Continuity Of Care For Patients Research Articles

Role of virtual modality for stroke caregivers in facilitating stroke survivors and assessing their perceptions in the midst of COVID-19 pandemic: A short review

Background Stroke survivors become either partially or completely dependent on their family members for assistance. Furthermore, the COVID-19 pandemic has created a new set of challenges for caregiving, due to government-imposed lockdowns. In the current crisis, the crucial role of virtual modality in stroke caregiving can no longer be ignored. Therefore, this review aims to report the utilization of virtual modality to facilitate stroke caregivers in delivering care to stroke survivors in this pandemic. Moreover, it will also assess the perceptions of stroke caregivers in managing stroke survivors during pandemic. Methods An electronic search was carried out between 1 December 2019 to 31 March 2022 to explore the role of virtual platforms to assess stroke caregivers’ perceptions and the use of a distant medium in managing stroke survivors’ care in the COVID-19 era by using four electronic data bases that includes PubMed, CINAHL Plus, Science Direct, and Cochrane. Results The COVID-19 pandemic has undoubtedly complicated the stroke caregiver’s life and their ability to deliver care. Therefore, utilizing virtual medium serves as a unique supplemental resource in warranting patient care continuity. The current review provides evidence for the integration of distant modality in facilitating stroke caregivers to manage stroke survivors and it also assesses their perception during pandemic. Conclusion The current review provides limited but encouraging data that promotes the efficacy of virtual models in healthcare. It was identified that distant healthcare services are suitable and accessible for the provision of care to the community of stroke caregivers during this pandemic.

Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis.

Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi-directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and-in turn-acute cerebral injury may induce or aggravate HF via imbalanced neural and neurovegetative control of cardiovascular regulation. The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiological interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiological mechanisms, complications, clinical management in acute conditions and in long-term care of patients with the comorbidity are presented and state-of-the-art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account. Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long-term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of HF and stroke.

Application of the SBAR-SAER technique by the nursing professional

The present study analyzed the application of the SBAR-SAER technique by nursing professionals. This was a quantitative, descriptive, and cross-sectional investigation with a non-probabilistic sample. They were applied to 154 nursing professionals from a hospital in Ambato, Ecuador. The main results show that most nursing professionals know this method for transferring information between professionals in charge of the continuity of patient care. In addition, several factors were identified for using this tool, such as patient safety, effectiveness, and ease of communication. Finally, there is a high rate of SBAR-SAER application among the hospital's nursing professionals.

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis.

The United Kingdom (UK) has a sustainable healthcare system. Nonetheless, the burden of acute coronary syndrome (ACS) is still a significant challenge. A scarcity of literature primarily focuses on the continuum of care for ACS patients in the UK. Moreover, limited research studies highlight the clinical trajectories of ACS patients across the UK. Therefore, the current study was designed to explore clinical trajectories and the continuum of care for patients with ACS in the UK. Secondary data was obtained from the Myocardial Ischaemia National Audit Project (MINAP) database. The latest data available in the MINAP database was used. As our objective was to explore clinical trajectories and the continuum of care for patients, we retrieved data regarding the care received by ACS patients admitted to hospitals across the UK. The data of 85574 ACS patients was retrieved. A large number (n=47035) of patients were estimated to be eligible for the angiogram; however, an angiogram was performed for 87.15% (n=40995) of eligible patients. Angioplasty within 72 hours of admission was required for most (n=26313) ACS patients. Nonetheless, angioplasty within 72 hours of admission was performed for 59.7% (n=15703) of the eligible patients. There was a significant difference (P<0.05) between different regions of the UK and the percentage of patients for whom angioplasty was performed within 72 hours of admission. Primary percutaneous coronary intervention (PCI) was performed for 23923 ACS patients, of which the door-to-balloon interval for 17590 (73.5%) patients was ≤60 minutes while the door-to-balloon interval for 3086 (12.9%) patients was ≤90 minutes. Out of the total 85574 ACS patients, 65959 (77.08%) patients were discharged on appropriate medications, while 19615 (22.92%) were transferred to another hospital or died there. A total of 75361 were eligible to be referred to cardiac rehabilitation settings. Nonetheless, 64518 (85.61%) were referred to cardiac rehabilitation. About 85000 patients were reported in the UK (England, Northern Ireland, Wales). Optimal care was provided to most patients in the UK. However, some patients received sub-optimal care, highlighting the disparity in the healthcare system. There is a need to explore further the factors that might be responsible for the sub-optimal care to the patients.

