Healthcare Commission Research Articles

The Roadmap for Action on AMR

Abstract The speaker will present the perspective of civil society, as well as its extensive work to raise awareness and bring together stakeholders committed to tackling AMR across Europe. The Stakeholder Network on AMR, hosted within the European Commission's Healthcare Policy Platform, along with the resulting Roadmap for Action on AMR will be presented. The speaker will explain how the Roadmap and the key strategies and targets identified encompass a 'One-Health' approach, emphasising that AMR can only be addressed through concerted cross-sectoral actions, ranging from infection prevention, better diagnostics and supporting Member States in implementing National Action Plans. The links between AMR and other EU initiatives such as the emerging Cancer Plan, the Farm to Fork Strategy and the European Green Deal will also be elaborated on. Finally, the role of the European Parliament in ensuring that AMR stays high on the agenda and mobilising Member States to act, will be discussed in the context of a newly established MEP Interest Group on AMR with an ambitious strategic work programme for the Parliamentary term 2019 - 2024.

British Thoracic Society Quality Standards for outpatient management of pulmonary embolism

IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for outpatient...

Letter to the editor

Editor, “Inside the word emerging is emerge, from an emergency new things come forth. The old certainties are crumbling first, but danger and possibility are sisters.’’1 The population burden of SARS-CoV-2, in terms of number of new cases, has declined significantly since the peak of the outbreak. Concerns rightfully persist regarding a possible second wave of infection. We feel the impact upon acute medicine warrants further discussion. Acute medicine by definition; the immediate management of life-threatening medical emergencies, the initial treatment (first 72 hours) of all presenting general medical ailments, and the provision of ambulatory care2 witnessed almost overnight changes in patient cohorts, emergency department attendance numbers,3 service delivery and staffing models. Of the patients presenting with COVID pneumonitis, in our hospital, the sickest were manged by our intensivist colleagues, while those needing respiratory support were managed by respiratory consultants and members of the acute medicine multidisciplinary team. New ways of providing care emerged4 with innovation powered on by collaborative spirit and an infectious ‘yes culture’. Allowing those clinicians with frontline experience to drive through changes to better deliver care for our patients, is the heart of what many of those in acute medicine just want to get on and do. Even against the harsh clinical scenarios witnessed, for many, accomplishing what acute medicine delivered was a silver lining of opportunity, not many will see again. Where does all that tremendous effort leave us now? How exactly do we run two versions of the NHS – a hot and cold, a red and green or a COVID and non COVID – for patients presenting with acute medical problems. How do we ensure we get the right person to the right place, first time?5 Do we need to re-explore our relationship with primary care and the walls within which acute medicine is delivered? Even our medicine has changed – the sequalae of COVID pathology, the delayed presentation of disease states, the impacts of social isolation and the economic fall-out, the tidal wave of undiagnosed, late presentation cancer that is about to befall us. And we haven’t even mentioned winter. Acute Medicine has always been composed of talented, committed people, skills and attributes. Examples of good practice are often shared throughout the acute medicine community, critiqued and then taken home to implement on our own ‘turf’. It is vital that at this time of significant change and reconfiguration that this continues to happen in some way. Dr Sue Crossland (President of SAM) and Dr Nicholas Scriven (Immediate Past President) outlined some of the challenges facing our specialty to the Health and Social Care Committee.6 We hope that by acknowledging that COVID 19 has impacted on the delivery of Acute Medicine, and that by starting a dialogue about how different AMUs have managed such extraordinary times; the good, the bad, and the ugly of COVID 19 can be used to harness the best for Acute Medicine going forwards and ensure it’s place in the heart of unscheduled care.

Morbidity Prevalence Estimate at 6 Months Following a Stroke: Protocol for a Cohort Study.

BackgroundKnowledge of the prevalence of morbidity secondary to stroke is important for health care professionals, health care commissioners, third sector organizations, and stroke survivors to understand the likely progress of poststroke sequelae and to aid in commissioning decisions, planning care, and adjusting to life after stroke.ObjectiveThe primary aim of the Morbidity PRevalence Estimate In StrokE (MORe PREcISE) study is to determine the prevalence of morbidity secondary to a stroke, predictors of morbidity, and trends in quality of life and functional status using patient-reported outcomes, cognitive and functional assessments.MethodsA total of 500 participants will be recruited across Wales and England within 14 days following an admission to a stroke unit for either an ischemic or hemorrhagic stroke as part of a multicenter cohort study. Participants are assessed at baseline ≤14 days poststroke and subsequently at 90 (± 14) days and 180 (± 14) days poststroke. At each time point, data will be collected relating to the following domains: participant demographics, routine clinical, patient reported, cognitive status, emotional well-being, and functional ability.ResultsRecruitment commenced in October 2018 with 20 sites opened as of September 2019 and was closed on October 31, 2019.ConclusionsThe primary outcome is the prevalence of morbidity at 6 months secondary to a stroke. Further analysis will consider temporal changes in the health-related domains to describe trends among baseline, 3-, and 6-month time points.Trial RegistrationClinicalTrials.gov NCT03605381; https://clinicaltrials.gov/ct2/show/NCT03605381International Registered Report Identifier (IRRID)DERR1-10.2196/15851

