception in the delivery of future care and anxiety they faced. As demonstrated by this survey, the National Institute for Health and Care Excellence (NICE) guidance did not influence clinician decision making in some aspects of patient care. Underutilization of tele-rheumatology in this survey should be considered whilst planning the restoration of rheumatology services in the post-COVID era.Key points• COVID-19 has generated significant concerns among rheumatology community about their mental well-being.• In over 50% of cases, rheumatologists stopped IV biologic drugs as per patients’ wishes during the first wave of the pandemic.• Tele-rheumatology has been used more widely during the pandemic, but the extent of its use in the post-COVID era is less clear. Evolving evidence will determine its future wider use.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10067-021-05601-1.

Improving Patient Access to Medical Images by Integrating an Imaging Portal With the Electronic Health Record Patient Portal.

As of 1996, HIPAA has granted patients access to all aspects of their medical record, including imaging studies [1]. Such access has been shown to improve many aspects of patient care [2]. Most patients utilize access to imaging reports when available, and the majority of patients prefer direct access to their imaging studies [3]. Determining how to best provide such access and meaningfully communicate complex medical information proves challenging.

A sex and gender medicine in emergency medicine course: a novel elective for trainees

ABSTRACT Evidence-based sex and gender differences in Emergency Medicine (EM) affect every aspect of patient care. Unfortunately, these important differences are not yet routinely incorporated into traditional medical curricula, leaving most EM trainees bereft of this knowledge, potentially resulting in suboptimal patient care. In an effort to close this knowledge and curricular gap, a unique introductory ‘Sex and Gender in Emergency Medicine’ (SGEM) course was created and offered to medical students and EM residents as an elective course. Pre- and post-course surveys were obtained. Surveys were designed to assess awareness, knowledge, and attitudes regarding Sex- and Gender-based Medicine (SGM). Pre-surveys demonstrate that less than half (44%) were familiar with the topic of SGM and none reported receiving any prior instruction or medical education regarding SGM. Despite this relative unfamiliarity with SGM, the majority (91.6%) felt that SGM knowledge was important and would improve one’s ability to care for patients. Post-survey responses consistently reflected that participants were now more familiar with SGM and additionally felt that SGM knowledge would affect their future clinical practice. All respondents felt that medical education should routinely incorporate SGM. An SGM/SGEM elective is feasible and an effective curricular addition to introduce SGM to medical students and residents.

A Study on Job Satisfaction, Stressors and Job Burnout of Nurses in a Third-Class Hospital in Haikou

Objective: With the development of society, people’s requirements and standards for nursing work continue to improve, under the premise of nursing human resources are relatively insufficient, nursing work from nursing skills to service attitude to ensure quality, this standard brings great work pressure to nursing staff, in addition, the increasing medical disputes, It increases the risk factor of personal safety attack in the workplace of nurses, and further increases the psychological pressure of nurses, thus increasing the incidence of job burnout of nurses. Methods: A multi-stage random sampling was adopted to conduct a questionnaire survey among 1049 nursing staff on December 1, solstice and December 30, 2015. The current situation of nurses’ job satisfaction, stressors and job burnout and its influencing factors were analyzed. Results: 1) The total score of nurses’ job satisfaction was 91.52 ± 17.99 points; 2) The total score of nurses’ work stressors was 86.52 ± 21.95 points; 3) The total score of nurses’ job burnout was 38.44 ± 7.55 points; 4) The aspects of patient care, management and interpersonal relationship were significantly correlated with nurses’ burnout (P < 0.001), and the total score of job satisfaction was positively correlated with nurses’ burnout, while the total score of job satisfaction was negatively correlated with nurses’ burnout. There was a significant correlation between job title and nurse burnout (P < 0.001). Conclusion: The job burnout of nurses is related to nurse satisfaction and work pressure. The problems of management and interpersonal relationship, title, total score of job satisfaction and patient care are the main problems of nurses’ job burnout.

