Clinical Professional Groups Research Articles

Lumbar spine fusion surgery versus best conservative care for patients with severe, persistent low back pain.

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians' views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials. There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred approach for spinal fusion (n = 19, 36.4%), and the preferred method of BCC was a combined programme of physical and psychological therapy (n = 35, 48.5%). This survey demonstrates that there is uncertainty about the role of lumbar spine fusion surgery and BCC for a range of example patients with severe, persistent LBP in the UK.

Communication in the intensive care unit during COVID-19: early experience with the Nightingale Communication Method.

ObjectiveTo assess the utility and frequency of use of the Nightingale Communication Method, during the early operational phase of the Nightingale Hospital London (NHL) 4000-bed field hospital’s intensive care unit.DesignSurvey-based cross-sectional assessment.SettingThe intensive care unit at the Nightingale London hospital.ParticipantsStaff working in the clinical area and therefore requiring full personal protective equipment (PPE).InterventionSurvey of all staff members sampled from a single shift at the Nightingale Hospital. This investigated perceived utility and actual use of identification methods (name and role labels on visors and gowns, coloured role identification tapes) and formal hand signals as an adjunctive communication method.Main Outcome MeasureSelf-reported frequency of use and perceived utility of each communication and personnel identification adjunct.ResultsFifty valid responses were received (72% response rate), covering all clinical professional groups. Prominent name/role identifications and coloured role identification tapes were very frequently used and were perceived as being highly useful. Formal hand signals were infrequently used and not perceived as being beneficial, with respondents citing use of individual hand signals only in specific circumstances.ConclusionPPE is highly depersonalizing, and interpersonal identification aids are very useful. Despite being difficult, verbal communication is not completely prohibited, which could explain the low utility of formal hand signals. The methods developed at the Nightingale hospital have enhanced communication in the critical care, field hospital setting. There is potential for wider application to a variety of healthcare settings, in both the current situation and future pandemic scenarios.

International survey of COVID-19 management strategies.

BackgroundWhile individual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled.MethodsFrom May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to individuals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken; media communication; how acute hospitals were re-organized; primary health organization; personal protective equipment; and staffing and training.ResultsA total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions; 57.9% were female and the majority had 10 or more years of experience in healthcare; almost half (46.5%) were physicians; and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions.ConclusionThe world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for example, effective swab testing and social control measures.

TELEMONITORING MULTIDISCIPLINARY PROFESSIONAL GROUPS IMPROVES THEIR SELF-EFFICACY IN THE CARE OF MINERS

SESSION TITLE: Occupational and Environmental Lung Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Given the re-emergence of pneumoconiosis in the U.S., there is a tremendous need to train rural professionals in its multidisciplinary management. The Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Program in New Mexico, U.S., provides longitudinal multidisciplinary telementoring to professionals taking care of miners. The impact of this approach on the self-efficacy of participants has not been previously evaluated. METHODS: This is a 12-month longitudinal study involving clinical and non-clinical professionals caring for miners. The study outcome was the change in self-efficacy scores, using a customized instrument of 14 measures, grouped into three domains: clinical, medicolegal and soft skills. The primary outcome utilized a retrospective pre–post design that collects “pretest” data at the post-intervention timeframe. RESULTS: Subjects reported significant improvements in nine of 14 items (p<0.05) and a significant decline in one of 14 items (with respect to their ability to interpret pulmonary function test results, p<0.001) since their start dates in the program. Subjects also reported significant improvement with respect to their scores for all three domains and for the 14-item total score (p≤0.01). Existing participants and clinical professional groups demonstrated greater improvement in selected items than fresh participants and non-clinical professional groups respectively. CONCLUSIONS: This study is the first in a stepwise approach to determine the benefit of participating in a multidisciplinary telementoring intervention by improving participant self-efficacy in caring for miners with complex mining-related diseases. Our study finding represents a potential solution to a growing access to care gap for miners with pneumoconiosis. CLINICAL IMPLICATIONS: Although future studies will determine whether improved participant self-efficacy correlates with improvement in patient outcomes, our study finding represents a potential solution to a growing access to care gap for miners with pneumoconiosis. This provides the rationale for utilizing systems that are already in place for rapid scaling of the Miners’ Wellness TeleECHO Program at other institutions nationally and globally. DISCLOSURES: no disclosure on file for Nour Assad; No relevant relationships by Ramni Khattar, source=Web Response No relevant relationships by Kyla LeSuer, source=Web Response No relevant relationships by Orrin Myers, source=Web Response No relevant relationships by Brian Soller, source=Admin input No relevant relationships by Akshay Sood, source=Web Response

A virtual community-of-practice approach by rural stakeholders in managing pneumoconiosis in the USA: a cross-sectional analysis.

