Filling Rate Research Articles

Improvement and Experimental Explore on Coordinated Control of Kinematic Mechanism of FDM 3D Printer

As the main component of the 3D printing industry, the fused deposition process covers all aspects of the industry with its advantages of low R&D investment, high practicability, and open source programs. However, due to process problems, problems have arisen in terms of printing efficiency and molding quality. To this end, we designed a large-scale multinozzle FDM printing device using the high-current fused deposition (FDM) printing principle. The defects of small size, slow printing speed, and low precision are deeply studied, and the machine structure is optimized according to the structural strength analysis. In this paper, the theoretical design and static analysis of the overall mechanical part of the large-scale FDM device are carried out, and then, the selection of the movement organization structure and movement method is theoretically analyzed. A modular flow chart is designed for the control system to coordinate and control the parallel and precise operation of multiple nozzles, and the relationship function between the main controller, power driver, and heating module is designed. By modifying the firmware parameter command, we can find out the optimal method running on the platform and discuss the function usage of the slicing software in detail. According to the current problems of FDM printing equipment, various factors affecting printing speed were analyzed from the perspective of printing accuracy, and the process parameters of 3D printer were studied through orthogonal experiments. Speed, nozzle temperature, idling speed, and fill rate were studied, and the relationship between factors affecting printing speed and printing accuracy was obtained. Use a simple model print to measure the overall performance of your product. The stability of the system is verified by short-term and long-term printing tests. The analysis results show that the forming performance and stability of the large-scale FDM are improved significantly.

Effect of photoperiod on live performance in broiler chicks from placement to 14-days-of-age

Lighting programs for broilers have traditionally employed continuous or near-continuous photoperiods through the first week of life to ensure chicks can successfully navigate the rearing environment for feed and water. Normal melatonin production and ocular development require a minimum of 4 h of darkness, yet photoperiod research in broilers has not typically examined the first week. This study examines the effect of a longer dark phase (scotophase) applied during the first 7 d post-hatch on live performance. A total of 384 Ross 708 broiler chickens were reared in 2 trials to 14 d of age using 2 different lighting program treatments (20L:4D vs. 23L:1D) applied from day-of-hatch. No significant differences were observed between treatment groups for live performance parameters including body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR). Crop fill rates were also assessed, and no significant differences were observed. Increased scotophase length may be implemented as early as day-of-hatch without any compromise in performance.

The Impact of Committing to Customer Orders in Online Retail

Problem definition: Online retailers are on a consistent drive to increase on-time delivery and reduce customer lead time. However, in reality, an increasing share of consumers places orders early. Academic/practical relevance: Such advance demand information can be deployed strategically to reduce costs and improve the customer service experience. This requires inventory and allocation policies that make optimal use of this information and that induce consumers to place their orders early. An increasing number of online retailers not only offer customers a choice of lead time but also, actively back-order missing items from a consumer basket. Methodology: We develop new allocation policies that commit to a customer order upon arrival of the order rather than at the moment the order is due. We provide analytical results for the performance of these allocation policies and evaluate their behavior with real data from a large food retailer. Results: Our policy leads to a higher fill rate at the expense of a slight increase in average delay. The analysis based on real-life data suggests a sizeable impact that should impact current best practices in online retail. Managerial implications: With the changing landscape in online retail, customers increasingly place baskets of orders that they would like to receive at a planned and confirmed moment in time. Especially in grocery, this has grown fast. This fundamentally changes the strategic management of inventory. We demonstrate that online retailers should commit early to customer orders to enhance the customer service experience and eventually, to also create opportunities for reducing the cost of operations. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.1124 .