The Authority for Certain Clinical Tasks Performed by Unlicensed Patient Care Technicians and LPNs/LVNs in the Hemodialysis Setting: An Update and Invitation to Take Action

As the demand on time and resources of licensed health care professionals increases and cost-containment measures challenge organizations, the use of unlicensed assistive personnel for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when registered nurses (RNs) delegate certain tasks and aspects of patient care. The principles of delegation from the American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the RN for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting varies significantly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. Knowing individual state Nurse Practice Acts remains the responsibility of the individual. This article discusses the results of a review of the available information on state positions on delegation of clinical tasks in hemodialysis.

Practising person-centred care. Selected abstracts from the virtual 26th WONCA Europe conference, 6–10 July 2021

Background From 6 to 10 July 2021, WONCA Europe and the Dutch College of General Practitioners as host organiser welcomed 1,266 family physicians/general practitioners, teachers, researchers, and students from 66 countries interested in sharing knowledge, experience and innovations in primary healthcare. Methods In cohesive sets of plenary presentations, round table sessions, and research masterclasses, aspects of patient care, research, and education around Practicing Person-Centred Care were presented and discussed. Actual topics in primary care such as covid-19, e-health and professional health, were covered in oral presentation sessions, one slide 5-minutes presentations, case presentations by young doctors and the e-poster gallery. All sessions were recorded and available on-demand for registrants until three months after the conference. All accepted abstracts have been published in the abstract book [https://www.woncaeurope.org/page/past-conference-abstract-books]. For this Journal, we selected the top 20 abstracts based on reviewers scores (mean of 3.5 or higher on a scale of 4) and consensus among members of the Scientific Committee. Results The selected abstracts are divided into the following themes: (1) clinical topics often encountered in primary care, such as acute chest pain, urinary tract infections, dementia, and covid-19 (N = 5); (2) personalised care and related issues such as addressing multimorbidity (N = 2); shared decision making and patient empowerment (N = 4); (3) overdiagnosis and overtreatment, focusing on deprescribing (N = 2); (4) health promotion and prevention, including mental health (N = 2); (5) quality and safety (N = 2); (6) professional development and education (N = 1); (7) research and innovation, including teleconsultation (N = 2).

Impact of Structured Clinical Handover Protocol on Communication and Patient Satisfaction.

The Handover process is an essential aspect of patient care in daily clinical practice to ensure continuity of patient care. Standardization of clinical handover may reduce sentinel events due to inaccurate and ineffective communication. Single arm experimental trial was conducted to assess the effect of standard Situation, Background, Assessment, Recommendation (SBAR) protocol implementation in overall bedside nursing handover process, patient satisfaction, and nurses’ acceptance. As a sample, all nursing staff of specified unit, all handover process performed by them, and patients admitted during study the period were included. Initially, the prevailing handover process and patient satisfaction regarding nursing handover was assessed using a structured observation checklist. During the implementation phase, nurses were trained on an SBAR handover protocol. After implementation, nursing handovers were again assessed and data regarding patient satisfaction and nurses’ acceptance were collected. There was a statistically significant difference (P < .05) in median scores between the pre and post-intervention group on overall nursing handover and patient satisfaction regarding nursing handover. Standardization of patient’s handover process is effective in terms of improving nursing handover process, patient satisfaction, and health professionals’ acceptance.

Junior Doctors and Conscientious Objection to Voluntary Assisted Dying: Ethical Complexity in Practice

In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.

Evidence-Based Strategies for the Treatment of Peritoneal Malignancies during Health Care Resource Restriction: The COVID-19 Pandemic.