The re-emergence of pneumoconiosis, particularly among coal miners (ie black lung), in the USA is a challenge for rural communities because more miners require specialized care while expertise is scarce. The Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Clinic, jointly held by the University of New Mexico and a community hospital in New Mexico, provides structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals, benefits counselors, lawyers/attorneys and others, forming a virtual 'community of practice'. This approach has not been utilized and evaluated previously. The study's bimonthly program uses the ECHO telementoring model, which uses technology to leverage scarce mentoring resources; uses a disease-management model that is proven to improve outcomes in other disease states, by reducing variation in processes of care and sharing best practices; uses the principle of case-based learning with highly contextualized discussions, which fulfils key learning theory principles; creates a virtual community of practice; and uses an internet-based database to monitor outcomes. This 1-year cross-sectional study from September 2018 to September 2019 used geographical mapping of all attendee locations, web-based continuing medical education surveys completed by attendees using iECHO software, and a Research Electronic Data Capture-based survey of a convenience sample of participants, which obtained detailed information on demographics, knowledge, self-efficacy and collective efficacy. Knowledge sharing among participants was examined using insights and methods from social network analysis. Subgroup analysis involved comparisons between clinical and non-clinical professional groups, and between new and existing participants. Groups were compared using Fisher's exact test for categorical variables, and non-parametric Wilcoxon ranked sum test or student's t-test for continuous variables. Participants were largely located in pneumoconiosis mortality hotspots of the USA. In a convenience sample of 70 participants, clinical professional groups such as clinicians (29%), home health professionals (20%) and respiratory therapists (17%) constituted the majority of the stakeholders. Participants demonstrated the lowest knowledge score on 'legal pneumoconiosis' among the knowledge areas questioned; reported low self-efficacy with respect to managing miners' conditions and interpreting test results; and rated the learning community highly in terms of trust (86%), willingness to help each other (93%) and being closely knit (87%). Analysis of knowledge sources indicated that participants receive substantial proportions of knowledge from individuals outside of their stakeholder and professional groups, but proportions differ among clinical and non-clinical professional groups, as well as among 'fresh' and existing participants. The present study demonstrates the successful creation of a virtual multidisciplinary community of practice in pneumoconiosis mortality hotspot rural regions of the USA, with participants reporting multidisciplinary knowledge transfer. The community is regarded highly by participants in relation to trust, willingness to help and being closely knit. This innovative educational approach may help ensure the delivery of high-quality interdisciplinary care to rural miners in pneumoconiosis mortality hotspots in the USA.

The expert meeting: review of survey data provided by lawyers and medicolegal experts

AvMA undertook the survey in order to examine whether Rule 35 of the Civil Procedure Rules that governs expert meetings was operating effectively. The survey was initially restricted to Claimant lawyers as this is the group that AvMA has most contact and dealings with. However, the survey was subsequently expanded to include some Defendant lawyers as well as medicolegal experts themselves. The scope of the study was to look at issues arising from the expert meeting. Although the survey referred to the expert ‘meeting’, in practice, many discussions between experts take place without the experts meeting at all. The term ‘expert meeting’ was to encompass all forms of discussions between experts. This paper presents a review of the survey returns with particular emphasis placed on problems encountered in the context of the expert meeting. The level of response to the survey from Claimant lawyers was higher than AvMA expected. The response to the survey from Defendant lawyers is less than would be needed for the claims to be considered representative of Defendant lawyers in general. For resource reasons surveys to medicolegal experts were restricted to those for whom AvMA already had e-mail details. This limited the scope of potential medicolegal expert responses. Notwithstanding this, general themes have been picked out throughout this study that AvMA regards as indicative of feelings within both the legal and clinical professional groups. The main findings were as follows: It is rare for lawyers to attend expert meetings; The majority of Claimant lawyers (72%) believe that lawyers should be present at the expert meeting. This contrasted with 33% of experts believing that lawyers should be present and with only 20% of Defendant lawyers agreeing. Less than 2% of Claimant lawyers attend an expert meeting. Less than 60% had ever attended an expert meeting; Less than 50% of lawyers had ever made an application to court in order to be present at an expert meeting; Ninety-eight percent of Claimant respondents reported difficulties in getting Defendant lawyers or the court to permit the presence of lawyers.

