Healthcare Assistants Research Articles

Barriers to optimal breastfeeding of medically complex children in the UK paediatric setting: a mixed methods survey of healthcare professionals.

Breastfeeding is indisputably significant for infants and children, as well as their mothers. However, when breastfed children are admitted to the paediatric ward, they may experience breastfeeding modification due to clinical challenges, lack of staff training and institutional barriers. Although previous research has identified multiple barriers to optimal feeding within the maternity, neonatal and community settings, we know less about the barriers that exist in paediatrics. Paediatric healthcare staff attitudes, training and awareness as well as ward culture are likely to have an impact on the experiences of families but are relatively unresearched in the paediatric setting, especially with regard to the multidisciplinary nature of clinical paediatric care. The aim of this study was to explore the attitudes, awareness and perceived barriers to effective breastfeeding support provision, as well as healthcare professional perception of barriers for families. This was a mixed methods study utilising a questionnaire which was completed by 409 healthcare professionals who identified as working within the paediatric setting. It included responses from paediatricians of all training grades, nurses, healthcare assistants and allied health professionals. Qualitative data from professionals were analysed to develop themes around professional and perceived parent barriers to optimal breastfeeding. This study explored the barriers experienced by staff, as well as professionals' perception of parent barriers. These included lack of knowledge of how to help, a default formula culture, the pressure of maintaining strict fluid balance and breastfeeding being a low priority in the face of critical illness. Of the paediatric departments represented by this sample of healthcare professionals, most had a relatively poor culture of supporting breastfeeding, with multiple institutional barriers identified. Most professionals felt that there was not enough support for breastfeeding families on an average shift, and a large proportion identified as being one of just a few breastfeeding advocates on their ward. In this relatively motivated and experienced sample of healthcare professionals, there were many identified barriers to optimal breastfeeding which could potentially be addressed by training that is carefully nuanced for the paediatric population. Ensuring that paediatric multidisciplinary healthcare professionals have sufficient skills and knowledge would address the identified challenge of poor awareness of breastfeeding and of how to overcome clinical lactation obstacles. Further improvements at policy level need to address the systemic lack of resourcing in paediatrics, as well as the lack of embedded breastfeeding-friendly organisational structures.

Mentoring approaches in a safe surgery program in Tanzania: Lessons learned during COVID-19 and recommendations for the future

BackgroundCOVID-19 has dramatically affected the delivery of health care and technical assistance. This is true in Tanzania, where maternal mortality and surgical infection rates are significantly higher than in high-income countries. This paper describes lessons learned about the optimal application of in-person and virtual mentorship in the Safe Surgery 2020 program to improve the quality of surgical services in Tanzania before and after the COVID-19 pandemic. MethodsFrom January 2018 through December 2020, Safe Surgery 2020 supported 40 health facilities in Tanzania's Lake Zone to improve the quality of surgical care. A blended surgical mentorship model, employing both onsite and virtual mentorship, was central to the program's capacity development approach. With COVID-19, the program pivoted to full virtual mentorship. Through continuous learning and adaptation processes, including a human-centered design workshop, surveys assessing mentors' confidence with different competencies, and focus group discussions with mentors, mentees and safe surgery program staff, the program distilled the optimal use of mentorship models. ResultsDeveloping complex surgical skills, addressing contextual considerations, problem-solving, and building trusting relationships were best suited to in-person mentorship, whereas virtual mentorship was most effective in supporting mentees' quality improvement projects, data use, case discussions, and reinforcing clinical practices. Leading successful virtual learning required enhanced facilitation skills and active engagement of health facility leadership. ConclusionsIn-person and virtual mentorship offer distinct benefits and complement each other when combined. Investing more in-person mentorship at the beginning of programs allows for the establishment of trust that is foundational to effective mentorship.

Challenges navigating publicly funded home care in Ontario, Canada: Perspectives from unpaid caregivers of persons living with dementia.