Background: The COVID-19 pandemic has put enormous pressure on hospital resources, and has affected all aspects of patient care. As operative volumes decrease, cancer surgeries must be triaged and prioritized with careful thought and attention to ensure maximal benefit for the maximum number of patients. Peritoneal malignancies present a unique challenge, as surgical management can be resource intensive, but patients have limited non-surgical treatment options. This review summarizes current data on outcomes and resource utilization to help inform decision-making and case prioritization in times of constrained health care resources. Methods: A rapid literature review was performed, examining surgical and non-surgical outcomes data for peritoneal malignancies. Narrative data synthesis was cross-referenced with relevant societal guidelines. Peritoneal malignancy surgeons and medical oncologists reviewed recommendations to establish a national perspective on case triage and mitigating treatment strategies. Results and Conclusions: Triage of peritoneal malignancies during this time of restricted health care resource is nuanced and requires multidisciplinary discussion with consideration of individual patient factors. Prioritization should be given to patients where delay may compromise resectability of disease, and where alternative treatment options are lacking. Mitigating strategies such as systemic chemotherapy and/or surgical deferral may be utilized with close surveillance for disease stability or progression, which may affect surgical urgency. Unique hospital capacity, and ability to manage the complex post-operative course for these patients must also be considered to ensure patient and system needs are aligned.

Cardiovascular Conundrums of COVID-19 Pandemic

The current COVID-19 pandemic is an enormous and unique challenge to the mankind Its unprecedented global health impact has exposed the vulnerability of existing healthcare systems and infrastructure of all the countries, rich or poor Devastating effects of COVID-19 have challenged all aspects of patient care, be it emergency or elective One of the worst affected population is those with underlying cardiovascular disease In addition to effects on healthcare workers, it has serious consequences for the education and training of fellows With currently worsening COVID-19 crisis in the country, one wonders the extent of its impact on various aspects of human health and the healthcare systems

Implementing Lean Quality Improvement in Primary Care: Impact on Efficiency in Performing Common Clinical Tasks.

Many primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency. To examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. Non-randomized stepped wedge with segmented regression and interrupted time series analysis (January 2011-December 2016). A total of 317 physician-led teams in 46 primary care departments in a large ambulatory care delivery system. Lean redesign was initiated in one pilot site followed by system-wide spread across all primary care departments. Redesigns included standardization of exam room equipment and supplies, streamlining of call management processes, care team co-location, and team management of the electronic inbox. Time-stamped EHR tracking of physicians' completion time for 4 common tasks: (1) office visit documentation and closure of patient charts; (2) telephone call resolution; (3) prescription refill renewal; and (4) response to electronic patient messages. After Lean implementation, we found decreases in the amount of time to complete: office visit documentation (- 29.2% [95% CI: - 44.2, - 10.1]), telephone resolution (- 22.2% [95% CI: - 38.1, - 2.27]), and renewal of prescription refills (- 2.96% per month [95% CI: - 4.21, - 1.78]). These decreases were sustained over several years. Response time to electronic patient messages did not change significantly. Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks. Our findings support the use of Lean techniques to engage teams in routine aspects of patient care. More research is warranted to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.

Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation

Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about patients’ psychological and spiritual well-being with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to adequately address these patients’ needs, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness, and shared decision making with patients’ families.

Home Care Program for Managing Oncology Patients during COVID-19 Pandemic. a Tertiary Referral Center Experience

BackgroundCOVID-19 pandemic disrupted heath care system all around the world and overwhelmed the capacity of hospital to manage regular patients including cancer patients. We implemented a new program to help managing oncology patients visited our Emergency Rooms (ER) and discharged home.MethodsOur home care program designed to cover all aspects of patients care while they are at home by checking the ER list on daily basis and identify all oncology patients on this list. We developed an algorithm, to follow up our patients and the COVID-19 test status and to act accordingly (figure 1). The team consists of oncologist, oncology nurse specialists, patient educator and data management person. The primary oncologist of each patient is notified and consulted on the plan. The team follows the result and decide further steps of management accordingly. The intervention includes regular clinical assessment by calling the patient, arranging medication delivery, sending patients brochures explaining the necessary protective measured needs to be taken by patient and care givers and respond to patient and family queries and concerns.ResultsBetween May 31 and July 31, 237 oncology patients seen in ED with different clinical presentations. One hundred forty two patients did not need admission and therefore discharged home. COVID-19 test was carried out according to the presenting symptoms and ARI score (test requested if score is 4 or more). Only 30 patients (21%) needed COVID-19 testing prior to discharge from ED and 6 patients tested positive. However, on our follow of those patients at home further 16 patients (11%) needed to be tested due to new developments of their symptoms and 3 patients tested positive. The main reasons for nor requesting COVID-19 for some patients either 1) recent testing in outpatient clinics or other health centers outside our institution Ministry of Health, 2) they are known to have covid-19 and still in active infection, 3) based on patient's MRP decision not to swab patient for COVID -19. During our daily monitoring of patients at their homes, 12 patients (8%) were called back due to worsening of their symptoms and needed further assessment and management after discussion with their MRP. As per our infection control department guidelines, repeating COVID-19 testing for asymptomatic patients was not necessary and patient can be discharged from our records. This new model of care in our institution was presented to the COVID-19 pandemic command center and the program got the approval and recommended to be implemented in other departments as per patients need.ConclusionOncology patients are vulnerable especially at this time of COVID-19 pandemic and our program is designed to reduce the risk of exposure and infection by looking after those patient while they are at home in addition to maintain the continuity of their cancer management.FigureDisclosuresNo relevant conflicts of interest to declare.