Optimal operational service levels in vendor managed inventory contracts - an exact approach

Vendor Managed Inventory (VMI) contracts are anchored on a fill rate at which the vendor is expected to meet the end-customer demand. Violations of this contracted fill rate due to excess and insufficient inventory are both penalized, often in a linear, but asymmetric manner. To minimize these costs, the vendor needs to maintain an operational fill rate that is different from the contracted fill rate. We model, analyze and solve an optimization problem that determines this operational fill rate and the associated optimal inventory decision. We establish that, for some special, yet popular, models of demand (e.g. truncated normal, gamma, Weibull and uniform distributions), the optimal solution can be derived in closed form and computed precisely. For other demand distributions, either the optimization problem becomes ill-defined or we may need to use approximate solution methods. An extensive computational study reveals that, for realistic values of problem parameters, the operational fill rate is often larger (by as much as 20%) than the contracted service level, possibly explaining the inventory glut commonly observed in real-world VMI systems.

Effects of pre-programmed 4D printing process parameters on the shape memory performance of polyurethane

4D printing technology endows printed samples with self-driven performance that increasingly show strong application prospects. Polyurethane, as a typical shape memory polymer, is widely used in 4D printing. Current researches on 4D printed polyurethane materials are focused on investigating polyurethane composites or novel printing techniques to optimize the shape memory properties of the printed samples. In this study, the effects of pre-programmed 4D printing process parameters on the shape memory properties of polyurethane were systematically investigated. The higher printing speed, higher printing temperature, and lower fill rate result in faster response time of the biomimetic samples with thermal stimulation. Based on the programming of process parameters (e.g., printing temperature, printing speed and filling rate), the biomimetic flowers and hands were processed to achieve a controlled behavior of sequential deformation. It was successfully achieved that only one printing material could demonstrate the shape memory effects with a sequential response process. The adjustable sequential deformations further enlighten the application of 4D printing technology in specific engineering fields such as aerospace, biomedicine, robot and military engineering, where parts must undergo a sequence of deformations to serve practical requirements.

Analysis of refilling late appointment cancellations in an outpatient practice at a community-based health system

Mayo Clinic Health System — Southwest Minnesota Region, one of four practice regions in the Midwest, provides primary and speciality care in ambulatory, procedural and hospital settings. Clinic appointment fill rates, no-show rates and late cancellation rates are closely monitored operational metrics, but at the time this study began, less was known about the refill rates of late appointment cancellations. This metric is of importance because these unfilled appointment times contribute to increased expenses for healthcare organisations, unnecessary delays in care and decreases in revenue. The main objectives of this study were to understand the current state and potential opportunities for refilling late cancellations. Qualitative and quantitative methods were used, including variance analysis, the Tukey post hoc test, Pareto analysis, the completion of interviews with important stakeholders and data extraction from the institution’s electronic health record. Findings showed that late cancellation rates remained steady in 2021 and that late cancellations were not being refilled consistently across departments and regions. Appointment refill rates were higher in departments with few or no requirements for preparatory evaluation, whereas in specialties that did require preparatory evaluations, refill rates were lower across the four regions of the Mayo Clinic Health System. Even in departments with high demand, the refill rates were lower, resulting in missed opportunities for patient visits. Mapping the workflow for late cancellations indicated inconsistent methods for refilling late cancellation openings and the lack of a defined process for refilling them that was understood by the entire care team. The logistics of optimising refill rates for late cancellations were affected by provider preference, selfscheduling functionality and appointment requirements. This study identified opportunities for optimising workflows to use the waiting list proactively to refill late cancellations.

New prescription fills of selective serotonin reuptake inhibitors before and during the COVID-19 pandemic in Los Angeles County, California

ObjectiveThis study examined whether the COVID-19 pandemic was associated with changes in new selective serotonin reuptake inhibitor (SSRI) prescription fills. MethodsUsing IQVIA Xponent data on new SSRI fills in Los Angeles (L.A.) County from March 2019 to June 2021, the authors implemented an interrupted time series analysis comparing the monthly volume and trend of overall fills and fills by age and gender from before to after the pandemic declaration. ResultsThe rate of new SSRI prescription fills briefly decreased after the pandemic declaration but then consistently increased through the rest of the study period. These increases were primarily driven by women, young adults (i.e., 18–39 year-olds), and those under 18 years old. LimitationsSample is limited to one county and may not be generalizable to other municipalities. ConclusionsThe COVID-19 pandemic was associated with significant increases in new SSRI fills among women, young adults, and those under 18. These increases were relatively small compared to increases in depressive symptoms during the same time period.