In Canada, persons living with dementia represent a sizable number of home care recipients. Although home care is not wholly publicly funded under provincial health insurance plans, some provinces like Ontario subsidize a maximum number of hours of home care provided by a personal support worker (PSW) on the basis of need. The public subsidization of home care may be interpreted as a mechanism of financial risk protection, enabling unpaid caregivers to maintain employment, income levels, and personal health. However, deficits in the availability of home care call into question how the organization of home care may be contributing to financial risk among unpaid caregivers. Inspired by qualitative phenomenology, this study describes the financial risks experienced by unpaid caregivers of persons living with dementia navigating publicly funded homecare in Ontario. Based on 24 interviews conducted between August-December, 2020, we found financial risk emerges across three dimensions: 1) receiving information about publicly funded home care that anticipates future care needs; 2) receiving flexible hours of support from a PSW; and 3) maintaining consistent access to quality support. Financial risks included turning to privately funded home care options, or taking time off work to provide care. Findings may inform local and international home care reforms aiming to protect caregivers from financial risk.

Clinical placement education during the coronavirus disease 2019 pandemic shapes new nurses: A qualitative study

BackgroundMany newly qualified nurses experience transition challenges because they feel unprepared for the reality of the nursing profession owing to the theory-practice gap. Transition challenges amongst newly qualified nurses have profound consequences for the nursing profession and patient care. A detailed and nuanced understanding of the complexity in transition-related challenges during extraordinary conditions like the coronavirus disease 2019 pandemic is needed for newly qualified nurses to remain in the nursing profession. ObjectiveThis study explored the experience of newly qualified nurses entering the nursing profession who had their clinical placement education missed, shortened, or substituted since they had to serve as health care assistants during the coronavirus disease 2019 pandemic. DesignAn exploratory and descriptive study design was used. SettingsWorkplaces for newly qualified nurses. ParticipantsA purposive sample of 10 newly qualified Norwegian nurses working in various clinical placement nursing settings were included. MethodsData were collected in April and May 2022 via individual interviews conducted via Zoom. Thematic analysis was applied to identify themes. Triangulation was employed to ensure trustworthiness. FindingsThree major themes emerged: relational aspects of nursing, practical aspects of nursing, and inadequacies in the pedagogical plan of teaching and learning. The themes indicate that the limited or suspended clinical placement education during the pandemic affected the competence of newly qualified nurses. ConclusionsDuring the coronavirus disease 2019 pandemic, clinical placement education for student nurses was limited or suspended owing to safety concerns. The short clinical placement durations affected the competence of newly qualified nurses, as they lacked exposure to real-world patient care scenarios as in non-pandemic times. Furthermore, our findings indicate that newly qualified nurses’ clinical placement experiences provide important knowledge and insight for educators in terms of education and support for future student nurses going into situations with short clinical placement hours. The conclusion highlights the implications of the findings and recommendations and the need for further support and education for newly qualified nurses after the pandemic. Study registration detailsThe study was approved by the Norwegian Social Data Service (project number 396247). The registration date was 2021–11–04. Tweetable abstractTransition-related challenges became more prominent during the coronavirus disease 2019 pandemic than during non-pandemic times.

'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England.

Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.

Staff experiences of the nursing associate role in a community setting.

The nursing associate role was introduced as a 'bridge' between healthcare assistants and nurses to support patient care. However, the role has involved many challenges in terms of its implementation in established nursing teams. This article details a service evaluation that explored the experiences of the nursing associate role among clinical staff in one community NHS trust using an online questionnaire and in-depth interviews. Three themes were identified from the data: nursing associate training and support; the nursing associate role in development; and nursing associate role recognition and prospects. Overall, the findings showed that trainee nursing associates enjoyed the academic aspects of their training, but support was variable. Additionally, the nursing associate role was viewed as being 'in development' and, while wider recognition of nursing associates is required, the nursing associate role offers a unique career opportunity.

Fear of Covid-19 and Burnout Among Healthcare Providers in Malaysia: Is Resilience a Missing Link?

Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.

Informal carers: series content and definitions

This series will explore the definition, meaning and roles of informal caring and informal carers, statistics and lived experiences regarding informal caring, the law and Government strategies regarding informal caring and the role of the nurse, nursing associate and healthcare assistant in supporting the informal carer. This first article will establish the purpose behind this series, what the series will cover and the definition and meaning of informal caring and the informal carer.

The impact of healthcare assistant education on pressure ulcer prevention: a systematic review.

To investigate the impact of education for healthcare assistants (HCAs) on their knowledge and skills in pressure ulcer (PU) prevention and on the incidence of PUs. A secondary aim was to evaluate education methodologies used in PU prevention programmes. Using systematic review methodology, key databases were searched with no limitations on date of publication. The search was conducted in November 2021 using the following databases: CINAHL, Embase, Scopus, MEDLINE, Cochrane Wounds Group Specialist Register and Cochrane Central Register of Controlled Trials. Inclusion criteria focused on studies that employed the use of education as an intervention, delivered to HCAs in any setting. The PRISMA guidelines were followed. The methodological quality of the studies was evaluated using the Evidence-Based Librarianship (EBL) appraisal checklist. Data were analysed using narrative analysis and meta-analysis. The systematic search yielded an initial 449 records, of which 14 studies met the inclusion criteria. Outcome measures of HCA knowledge scores were reported in 11 (79%) studies. Outcome measures related to PU prevalence/incidence were reported in 11 (79%) studies. An increase in knowledge scores of HCAs post-educational intervention was reported in five (38%) studies. A significant reduction in PU prevalence/incidence rates post-educational intervention was reported in nine (64%) studies. This systematic review affirms the benefits of education of HCAs on their knowledge and skills of PU prevention, and on PU incidence. The results must be treated with caution due to quality appraisal issues of included studies.

Implementation of a Multicomponent Program to Improve Effective Use and Maintenance of Medical Equipment in Sri Lankan Hospitals

Abstract Background: Medical equipment (ME) maintenance retains an asset’s original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and implemented a multicomponent program to improve ME use and maintenance in nine Sri Lankan hospitals from May 2020 to May 2021. Methods: This pre–post implementation study involved an initial baseline assessment of existing ME maintenance systems, the development and implementation of a multicomponent improvement program, and a 3-month postevaluation. Five targets ME were selected for the study: oxygen regulator, electrocardiogram (ECG) machine, suction apparatus, blood pressure apparatus, and mini autoclave. A pretested questionnaire was administered to randomly selected nursing officers (n = 101) and health-care assistants (n = 120) to obtain baseline ME maintenance data. Six focus group discussions and 24 key informant interviews were conducted with key stakeholders to codesign the multicomponent interventions, which included: developing a standard operating procedure targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at 3 months postimplementation using the seven predefined outcome variables. Results: Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. The highest availability was observed for oxygen regulator (62% to 82.3%) and ECG machine (66.1% to 84.7%). The highest functionality improvement was observed for ECG machine (40.4% to 79.7%). The positive perception of maintenance process of ME achieved the highest (33% to 80%) improvement. Following program implementation, improvements were noted in: the availability (P = 0.00) and functionality (P = 0.00 to P = 0.02) of all selected ME; equipment maintenance processes (P = 0.000); as well as staff knowledge, skills, perceptions, and satisfaction. Conclusions: The program improved the use and maintenance of ME and was widely supported by the key stakeholders. The approach is relevant to other resource-poor hospital settings, as inadequate ME maintenance causes health system inefficiencies.

Understanding Measurement of postural hypotension: a nationwide survey of primary care practice in England.