Sero-Epidemiology And Pattern Of Transfusion-Transmissible Infectious Diseases Among Family Replacement And Voluntary Blood Donors In Lagos University Teaching Hospital (2018-2019), South-West Nigeria

Abstract Introduction/Objective Despite innovations and giant strides achieved in medicine, blood transfusion has continually remained an integral aspect of patient care and management. Currently, blood and blood products are part of the World Health Organisation (WHO) model list of Essential Medicine (EML). However, despite being a ‘life saver’, potential risks of transfusion of fatal infections (TTI) are associated with its use, hence this study to evaluate the trend of TTI in blood donors. Methods In this study, 21,464 donors were screened for HIV, HBV, HCV and Syphilis between 2018 and 2019 via 4 th generation ELISA. Retrospective data was gotten from records. The results were read using a spectrophotometer. Optical Density was calculated for positive and negative controls and only results from runs in which controls had passed were used and released. Results Of the 21,464donors tested, 3818 (17%) were voluntary blood donors (VBD) and 17,646 (83%) were family replacement donors (FRP). Total number of TTI was 1928 (0.1%) of units donated. Of the screened units positive for TTI, HBV accounted for the highest prevalence 1031 (54%), HCV 498 (26%), HIV 246 (13%) and Syphilis 147 (8%). A much higher incidence of TTI sero-positivity was observed in FRP (85%) as compared with voluntary blood donors (15%). Cumulative discard rate from TTI was approximately 0.1%. Conclusion Our results in this study showed that FRP are more likely to transmit TTI than VBD. Blood transfusion services should work more on replacing family replacement donors with voluntary donors. This can be achieved by reinforcing the culture of voluntary blood donation through the media, secondary and higher institutions as well as through advocacy. Indeed the WHO recommends 100% voluntary blood donations for all nations.

Increasing the capacity to provide compassionate care by expanding knowledge of caring science practices at a pediatric hospital

BackgroundThe emotional aspects of patient care affect care givers' capacity to remain present, safe and caring. As demands increase and capacity decreases care providers are at risk for compassion fatigue (CF). Local problemOur organization treats children with complicated diagnoses. Nurses carry a heavy emotional burden due to prolonged exposure to suffering with chronically ill children, ethical dilemmas, and an onus to also care for the parents. MethodsOur program highlights theory guided practices that honor the complexities of caring for others and creates opportunity for the care giver to slow down and prioritize how they care for themselves. InterventionsCaritas Circles, a small group intervention program, was developed to offer a deeper exploration of Jean Watson's Caring Sciences practice and theory using intentional practices to pause, be present and find peace in the midst of caring for sick children. ResultsQuantitative and qualitative measures show improvement in care providers' ability to prioritize their own needs as they care for others. Care providers noted the need to have organizational support for resiliency, a connection to purpose as a care provider, and opportunity to let go of the emotional residue found in their role. ConclusionsOrganizations can no longer afford to ignore the emotional labor that care givers experience. This program highlights the need for hospitals to prioritize this type of experiential intervention and offer time during work hours where providers are honored and cared for, so they can continue to care for patients and families.