Middle Miocene faulting and basin evolution during central Basin and Range extension: A detailed record from the upper Horse Spring Formation and red sandstone unit, Lake Mead region, Nevada, USA

AbstractMiocene basins of the Lake Mead region (southwestern United States) contain a well-exposed record of rifting and the evolving paleogeography of the eastern central Basin and Range. The middle Miocene Horse Spring Formation and red sandstone unit allow for detailed stratigraphic, chronostratigraphic, and structural analysis for better understanding the geologic history of extension in this region. We present new data from the White Basin and Lovell Wash areas (Nevada) to interpret the evolution of faulting, basin fill, and paleogeography. We conclude that tectonics strongly influenced sedimentation and hypothesize that climate may have played a secondary but important role in creating stratigraphic variations. Deposited from 14.5 to 13.86 Ma, the microbialitic Bitter Ridge Limestone Member of the Horse Spring Formation, the stratigraphically lowest unit in this study, records a widespread shallow and uniform lake which had moderate and steady sedimentation rates, both of which were controlled by a few faults. The persistent lake was broken up by fault reorganization followed by deposition of the highly variable fluvial-lacustrine facies of the Lovell Wash Member from 13.86 to 12.7 Ma. During this time, faulting shifted from the northeast-trending, oblique normal left-lateral White Basin fault to the northwest-trending, normal Muddy Peak fault and other smaller northwest-trending faults. The lower and middle portions of the red sandstone unit, 12.7–11.4 Ma, record an increase in the sedimentation rate of basin fill near the Muddy Peak fault as well as the return to widespread lacustrine conditions. Sedimentation and faulting slowed during deposition of the uppermost red sandstone unit, but some deformation occurred post–11.4 Ma. This study records basin-fill evolution including variations in depositional environments laterally and vertically, documents changes in the location and magnitude of faulting, supports earlier work that hypothesized faulting proceeded in discrete westward steps across the Lake Mead area, and helps constrain the paleogeographic and tectonic evolution of the region.

Controlling inventories in omni/multi-channel distribution systems with variable customer order-sizes

The fast growth of e-commerce and omni/multi-channel retailing brings new challenges for efficient inventory management. One such challenge concerns service differentiation across channels when upstream central warehouses satisfy both direct customer demand and replenishment orders from downstream retailers. Motivated by industry collaboration, we address this issue by developing a combined stock method for control of one-warehouse-multiple-retailer inventory systems with direct customer demand at the central warehouse. The combined stock method, used for service differentiation at the central warehouse, may be described as a critical level policy. The computationally efficient heuristics we present are designed to deal with real-life one warehouse multiple retailer inventory systems characterized by highly variable customer order-sizes, (R,Q) policies at all stock points, and fill rate constraints. A numerical study, including real data from two different companies, illustrates that the heuristics perform well; offering near optimal solutions close to target fill rates, with significant opportunities to reduce total inventory costs compared to existing methods.

Effect of modeling parameters on the mechanical response of macroscopic crushing of agglomerate

The discrete element method is widely used in agricultural engineering and is especially for analyzing the crushing of agricultural materials. However, research on agglomerate mode parameters is relatively limited. Therefore, it is necessary to investigate the impact of agglomeration model parameters on the macroscopic mechanical reaction of crushing. In this paper, agglomerate models of corn kernels were built based on the Bonded Particle Model, and the crushing behavior of the agglomerate was simulated by the compression test. The results show that the particle filling method, particle size, and particle bonding contact radius all have a significant impact on the network force chain structure within the agglomerate, which affects the mechanical properties of the agglomerate. There is a DoseResp function relationship between the average coordination number of particles and the crushing resistance of agglomerates. The research results can provide some theory references for constructing the agglomerate model. • Models of corn kernel agglomerates with different modeling methods based on BPM. • The effect of model parameters on agglomerate mechanical properties. • The effect of fill rate and bonded radius on the average coordination number. • Effect of average coordination number on the crushing resistance of agglomerates. • A relationship between the average coordination number and the bond's intact rate.