Postural hypotension (PH), the drop in blood pressure (BP) on standing, is associated with falls, all-cause mortality and cognitive decline. PH diagnostic criteria require lying-to-standing BP measurements. PH Prevalence in older adults is 20%, however, it is infrequently recorded in primary care records, suggesting PH testing and/or recording is under-utilised in this setting. To understand current PH measurement and management by primary care practitioners in England. Clinical Research Networks circulated an online survey to primary care clinicians involved in measurement of BP. Demographics and responses were summarised as percentages, or median and inter-quartile ranges (IQR), as appropriate. The survey remains open until 30 November 2022; full results will be presented at the conference. To date, there are 669 replies (341 doctors, 179 nurses, 70 healthcare assistants, 23 pharmacists, 56 other roles); median age 45 (IQR 38 to 53), 72% female. Overall, 597 (89%) responders check for PH, predominantly when symptoms are present (98%). Less common reasons to check include patients being over 80 (24%), Parkinson's disease (21%), hypertension reviews (18%), medication reviews (12%) or diabetes reviews (11%). Sitting-to-standing BP measurements are common (77%); only 22% use lying-to-standing. Only 64% ensure a rest period before sitting or lying BP measurement and only 1 (IQR 1 to 2) standing BP measurement is made, usually (66%) within the first minute of standing. Interim findings suggest that most PH assessments in primary care do not meet current guideline criteria. Full findings from this survey are expected to inform and influence future national guidelines.

Mapping, profile and training of immunization stakeholders, Benin, 2020

The Benin Immunization and Logistic Directorate commissioned this study to provide evidence-based data to improve the performance of the Expanded Programme on Immunization. The objectives were to identify immunization stakeholders, describe their profile, their geographical distribution and determine their training needs. In December 2020, we conducted a census of Benin's immunization stakeholders via their administrative files and telephone interviews. The data were collected in each departmental directorate and health zone by focal points using an Excel® grid. The authorizations of the ethics and personal data protection committees were obtained. We identified 3, 893 immunization workers, 39 years old on average, 66% of whom were women, 53% were health care assistants, 77% were vaccinators, and 56% were government contract workers. About 96% of them worked in peripheral centers. Approximately 56% were untrained and 14% had been untrained for more than 5 years. More than half of the actors were not trained for their function. The proportion of actors needing training was estimated at 70%. The training needs were at least 72% in the departmental hospitals, zone hospitals and health centers. 98% of actors reported a need for training, including immunization (74%), vaccine management (69%), cold chain (61%), monitoring (61%), and maintenance (47%). The predominance of nurses' aides and women and the low proportion of trained personnel among immunization workers were also observed in other sub-Saharan African countries. Benin's Immunization and Logistics Directorate should mobilize sufficient resources to strengthen the technical capacities of the majority of immunization stakeholders.

Use of the PRECEDE-PROCEED Model to Pilot an Occupational Physical Activity Intervention: Tailored Through a Community Partnership.

Healthcare and social assistance workers are at increased risk for obesity. This industry has limited access to workplace health promotion resources and reports low rates of physical activity programs for workers. This article describes the application of the PRECEDE-PROCEED Model (PPM) to plan, implement, and evaluate a pilot physical activity intervention, Project Move, tailored to promote occupational physical activity and reduce sedentary behaviors among female workers. Actions taken by the community-based participatory research partnership assisted in the identification of the predisposing, reinforcing, and enabling factors that influenced the physical activity behaviors of female workers. The resources and capacities of the partnership were leveraged to implement and evaluate the pilot intervention. After the 12-week intervention, the participants' daily average steps while at work met the recommended minimum 7,000 steps/day, and the time spent sitting decreased along with positive changes in health-related psychosocial measures. The PPM represents a feasible approach for community-based participatory partnerships to create a tailored intervention to address the occupational physical activity and sedentary behaviors of at-risk female healthcare and social assistance workforce.