Epidemiology of Neuroendocrine Neoplasms and Results of Their Treatment with [177Lu]Lu-DOTA-TATE or [177Lu]Lu-DOTA-TATE and [90Y]Y-DOTA-TATE-A Six-Year Experience in High-Reference Polish Neuroendocrine Neoplasm Center.

Neuroendocrine neoplasms (NENs) are a group of neoplasms arising from neuroendocrine cells. The worldwide incidence and prevalence of the NENs are estimated to be 6/100,000 and 35/100,000, respectively. Those numbers are increasing every decade, requiring higher and higher diagnosis and treatment costs. Radioligand therapy (RLT) using beta-emitting radioisotopes is an efficient and relatively safe method of treatment, typically used as a second-line treatment. RLT tolerability is higher than other available pharmacotherapies (chemotherapy or tyrosine kinase inhibitors). Recent studies show an increase in overall survival among patients treated with RLT. The present study aimed to learn the epidemiology of NENs in Poland and assess the effectiveness of RLT in a high-reference center. A prospective analysis of 167 patients treated with RLT in one of Poland's highest-reference NEN centers was performed. The analysis covered 66 months of observation (1 December 2017-30 May 2023), during which 479 RLT single administrations of radioisotope were given. The standard procedure was to give four courses of [177Lu]Lu-DOTA-TATE alone, or tandem therapy-[177Lu]Lu-DOTA-TATE and [90Y]Y-DOTA-TATE. Grading analysis showed that most patients had non-functioning G2 NEN with a mean Ki-67 of 6.05% (SD ± 6.41). The most common primary tumor location was the pancreas. Over two-thirds of patients did undergo surgery due to primary tumors or distant metastases. The majority of patients were using lanreotide as a chronically injected somatostatin analog. Median progression-free survival (PFS) on somatostatin analogs was 21.0 (IQR = 29.0) months. Directly after the last course of RLT, disease stabilization was noted in 69.46% of patients, partial regression was noted in 20.36% of patients, complete regression was noted in 0.60% of patients, and progression was noted in 9.58% of patients. In long-term follow-up, the median observation time among patients who underwent four treatment cycles (n = 108) was 29.8 (IQR = 23.9) months. Stabilization of the disease was observed in 55.56% of the patients and progression was observed in 26.85% of the patients, while 17.59% of patients died. Median PFS was 29.3 (IQR 23.9), and the median OS was 34.0 months (IQR 16.0). The mean age of NEN diagnosis is the sixth decade of life. It takes almost three years from NEN diagnosis to the start of RLT. In long-term observation, RLT leads to disease stabilization in over half of the patients with progressive disease. No differences in PFS or OS depend on the radioisotope used for RLT. In Poland, organized coordination of NEN treatment in high-reference centers ensures the continuity of patient care.

French mental health care system: Analysis of care utilisation patterns and the case for a stepped care approach

ContextIn France, spending on mental health and psychiatric care, in proportion to GDP, is close to the EU average. However, there are complaints that the French system is overwhelmed and potentially underfunded. ObjectiveTo describe the utilisation of psychiatric and mental health care in different settings to consider the appropriateness of care provision and resource allocation. MethodsFor the year 2018, several national databases on the use of all type of psychiatric care provision (full and part-time hospitalisations, private and public, public ambulatory care, private office-based psychiatrists) were cross-tabulated with diagnosis categories for different age groups and illness severity in order to assess the use of resources and evaluate the appropriateness of resource allocation. ResultsA sizable proportion of patients with mild and moderate mental disorders are treated in psychiatric care whilst there is insufficient continuity of care for patients with severe disorders, who are not adequately followed up after discharge from hospitals. This contributes to increase the rate of re-hospitalisations, the use of emergency departments, and longer stays in hospitals. ConclusionThe several components of the French mental health care system are used inappropriately, not only in geographical terms but also in terms of service use. We argue that strengthening the access to affordable psychotherapy and the implementation of a stepped-care approach could contribute to solve this issue.