The added value of advance demand information for the planning of a repair kit

In this paper the repair kit problem is studied, where technicians have to visit several customers to repair broken appliances (such as copiers or heating systems) and they can only take a limited set of parts with them (called the repair kit). In this problem, it has to be decided which spare parts to include in the repair kit. We consider a version of this problem in which partial advance demand information is available. That means we divide the set of parts into two subsets, where the condition of parts in one subset is monitored by sensors. In case an appliance fails and a repair job is requested by a customer the service provider is able to access this sensor data before a technician visits the customer. For this setting, we derive an expression for the job fill rate, which is used as a constraint in the optimization model, where holding and replenishment costs are minimized. We use a greedy heuristic to determine near-optimal repair kits. In a numerical study, we find that integrating advance demand information yields substantial cost savings. In order to find out for which parts having advance demand information is most valuable, we examine the effect of parts’ demand probabilities and their prices. We find that monitoring parts that are expensive and likely to fail leads to the largest cost savings. In particular, the price of the monitored parts and the achievable cost savings are strongly correlated.

전열밀폐식 X-L 파이프 보일러 난방장치의 열매체 충진율 해석

전통적인 온돌을 포함하여 실내바닥용 가열장치로서 보통 보일러 시스템이 많이 이용된다. 보일러용의 연료로서 목재 외에 가스 및 석유 등이 있으며 보일러 시스템은 열원, 파이프 라인 및 전기 장치 등을 포함한다. 화석연료의 직접적인 연소는 CO₂, HC, NOx 등과 같은 배기가스로 인한 환경문제가 발생한다. 본 연구는 보일러의 열원으로서 연소가 아닌 전기를 이용하는 전열선 가열 방식을 적용한 전열밀폐식 X-L 파이프 보일러에서 X-L 파이프 내 열매체의 최적 충진율에 관한 조사를 수행하였다. 그 결과 열매체의 온도는 열매체의 충진율이 92%일 때 최대이며 86%일 때 최소를 보였다. 또한 본 해석조건 중에서 X-L 파이프 전열선의 온도가 최소 90℃ 이상일 때 비교적 높은 난방효과를 얻을 수 있었다.

Order Choices: An Intraday Analysis of the Taiwan Stock Exchange

This paper employs order-, trade-, and quote-level data to examine the determinants of order choices and the impacts of order choices on execution quality by various investor types in the Taiwan Stock Exchange. We find marketable-quote orders have a higher degree of price aggressiveness, larger order size, higher trade value, shorter duration, and higher fill rate than behind-the-quote orders. There exists a transient order serial correlation. Different types of investors have their own preferences in order choices, while market microstructure factors, such as transitory volatility, spread, market depth, and trading interval, significantly influence stock traders’ order choices. Findings show that marketable-quote orders tend to perform better in terms of order duration. Moreover, institutional investors spend less time on completing their trades than do individuals, particularly for foreign investors after controlling all other factors.

Dynamic heat transfer characteristics of gravity heat pipe with heat storage

For the thermal performance enhancement of electronic components under intermittent high heat load, this paper proposes a gravity heat pipe with heat storage (GHPHS) that couples the advantages of GHPs and latent heat storage (LHS) units. A three-dimensional heat transfer model of GHPHS is developed and numerically studied, focusing on the comparison with traditional GHPs. Furthermore, the effects of the position and fin number of LHS units as well as the type and filling rate of phase change materials (PCMs) are investigated. The results indicate that the average heat source temperature reduces by 48.4 % and the maximum temperature duration shortens by 50 % with adding LHS units into GHPs, which can reduce the transient heat load shock and enhance the overall temperature uniformity. Moreover, the closer the LHS units is to heat sources, the better the temperature uniformity of GHPs is. When gallium is the PCM, the maximum heat source temperature reduces by 26 % when compared with the paraffin, and the increase in PCM fill rate facilitates a delay in the onset of maximum temperature and enhances the temperature uniformity. The fin number significantly affects the competition mechanisms between heat convection and conduction during the melting and solidification. As the fin number increases from 38 to 150, the maximum temperature of heat sources decreases by 29.7 % and the overall temperature uniformity of GHPs increases by 31.7 %. However, there is a limit to the influence of fin number on the thermal enhancement of GHPHSs.