Attainment of competency in management and leadership

PurposeThe purpose of this paper is to provide a summary of a research and consultation project being undertaken by the NHS Institute for Innovation and Improvement and The Academy of Medical Royal Colleges to develop an integrated medical management and leadership competency framework. This will apply to all doctors in training at undergraduate and postgraduate levels and post‐registration.Design/methodology/approachA literature review and consultation approach has been adopted. By interviewing appropriate stakeholders from medical professional, educational, service and regulatory bodies, a high level of awareness and engagement has been realised. This should pay dividends at the implementation phase.FindingsWhilst some management and leadership is included within current curricula, it is highly variable both in terms of its coverage and relevance. At undergraduate level, it is often covered within professional development modules. At postgraduate level, some exciting initiatives are offered for some doctors but no integrated, systematic and coherent framework exists. Findings from the research are influencing the design and content of the emerging competency framework.Research limitations/implicationsThe approach used has provided a good range of information however, neither an exhaustive set of views or a full literature review has been obtained.Practical implicationsIntroduction of the Medical Leadership Competency Framework will have a significant impact on how doctors are trained. To be deemed an effective and safe doctor in the future, competence in both clinical and wider non‐clinical competences including management and leadership will be required.Originality/valueThis paper will raise awareness of this important initiative and offer a methodology for other clinical professional groups, nationally and internationally.

The Contribution of the Commercial Sector to Tissue Viability

Tissue viability is typically presented as an area of health care which best achieves successful results through multi professional collaboration. The contributions of the different academic and clinical professional groups, and of their constituent specialities, to tissue viability, are beginning to be stated explicitly 1 • 2 • 3 • This article presents a strictly personal view of the contribution of the commercial sector to tissue viability. Clearly I cannot claim to represent each of the thousands of individuals who work to develop and offer new technologies to assist wound healing. Perhaps, for many, the contribution of the commercial sector begins, and ends, with the availability of products. The past decade has witnessed the rapid growth of new products with each promoted as an effective solution to differing tissue viability problems. While the increased range of interventions is an obvious contribution of the commercial sector to the field of tissue viability, the value of many of these new technologies is open to question. For example, while at least 200 different forms of pressure-redistributing mattress are commercially available, only 30 randomised controlled trials comparing the efficacy of such devices are available in the literature 4 with the majority of these investigations reported to exhibit significant methodological flaws. The provision of data to support claims of efficacy is a key responsibility of the commercial sector. Given this responsibility manufacturers, through their funding of investigations, can make a strong contribution to the development of the evidence base which underpins tissue viability. However, for such a contribution to be fully achieved, the credibility of commercially funded research must be enhanced. Bero and Rennie 5 recently reviewed the quality of published studies which had been funded by the pharmaceutical industry. This review highlighted that these publications were often seriously flawed, with three key weaknesses noted; negative results were frequently not published, the funder controlled the content of the publication with articles published without peer-review. Research into wound prevention and healing, which frequently derives its funding from product manufacturers, will continue to be viewed with caution unless the tissue viability community works together to enhance the credibility of studies funded by industry. Bero and Rennie 5 offered a number of initiatives which would improve the credibility of industry funded research. Fundamental to this process was the recommendation that 'companies commit themselves to submitting for publication every study that is undertaken, regardless of the findings'. This commitment to publication could, according to Bero and Rennie, be monitored through the implementation of a register of new studies. Perhaps the development and maintenance of such a register could be one future activity for the Tissue Viability Society? The commercial sector has a major role to play in the generation of new evidence but this contribution will flower best when industry, researchers, and journal editors take responsibility for the quality of studies that are published 5 •