Caraterização dos Acidentes de Trabalho num Hospital Terciário Português entre 2017 e 2022

Introduction Healthcare professionals are exposed to a multitude of occupational risks that can lead to work-related injuries, resulting in implications both at the hospital management level and community level. For the development of a preventive safety culture, it is essential to analyze the causes that lead to their occurrence. This study is a descriptive and analytical analysis of the work-related injuries that occurred in a hospital unit, characterizing them and relating them to occupational risks. The target population of the study consists of healthcare workers from a tertiary hospital in the north of Portugal. Aims Analysis of the work-related injuries recorded by the Occupational Health Service in a Portuguese tertiary hospital. Methods Retrospective observational study between January 2017 and December 2022. Data were obtained from the Occupational Health Service software. Results A total of 1279 work-related injuries were recorded from 2017 to 2022, of which 93,8% took place in the facilities of the Hospital Center. The majority of them (82,8%) occurred in female workers. A higher number of work-related injuries was observed among healthcare assistants (43.2%) and nurses (35.5%). The mechanical risk was found to have the highest incidence (46,4%), followed by biological (26,3%) and ergonomic (22,4%) risks. The upper limb (46,3%) and lower limb (22,4%) were the anatomical regions most affected by the accidents. Most of the lost days resulting from work-related injuries were in the range of 3 to 30 days (58,8%). Discussion and Conclusion Work-related injuries presented a variable distribution throughout the studied period and most of these took place within the Hospital Center. The mechanical risk, which is essentially responsible for musculoskeletal injuries, was the leading cause of injury, followed by biological risk, in accordance with the literature. There was a significant increase in the number of work-related injuries related to psychosocial risks, which is directly related to violent behaviors against hospital staff making it urgent to develop preventive measures in this area. Due to the morbidity caused and the consequent absenteeism, work-related injuries contributed to a significant loss of productivity. Therefore, it is essential to keep investing in preventive policies and improvement of the work conditions in the healthcare sector. KEYWORDS: Work-related injuries, Health Professionals, Injury, Disability, Absenteeism.

Transforming Healthcare System through AI Sustainability: Chatbots and Emergency Assistance

Abstract: The healthcare sector is facing numerous challenges, including the spread of misinformation on the internet, a shortage of healthcare assistance, inadequate patient management, emergency care, and disease detection. The process of appointments can also be time-consuming and inconvenient for patients who may not be able to visit a hospital or doctor for all minor issues and doubts. The paper suggests using AI chatbots and portals to improve patient access and information, an Emergency Fatality Assistance and SOS system for immediate care, a Report & Medicine Tracking system for better patient outcomes, and AI technology in disease detection for early diagnosis and treatment. This proposed system aims to contribute to the existing literature on the integration of AI sustainability in healthcare services to address these challenges and improve patient outcomes.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AimThis article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution. BackgroundThere is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals. MethodsBased on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others. ResultsComprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called “Over the Rainbow'' and totals of 60 h of education. ConclusionsThis m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals’ practice to offer more equitable health care for the LGBT+ population.

BT06 Using artificial intelligence to triage skin cancer referrals: outcomes from a pilot study

Abstract Artificial intelligence (AI) is a rapidly emerging field in dermatology, aimed at delivering efficient and effective patient care. To date, there is a lack of substantial evidence for the use of this technology in a clinical setting. However, the pandemic era has placed significant pressures on dermatology services, specifically the skin cancer clinics at our trust, which has experienced a 30% increase in demand compared with prepandemic levels. A novel solution for urgent referrals was to test the use of AI teledermatology software using a UK Conformity Assessed marked Class IIa Medical Device (and therefore regulated by the Medicines and Healthcare products Regulatory Agency). Appropriate cases are selected and booked for a teledermatology appointment at one of our four community-based hubs. Clinical and dermoscopic images, together with a short questionnaire, are uploaded to the software by a healthcare assistant. The AI immediately assesses the dermoscopic images of the lesion, and those cases identified as benign are discharged back to the general practitioner (GP), following a safety check by a consultant dermatologist employed by the AI provider. The trust dermatology consultants have chosen to further triage all cases suspected to be nonbenign. Patients with suitable small lesions at low-risk sites receive a telephone appointment to discuss surgery and obtain consent. Those with precancerous lesions can be discharged back to the GP with management advice. Low-risk basal cell carcinomas case are transferred to a routine pathway. Selected cases may be referred directly to other teams. The pilot started in March 2022 and now processes 5–600 cases per month at four photography hubs. To date, 19% of cases have been discharged back to the GP with a benign diagnosis. A further 15% of cases have been discharged back to the GP by the trust dermatologists, giving an overall discharge rate of 34%. Ten per cent of patients have received a telephone call to take consent for biopsy, and 2% have been referred directly to another speciality. Thirteen per cent of cases have been triaged to a routine pathway, and 38% of patients have required an urgent face-to-face appointment with a dermatologist. The trust has seen > 90% 2-week wait referrals within 2 weeks in the last two quarters. Since the introduction of this AI teledermatology service, we have seen a 62% reduction in the number of patients requiring an urgent face-to-face appointment with a dermatologist. Ongoing audit work is focused on the safety, acceptability and cost-effectiveness of this pathway, and will shape decision-making in the ongoing use of this technology both locally and across the UK.