Increased incident rates of antidepressant use during the COVID-19 pandemic: interrupted time-series analysis of a nationally representative sample.

The COVID-19 pandemic has been associated with increased levels of depression and anxiety with implications for the use of antidepressant medications. The incident rate of antidepressant fills before and during the COVID-19 pandemic were compared using interrupted time-series analysis followed by comprehensive sensitivity analyses on data derived from electronic medical records from a large health management organization providing nationwide services to 14% of the Israeli population. The dataset covered the period from 1 January 2013 to 1 February 2021, with 1 March 2020 onwards defined as the period of the COVID-19 pandemic. Forecasting analysis was implemented to test the effect of the vaccine roll-out and easing of social restrictions on antidepressant use. The sample consisted of 852 233 persons with a total antidepressant incident fill count of 139 535.4 (total cumulative rate per 100 000 = 16 372.91, 95% CI 16 287.19-16 459.01). We calculated the proportion of antidepressant prescription fills for the COVID-19 period, and the counterfactual proportion for the same period, assuming COVID-19 had not occurred. The difference in these proportions was significant [Cohen's h = 10-3 (0.16), 95% CI 10-3 ( - 0.71 to 1.03)]. The pandemic was associated with a significant increase in the slope of the incident rate of antidepressant fills (slope change = 0.01, 95% CI 0.00-0.03; p = 0.04) and a monthly increase of 2% compared to the counterfactual (the estimated rate assuming no pandemic occurred). The increased rate was more pronounced in women, and was not modified by lockdown on/off periods, socioeconomic or SARS-CoV-2 status. The rate of observed antidepressant fills was similar to that forecasted under the assumption of ongoing COVID-19 distress. These findings underscore the toll of the pandemic on mental health and inform mental health policy and service delivery during and after implementing COVID-19 attenuation strategies.

Estimating the reorder point for a fill-rate target under a continuous review policy in the presence of non-standard lead-time demand distributions

Skewed and multimodal lead-time demand (LTD) distributions can be present in supply chains. Under these conditions, logistics managers find that conventional approaches, which assume standard LTD distribution shapes, yield unreliable estimates of a single item’s reorder point (ROP) in relation to meeting fill-rate targets under a continuous review inventory policy. Furthermore, logistics managers have limited data available from which to determine the true shape of the underlying LTD distribution. In this study, I present a non-parametric bootstrap approach to set a least-biased estimate of the ROP. In addition, to deriving bootstrap expressions for non-standard LTD shapes, I derive expressions for standard distribution shapes to estimate the ROP across a range of fill rates. Thus, eliminating the double counting of stockouts with conventional fill-rate measures. Using Monte Carlo simulation experiments, I show that in comparison to the conventional state-of-the-art approaches the non-parametric bootstrap approach yields the least-biased ROP estimates robust to both the shape of the LTD distribution and the sample size. This research offers more accurate ROP estimators, which can serve as a basis for expanding the scope of future inventory management research and enabling logistics managers to reduce inventory while maintaining and even improving fill rates.

What is driving declines in oncology-prescribed opioids?