Lean and Safety Management: a Project to Improve the Continuity of Care for Chronic Patients

Enhancing the quality of care for chronic patients means guaranteeing the delivery of integrated care. Integrated health systems help overcome the fragmentation of care processes, by bridging the organisational, managerial, and informational gaps, with the final purpose of improving the access, quality, and continuity of services. Indeed, chronic patients require the assistance of multiple providers, referring to different levels of care (primary, secondary, or tertiary). However, hyper-specialised and fragmented healthcare systems hamper the achievement of these goals, resulting in suboptimal care, higher cost, and poor quality of care. The implementation of lean and safety management (L&amp;SM) within hospitals demonstrated its ability to improve efficiency, effectiveness, and patient satisfaction, through proactive identification and reduction of risks and wastes. The novelty lies in adopting this approach to act on integration and continuity between different levels of care. With this aim, a L&amp;SM project has been developed in a Spanish hospital. The project focuses on improving the discharge process from internal medicine to primary care, essential to prevent further patients’ readmissions. In fact, cooperation between the hospital and primary care is crucial to ensure continuity in chronic pathways, providing adequate assistance to patients’ healthcare and social needs. The first results show how this approach was instrumental to engage in the project all key actors involved in the pathways, overcoming departmental barriers, and enhancing continuity of care. Moreover, this approach facilitated the convergence of identified inefficiencies with the clinicians’ interests, focusing only on the aspects considered of primary importance, such as the communication between the hospital and primary care. The expected outcomes encompass the achievement of a better understanding of the process, the identification of the criticalities in terms of risks and waste, the proposal and implementation of improvement interventions. This project represents an innovative attempt to implement L&amp;SM outside of hospital boundaries to improve new performance dimensions, focusing on integration and continuity of care.

Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity – a cross-sectional study

Abstract Background To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. Methods Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. Participants Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. Primary outcome measures In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. Results Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. Conclusions Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.

Evaluation of patients engagement with a digital intervention for daily disease management in pulmonary arterial hypertension

Abstract Introduction Pulmonary arterial hypertension (PAH) is a chronic rare disease with a complex treatment that affects the daily life of patients and requires ongoing monitoring and assessment. In comparison with other chronic diseases, the application of digital health approaches to address patients’ needs in disease self-management has not been comprehensively studied [1], [2]. Within the framework of a clinical study, PAH patients’ engagement level and adherence to using a digital health platform have been studied. The platform allows patients to log health and lifestyle information while also providing structured content for patient education, medication reminders, and lifestyle coaching from a remote HC. Purpose The study aimed to measure the impact of the use of the platform on the Health-Related Quality of Life of the patients (HRQoL) and other clinical endpoints (patient’s functional status, signs and symptoms of PAH, patient costs and healthcare resource utilization) and also to assess patients’ engagement and satisfaction with the use of the platform. Method 53 PAH patients enrolled in a prospective, single cohort, multicentre study [3] from 5 specialized PAH units of reference public Spanish hospitals. The duration of the study was 6 months and to avoid interferences with routine clinical practice, clinical investigation visits matched the clinical guidelines for PAH patients in Spain, which recommend scheduling monitoring visits every 3-6 months. Questionnaires were administered to assess the QoL and satisfaction and for assessing the engagement levels, the app usage data has been analysed. Results Regarding the impact of platform usage for 6 months on the HRQoL and clinical endpoints of PAH patients, no statistically significant changes have been observed. However, as per the engagement, patients showed a great interest in using the app and connecting to the Health Coach (HC). More than 45% of patients finished 2 out of 4 levels of the structured educational content, 96.1% of patients used the activity logging feature. Over 79% of patients visited the app monthly and on average, the app was launched 1500 times per month. The communication between the patients and HC was steady during the study, another indication of adherence to the program. As per user experience, the overall outcomes of the questionnaire showed that 84.2% of patients considered that their needs have been met suggesting that the purpose of the program is well addressed. Additionally, 92.1% of patients were satisfied with the program and would use it again. Moreover, 94.7% of patients expressed that they would recommend the program to a PAH patient. Conclusion Elevated satisfaction and engagement levels of patients demonstrate that the digital intervention is useful for the patients and supports companionship and knowledge. In this context, the development of digital solutions provides opportunities to ensure continuous PAH patient care and patient empowerment.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Doctors' pay in the United Kingdom: evaluating the broader impacts of change.