A Prospective Analysis of Quality of Life in Patients Undergoing Whole Breast Irradiation

The impact of Whole Breast Irradiation (WBI) on Quality of Life (QoL) outcomes is unclear, especially in developing countries, therefore a prospective, observational, cohort study was conducted to gain insight into this aspect of patient care. 74 women with stage I-III breast cancer and treated with breast-conserving surgery followed by adjuvant systemic therapy, were prospectively enrolled in this study, after ethics committee approval. CT based target delineation was performed according to RTOG guidelines. The entire breast comprised the PTV, which was prescribed either 46–50 Gy in 23-25 fractions or 40–42.5Gy in 15-16 fractions, as per physician preference. All patients were treated with Forward-Optimized IMRT, following which they received a boost to the lumpectomy cavity (10 Gy in 4 fractions). QoL assessment was performed using the self-administered FACT-B questionnaire (in English or patient's native language). All FACT-B subscales [Physical (PWB), Emotional (EWB), Social (SWB) and Functional (FWB) well-being, as well as Breast Cancer-Specific Subscale (BCSS)] were assessed. The assessments were performed before starting radiotherapy, at the end of every week during radiotherapy, and at 3 and 6 months after radiotherapy. Repeated measures ANOVA was performed to determine any statistically significant differences throughout radiotherapy delivery. A comparison between baseline and every time-point henceforth was performed using the paired t-test. For the entire cohort and across all subscales, scores at 3 and 6 months were higher compared to baseline scores (p < 0.001 for all comparisons). During radiotherapy delivery, PWB, FWB and BCSS scores increased during the first week of treatment, followed by a gradual decline towards end-of-treatment, whereas SWB and EWB gradually improved (p < 0.001 for all comparisons). FACT-B score improved for first 2 weeks followed by a gradual decline towards end-of-treatment. There is a significant QoL reduction in all patients undergoing adjuvant WBI irrespective of fractionation regimen. However, QoL returned to baseline after completion of WBI.Abstract 2498; TableMean scores with standard deviations for all assessed QoL subscales. (*Week 5 & 6 assessment was performed for patients undergoing conventionally fractionated WBI)SubscalesBaselineWk 1Wk 2Wk 3Wk 4Wk 5 *Wk 6 *3 mo.6 mo.PWB9.5 ± 1.015.3 ± 2.814.2 ± 3.212.1 ± 3.49.6 ± 3.17.1 ± 3.66.1 ± 3.321.0 ± 2.915.1 ± 3.7SWB19.3 ± 1.420.8 ± 5.221.3 ± 5.122.2 ± 4.822.7 ± 4.922.8 ± 4.923.0 ± 4.825.7 ± 2.725.6 ± 3.9FWB12.5 ± 1.015 ± 5.314.1 ± 5.313.5 ± 5.512.5 ± 1.010.7 ± 5.49.8 ± 5.320.8 ± 4.517.0 ± 4.6EWB15 ± 2.815.1 ± 2.315.2 ± 2.415.4 ± 2.615.4 ± 4.815.6 ± 4.616.0 ± 4.518.7 ± 4.218.7 ± 4.1BCSS10 ± 1.421.2 ± 2.818.6 ± 3.315.6 ± 3.912.8 ± 3.910.6 ± 3.78.9 ± 3.724.4 ± 2.818.2 ± 4.8FACT-B66.4 ± 3.787.4 ± 11.383.4 ± 11.378.6 ± 12.372.5 ± 14.766.8 ± 14.663.8 ± 14.1110.5 ± 10.494.4 ± 15.4 Open table in a new tab