6583 Background: Patients with cancer have experienced sharp declines in opioid prescribing during the past decade, raising concerns about insufficient pain management in a population with high rates of undertreated pain. It is unclear whether these declines are driven by certain oncology subspecialties, payors, or clinical guidelines regarding opioid prescribing released in/after March 2016. Methods: We conducted time series analyses using 2006-2019 IQVIA Longitudinal Prescription Data, which represents up to 92% of all U.S. prescription fills. Using log-linear regression stratified by group, we estimated annual percent change in opioid receipt by: subspecialty (medical oncology MO, radiation oncology RO, and surgical oncology SO); payor (third-party; Medicare, including Medicare Part D; Medicaid; cash/out-of-pocket); and pre- versus post-March 2016. Opioid receipt outcomes included: monthly fills of any opioid; monthly fills of extended-release/long-acting (ER/LA) opioids; and monthly number of patients receiving long-term opioid therapy (LTOT). Outcomes were per 1,000 survivors to account for temporal changes in cancer prevalence. Results: Between 2006 and 2019, 14,301,900 opioid fills were prescribed by oncologists to 3,476,354 distinct patients. Across all outcomes, MO had the highest levels of dispensing, followed by RO, then SO; for example, in 2006 MO dispensed 6.2 fills per 1,000 survivors (compared to 1.9 fills among RO, and 0.5 among SO). We observed substantial declines in all opioid outcomes. Per 1,000 survivors, there was an annual decline of: 5.7% (95CI: 5.1-6.3; total unadjusted decline 2006-2019=70.2%) in the rate of all opioid fills; 4.9% (95CI: 4.1-5.6; total unadjusted decline=66.8%) in ER/LA fills; 3.2% (95CI: 1.5-5.0; total unadjusted decline=56.2%) in LTOT fills, and 1.9% in average daily dose (95CI: 1.9-2.0; total unadjusted decline=29.8%). The annual decline in opioid fills prescribed by MO (7.1%, 95CI: 6.6-7.7) was sharper than for RO (5.9%, 95CI: 5.4-6.4) and SO (5.2%, 95CI: 4.7-5.7). Annual declines were steepest among fills paid out-of-pocket (14.5%, 95CI: 13.9-15.0), followed by those paid by Medicaid (13.1%, 95CI: 12.5-13.6), third-party payors (9.3%, 95CI: 8.7-9.9), and Medicare (2.4%, 95CI: 1.8-3.1). Declines in every outcome accelerated following clinical guidelines released in/after 2016. Conclusions: Opioids prescribed by oncologists declined dramatically across groups and outcomes. Medical oncologists were responsible for a disproportionate share of opioid fills in 2006, and for the sharpest declines. Out-of-pocket fills declined more sharply than fills covered by insurance and clinical guidelines may have contributed to accelerating declines. While de-escalation of opioid therapy may reduce risk of opioid-related harms to cancer survivors, care is needed to ensure cancer-related pain is appropriately treated.

Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic

COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown. To investigate whether disruptions in filled buprenorphine and naltrexone prescriptions differed by race and ethnicity and insurance status or payer type. This cross-sectional study used retail pharmacy claims from May 2019 to June 2021 from the Symphony Health database, which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories. Interrupted time series were used to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. Included individuals were those who filled buprenorphine and extended-release naltrexone prescriptions. Data were analyzed from July 2021 through March 2022. Weekly rates of dispensed buprenorphine and extended-release naltrexone prescription fills per 1000 patients and proportion of longer (ie, ≥14 days' supply) buprenorphine prescription fills were calculated. Analyses were stratified by patient race and ethnicity and further by insurance status and payer type for White and Black patients. A total of 1 556 860 individuals who filled buprenorphine prescriptions (4359 Asian [0.3%], 94 657 Black [6.1%], 55 369 Hispanic [3.6%], and 664 779 White [42.7%]) and 127 506 individuals who filled extended-release naltrexone prescriptions (344 Asian [0.3%], 8186 Black [6.4%], 5343 Hispanic [4.2%], and 53 068 White [41.6%]) from May 6, 2019, to June 5, 2021, were analyzed. Prepandemic increases in buprenorphine fill rate flattened for all groups after COVID-19 onset (30.5 percentage point difference in trend; P < .001) compared with prepandemic trends. Significant level decreases in buprenorphine fills (ranging from 2.5% for Black patients; P = .009 to 4.0% for Hispanic patients; P = .009) at pandemic onset were observed for members of racial and ethnic minority groups but not White patients. At pandemic onset, rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001). No decreases were found among Medicaid patients. Unlike buprenorphine, extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups. This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals. These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.