BT12 A comparison of outcomes and cost-effectiveness in a teledermatology vs. a standard face-to-face 2-week wait UK model

Abstract Teledermatology (TD) assessment of lesions referred on the 2-week wait (2WW) pathway reduces the need for in-person review, and thus facilitates increased clinical capacity. Although studies have demonstrated that TD can be cost-effective compared with a standard face-to-face (F2F) model, there is a lack of literature on the cost-effectiveness of TD with medical photography in the UK 2WW skin cancer pathway (Snoswell C, Finnane A, Janda M et al. Cost-effectiveness of store-and-forward teledermatology. JAMA Dermatol 2016; 152:702). In this study, we undertook a retrospective analysis of a store-and-forward TD 2WW pathway supported by medical photography at a UK centre (October–November 2022). As a comparator, we looked at the outcomes of a 2WW F2F clinic that took place 1 year earlier. Primary outcomes included comparing costs associated with both TD and F2F clinics, and outcomes after initial TD vs. F2F review (discharges, surgeries and subsequent F2F reviews). Inclusion criteria for TD were age 18–60 years, < 3 lesions referred and lesions being on culturally nonsensitive body sites. Cost estimates were included for physicians, nurses, healthcare assistants, administration staff and medical photographers. The tariff per 2WW skin cancer referral to the trust is £159.27. In total, 292 patient images were reviewed virtually in this study. Thirty of 68 patients in the F2F group met the same age criteria as those in the TD group (18–60 years), and thus these patients were used as comparators. Each 4-h TD session comprised an assessment of 25 patients vs. 12 patients per F2F session. Discharge rates from the first clinic appointment were higher for F2F clinics than for TD clinics (76.7% vs. 58.6%). Referrals for surgery were similar between the two groups (16.7% for F2F and 17.8% for TD). However, we found there were substantially more follow-ups requested after TD assessment vs. patients reviewed in F2F clinics (23.2% vs. 6.7%). The nonattendance rate for TD was 36 of 328 patients (11.0%) vs. five of 73 (6.8%) for F2F. Per-patient cost of the TD pathway was estimated to be £16.16 vs. £25.68 for a F2F 2WW appointment. Total revenue to the trust per clinical session was estimated to be £3981.75 (TD) vs. £1911.24 (F2F). This represented additional revenue of approximately £1975 for TD. Twenty-nine of 33 TD patients who completed feedback questionnaires reported overall satisfaction with the TD pathway. In this study, outcome rates between TD and F2F groups were similar in terms of planned surgeries. Planned subsequent F2F review rates were higher for TD, and discharge rates were higher for F2F. The revenue to the trust was greater for TD than F2F.

Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis.

Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.

‘That just doesn’t feel right at times’ – lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study

Background: Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients’ homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone. Aim: To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs. Design: Qualitative exploratory study using semi-structured interviews. Setting/participants: Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK. Results: Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing. Conclusions: Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.