Mobilising intensive care patients early

Background: Early mobilisation in the intensive care unit has been suggested to improve outcomes. However, safety and practical concerns have led to the slow uptake of early mobilisation. Objectives: We designed a study to evaluate the practicability and efficacy of an early mobilisation protocol in intensive care unit patients. Methods: We performed a prospective non-blinded observational cohort study based on a quality improvement project. We implemented a protocol for early mobilisation of suitable patients admitted to medical and surgical intensive care units of a tertiary care hospital. All other aspects of patient care were managed as usual. Patients were followed up to discharge. Data were collected from July to August 2016 pre-implementation and from November 2016 to February 2017 following protocol implementation. The primary outcome measure was the mobilisation rate, defined as the number of days mobilised divided by the number of days each patient met mobilisation criteria. Secondary outcome measures included adverse event rate, length of mechanical ventilation, intensive care unit and hospital stay, intensive care unit and inhospital mortality and discharge destination. Results: A total of 312 patients were analysed, of which 60% were men with a mean age of 63.4 years. Following early mobilisation implementation, the mobilisation rate increased from 39% to 65% ( P=0.006). The percentage of patients discharged home increased from 49.0% to 75.9% ( P&lt;0.001). Mortality, length of mechanical ventilation, length of stay and adverse event rate did not differ significantly. Conclusion: The implementation of an early mobilisation protocol in our intensive care unit was both safe and effective without requiring additional staffing. Efforts are ongoing to increase compliance with the protocol.

Communication Skills: Use of the Interprofessional Communication Curriculum to Address Physical Aspects of Care.

The literature has emphasized the importance of effective communication regarding psychosocial needs; however, other aspects of patient care, including attention to physical needs, are equally important. The aims of this article are to (a) describe an Interprofessional Communication Curriculum (ICC) in oncology, (b) detail the curriculum content specifically focused on physical aspects of care, and (c) illustrate the importance of interprofessional care in oncology. The ICC is organized by the 8 domains of the National Consensus Project for Quality Palliative Care and centers on communication skills needed in oncology clinical practice. Based on initial pilot data, oncology clinicians indicate a high level of satisfaction with the ICC. Additional future training courses supported by the National Cancer Institute will prepare oncology teams to enhance communication with patients and families.

Sharing the helm: medical co-management for the older surgical patient.

The management of frail older patients with multiple comorbidities requires considerable medical expertise. While all surgeons are doctors, the rapid expansion of evidence relating to best treatment means that no medical practitioner can expect to be expert in all aspects of patient care. Greater scrutiny of surgical outcomes through initiatives such as the Australian and New Zealand Audit of Surgical Mortality1 and the Australian and New Zealand Emergency Laparotomy Quality Improvement quality initiative2 has reframed the concept of quality surgical care from the outcome of the procedure alone to encompass the whole patient journey and highlighted the importance of older age, frailty and comorbidity in determining outcomes. Multidisciplinary consultation and decision‐making around optimal management depends upon collaboration between different specialties. The Royal Australasian College of Surgeons competency framework recognizes the importance of non‐technical skills required of today's surgeon in providing patient‐centred care.3, 4 This article discusses medical expertise and collaboration as applied to the management of older surgical patients and provides a practical example of a service, which strives to meet this challenge, but the authors recognize there is considerable overlap with the other competencies, particularly ‘communication’, ‘management and leadership’, ‘decision‐making’ and ‘professionalism’.

Capturing domain expert perspectives in devising a rating scale for a health specific writing test: How close can we get?

Abstract The importance of input from occupational experts in defining valid criteria to assess performance on English for specific purposes (ESP) tests is widely acknowledged. However, few studies have described the process of collecting indigenous criteria and establishing their suitability for a language testing context. The paper reports on this process with specific reference to the writing sub-test of the Occupational English Test (OET) for overseas-trained health professionals. The OET writing task requires candidates, in the role of health professional, to draw on a set of written prompts to write a letter of referral to a colleague on an aspect of patient care. With the aim of expanding the test construct as reflected in the criteria, health professionals from hospitals were asked to judge the adequacy of patient records obtained from health settings. Based on their feedback, an elaborate checklist was developed to reflect the qualities of the written documents that they considered critical. The paper discusses the challenges involved in the process, including the inevitable construct shrinkage evident in the final version of the checklist indicators due to the constraints of the testing situation. The study has implications for our understanding of authenticity in ESP assessments.