A Survey of Long Case Psychotherapy Experiences of Psychiatric Trainees Working in South London and Maudsley NHS Trust

AimsPsychotherapy is a mandatory component of the Royal College of Psychiatrists training curriculum. The long-term benefits of psychotherapeutically-informed practice to both patients and doctors are well recognised. In the face of regular service configurations, there was a wish to gather evidence to ensure continued provision of this training experience to a high quality. The purpose of this survey was to obtain feedback from trainees regarding their experience of the psychodynamic psychotherapy long case to evidence the relevance and value of this component of the training programme.MethodsThe anonymous survey, including questions, numerical rating scales and free text boxes, was sent to 294 trainees on a combined mailing list. This number may be slightly inaccurate due to incorrect email addresses and duplicates. A reminder email was sent one week later to encourage a higher fill rate.ResultsThere were 35 responses: a fill rate of approximately 12%. The largest group of respondents were Core Trainees (3rd year) of whom just over half had completed the long case.92% of respondents found the long case to be at least ‘slightly useful’, of whom almost a third found it ‘extremely useful’. 94% of trainees found the experience to be at least ‘slightly helpful’ in understanding psychodynamic concepts and 75% found supervision ‘very’ or ‘extremely useful’.Qualitative responses described it as a unique experience not offered elsewhere in the curriculum that provided important transferable skills.Difficulties mentioned were similar to those found by previous studies, including practical concerns relating to patient and service factors. There were suggestions for more in-depth training and suggested reading to increase trainees’ confidence. An email was sent signposting trainees to further support in response to some specific concerns.ConclusionOverall, the responses suggest that the majority of trainees find the long case a valuable training opportunity. These data are useful to evaluate and improve trainees’ experience within the trust, and could be helpful for other training programmes nationally.Due to the nature of psychotherapy, there is inevitable variation in trainee experiences but attempts to clarify and/or standardise some elements may result in greater trainee satisfaction. Trainees suggested improvements including addressing practical issues, patient factors, supervision content, and educational resources. A future survey following implementation of some suggested improvements would be helpful; the impact of the COVID-19 pandemic and the switch to remote working is another area that may be useful to explore.

Impact of Telehealth on Medication Adherence in Chronic Gastrointestinal Diseases.

BackgroundWith the COVID-19 pandemic, the demand and availability of telehealth in outpatient care has had exponential growth. Although use of telehealth has been studied and validated for various medical specialties, relatively few studies have looked at its role in gastroenterology.AimTo assess effectiveness of telehealth medicine in gastroenterology by comparing medication adherence rate for patients seen with telehealth and traditional in-person appointment for various gastrointestinal conditions.MethodsRetrospective chart review of patients seen in outpatient gastroenterology clinic was performed to identify patients who were given prescription to fill either through telehealth or in-person appointment. By using provincial pharmacy database, we determined the prescription fill rate.ResultsA total of 206 patients were identified who were provided new prescriptions or prescription renewal at their gastroenterology clinic visit. One hundred and three patients were seen through in-person visit during pre-pandemic period, and 103 patients were seen through telehealth appointment during COVID-19 pandemic. The mean age of patients was 49.2 years (55% female). On average, patients had 4.7 previous visits with their gastroenterologists before their visit. IBD management was the most common reason for visits (37.9% and 46.6% in telehealth and in-person groups, respectively). Prescription fill rate for patients seen through telehealth was 92.2% compared to 81.6% for the in-person group (OR: 2.69, 95% CI: 1.12–6.45; P = 0.023).ConclusionsMedication adherence rate for telehealth visits was higher than for in-patient visits. These findings suggest that telehealth can be an effective method of care delivery, especially for patients with chronic gastrointestinal conditions like IBD.