The United Kingdom's National Health Service (NHS) faces a mounting workforce crisis, with compensation being a focal point of discontent. This editorial explores the real-term erosion of doctors' salaries in the UK, using the Retail Price Index as a more comprehensive measure of inflation. Comparisons with international standards reveal significant disparities, contributing to the emigration of medical talent. The NHS's increased reliance on agency locum doctors poses financial strain and affects continuity of patient care. Economic considerations debunk common counterarguments against pay restoration, emphasising the broader implications for healthcare delivery and societal well-being. The editorial concludes by advocating for policy measures to address this pay disparity as both an economic imperative and a strategic necessity to sustain the NHS.

Primary Care Behavioral Health in Sweden – a protocol of a cluster randomized trial evaluating outcomes related to implementation, organization, and patients (KAIROS)

BackgroundProviding comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavioral Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated.MethodsThis cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity.DiscussionA randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere.Trial registrationClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.

Analisis Pelaksanaan Komunikasi Efektif SBAR Perawat dan Dokter

The aim of this research is to map research results related to the implementation of effective SBAR communication between nurses and doctors. The research method used, namely Scoping Review, was used to map the literature using PRISMA guidelines. The synthesis method uses PCC modification. Articles obtained from the Google Scholar search engine as well as the electronic databases PubMed and ScienceDirect. Search results, from 87 relevant articles with titles and abstracts, 6 articles were found that met the inclusion and exclusion criteria. The research results found that the analysis of the implementation of effective SBAR communication between nurses and doctors contained seven themes, namely patient safety and satisfaction, lack of self-confidence, environment, lack of interpersonal communication, lack of training, and work safety climate. In conclusion, effective communication and collaboration between doctors and nurses is very necessary in managing and limiting disturbances that can endanger patient safety and the continuity of safe care for at-risk patients.&#x0D; &#x0D; Keywords: Implementation Analysis, Effective Communication, SBAR

A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland

BackgroundIn May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored.MethodsTo gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person’s care, and disability services. Thematic Analysis was applied to the data to identify key themes.ResultsThe impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic.ConclusionsLimited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised.

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice

ObjectivesAlbeit treatable, metastatic breast cancer (MBC) remains incurable. To achieve remaining life years lived well, extended survival should be balanced with optimal health-related quality of life (HRQoL) and timely initiated supportive, palliative, and end-of-life care. The Advanced Breast Cancer (ABC) Global Alliance identified 10 urgent and actionable goals for the decade between 2015 and 2025 to achieve substantial improvement in the lives of patients living with ABC, including MBC. Enhancements are needed for HRQoL, research, quality of care, and survival. We explore the potential of patient-reported outcome measures (PROMs) in addressing these gaps and aim to describe opportunities and current initiatives for improving the MBC care continuum through PROMs. Data sourcesNarrative description of recent literature on MBC and PROMs. ConclusionWe believe PROMs can make valuable contributions to seven of the 10 goals described: 1) enhancing the understanding of MBC through high-quality data collection, 2) improving HRQoL and raising consideration of survival versus HRQoL, 2) prolonging survival, 4) increasing referral to nonclinical support services, 5) supporting patient–healthcare provider communication, 6) encouraging improvements in healthcare access, and 7) supporting meeting patients’ informational needs. Implications for Nursing PracticeMaximizing the benefits of PROMs requires effective implementation. Because nurses and nurse practitioners are at the forefront of care, they can offer a comprehensive understanding of patients’ needs and play a crucial role in facilitating the integration of PROMs into routine care for MBC patients and ultimately optimizing patients’ outcomes and life years and months left.

Improving weekend handover in a teaching hospital elective general surgery department.

Effective documentation and transfer of clinical information are vital for the continuity of care, patient safety, and maintaining medico-legal records, as outlined by the Royal College of Surgeons "Safe Handover: Guidance from the Working Time Directive working party". Our elective surgery weekend team cross-covers both Colorectal and Upper Gastrointestinal surgical specialties across multiple wards, which poses a significant challenge. The aim of this study was to improve the documentation of patients' weekend plans through the introduction of a weekend handover proforma. We reviewed the weekend plans of 199 patients overall. 41 records were initially reviewed over a 2-week period. The surgical multidisciplinary team was then surveyed to establish the need for an improved weekend handover. Following this, a weekend handover proforma was introduced as part of the Friday ward round and education on the expectations were provided at a local Surgery Clinical Governance meeting. The documentation of the weekend plan was reviewed for 158 patients over a 6-week period and a post-intervention survey was disseminated. The preliminary survey highlighted concerns for delayed discharges and patient safety over the weekend, with 88.2% of respondents agreeing a weekend handover proforma would be beneficial. The initial data confirmed inadequate documentation of diagnosis (19.5%), operation/procedure (28.1%), and weekend plans for blood tests (19.5%), discharge planning (2.4%), diet (46.3%), antibiotics (19.5%), intravenous (IV) fluids (22.0%), mobility (19.5%) and drain/wound care (37.5%). After education and implementing a weekend handover proforma, these results increased for documentation of diagnosis (61.2%), operation/procedure (83.2%), blood tests (59.7%), and discharge planning (85.8%). However, there was little improvement in diet (53.0%) and no improvement in the weekend plans for antibiotics (14.2%), IV fluids (17.2%), mobility (14.9%) and drain/wound care (20.2%). The post-intervention survey showed an improvement across all areas, notably continuity of care and patient safety, with 95.5% of individuals finding the weekend handover proforma aided in patient care over the weekend. Education of the ward team and implementation of a weekend handover proforma resulted in a marked improvement in the documentation of patients' weekend plans, which is essential to ensure the continuation of safe and effective patient care.

Benefits and challenges of adopting Electronic Medical Records in Nigerian Federal Capital Territory Hospitals-lessons learned

Electronic Medical Records (EMR) is a digital version of paper-based medical records designed to enhance patient outcomes. EMR in the healthcare system is fundamental to the continuity of patient care and the improvement of quality services. However, the lack of adequate and sustainable funding for health system utilization remains a significant challenge to the successful adoption of EMR. This study aims to identify the benefits and challenges associated with the adoption of Electronic Medical Records in the Federal Capital Territory (FCT) Hospitals in Abuja, Nigeria. A qualitative research method was employed to examine the benefits and challenges of adopting EMR in FCT hospitals. Questionnaires were administered to 310 participants, and collected data were analyzed using a thematic approach. The implementation of Electronic Medical Records (EMR) in FCT hospitals led to better healthcare services such as prompt tracking of patients’ records, and reduced costs associated with repetitive medical tests arising from the loss of patient files. Despite these benefits, a lack of sustainable funding and inadequate infrastructure technology were identified as major obstacles to the successful adoption of EMR in FCT hospitals. To ensure the continued use of EMR in FCT hospitals, it is essential to maintain efficient governance and regulation alongside upgrading the hospitals’ Information Communication Technology (ICT) infrastructures.

A multisectoral and multidisciplinary endeavor: a review of diabetes self-management apps in China

BackgroundWhile the use of self-management apps has considerable promise to efficiently reduce the diabetes burden that disproportionally affects low- and middle-income countries (LMICs), and the multisectoral and multidisciplinary approaches have been encouraged to be used in diabetes management, little is known about the status of the integration of these approaches in the existing diabetes self-management apps. This review examines the diabetes apps in China as an indication of the current status of integrating multisectoral and multidisciplinary approaches in diabetes mHealth care in LMICs. MethodsEligible diabetes apps were searched on major Chinese app stores up to December 23, 2022. The app comprehensiveness index (ranging 0–80) regarding the app functions and diabetes management domains was created. The multisectoral and multidisciplinary features were summarized using indices derived from current guidance. ResultsSixty-six apps were reviewed, all developed by private companies. The average comprehensiveness score was 16, with many major self-management domains and functions not represented among the reviewed apps. Forty apps (61%) involved multiple sectoral entities, with public/private and private/private collaborations being the most common collaborative combinations. Thirty-seven apps (56%) involved multiple disciplines, among which endocrinology/metabolism, nutrition, and cardiovascular medicine were the top three most common disciplines. Compared to non-multidisciplinary apps, multidisciplinary apps tended to provide more comprehensive services in apps (6.14 vs. 5.18, p = 0.0345). Different sectors and disciplines tended to work independently, without robust interactions, in providing diabetes management services in the reviewed apps.ConclusionMultisectoral and multidisciplinary features has presented in the current diabetes self-management apps in China; however, it is still in its infancy and significant limitations existed. More engagement of civil society organizations and community groups and innovative collaborations between sectors and disciplines are needed to provide comprehensive, continuous, and patient-centered mHealth care for patients with diabetes in LMICs like China. Clear guidance for integrating and evaluating the multisectoral and multidisciplinary efforts in self-management apps is necessary to ensure the effective use of mHealth solutions for diabetes management in LMICs.

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care.

Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.

Obstetric anaesthesiology: manpower and service provision issues in India

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.