THE POTENTIAL OF THE IMPLEMENTATION OF DENGUE HEMORRHAGIC FEVER (DHF) PARTICIPATORY MAPPING TRAINING FOR LARVAE OBSERVER CADRES (JURU PEMANTAU JENTIK / JUMANTIK)

Jumantik plays a pivotal role in the control of Dengue Hemorrhagic Fever (DHF). Participatory mapping training can enhance its risk of transmission recognition. This research aims to identify the potential use of DHF risk factors participatory mapping training for Jumantik. This experimental research carried out from October 2013-January 2014 in four DHF highest prevalence regions in Malang. Mapping is based on data from Google Earth, DHF risk factors like homes, ovitrap sites, and larva-positive buildings, and the DHF prevalence over the past 6 months. The results indicate a variety of participant’s capacity to generate maps while the ability to analyze and plan was conspicuously absent. Qualitative data reveals there's an intention to map DHF individually by a few numbers of jumantik and primary healthcare staff. The conclusion is that this training prototype can be further adapted by accounting participant’s features, approaches, and capabilities as well as primary healthcare commitment for its continuity.

Repurposing and reshaping of hospitals during the COVID-19 outbreak in South Korea

During the extensive outbreak of coronavirus disease 2019 (COVID-19) in South Korea, many strategies in the hospital setting, such as stratified patient care, the assignment of hospitals/beds by a task force team, and the establishment of dedicated COVID-19 hospitals, dedicated COVID-19 emergency centers, COVID-19 community facilities, and respiratory care split hospitals, were adopted to mitigate community transmission and prevent nosocomial infection. Most of these strategies were used during the Middle East Respiratory syndrome outbreak and were applied again successfully during the COVID-19 outbreak. The reallocation of health care capacity, repurposing of hospitals, and close collaboration between the government and the health care committee might have been the key to successfully addressing the crisis of COVID-19 given the shortage of health care resources.

Ten minutes with Dr Ian Reckless, Medical Director, Milton Keynes University Hospital NHS Foundation Trust

### Biography Ian Reckless is Medical Director at Milton Keynes University Hospital NHS Foundation Trust, and Consultant in Stroke and General Medicine in Milton Keynes and at Oxford University Hospitals...

Publishing Medical Research in Pakistan; Challenges and the Way Forward

Publishing Medical Research in Pakistan; Challenges and the Way Forward

Realizing policy aspirations of voluntary sector involvement in integrated care provision: Insights from the English National Health Service

Integrating voluntary sector organizations (VSOs) into complex health and social care provision is a priority in global healthcare policy. However, realization of these policy aspirations in practice is limited, as VSOs struggle to collaborate with health and social care professionals, or influence the wider healthcare system, undermining their potential involvement in care provision. This paper aims to increase understandings of how the policy implementation gap could be addressed, by asking: how do new workforce roles support VSO involvement in delivering integrated care? Drawing on 40 interviews with VSO workers, healthcare commissioners, and healthcare professionals, conducted over 18 months in the English NHS, we outline how workforce capacity development through the introduction of coordinating roles, coupled with increasing regulatory control of VSO involvement, resulted in enhanced VSO integration in service provision. However, we also warn against the potential for exploitation of VSOs whereby they become replacements for health and social care provision, rather than a complementary service within an integrated team, resulting in patient harm. Our findings have important implications for policy makers, practitioners, VSO leaders and healthcare commissioners. We conclude that policy realization is dependent on the development of coordinating roles, coupled with levels of regulation which protect against exploitation without becoming normatively restrictive, thereby losing the important flexibility of VSOs.

An evaluation of a training intervention to support the use of evidence in healthcare commissioning in England.

Clinical commissioning groups (CCGs) in England are responsible for the health of their populations through the services they provide, yet we know that the use of evidence to inform commissioning decisions is low. A programme of training in seven CCGs in England was instigated in a joint piece of work by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care and Academic Health Science Network in the West of England, to help build an evidence informed culture in commissioning. Evidence workshops were delivered in each of the seven CCGs in the West of England by an experienced senior lecturer (the author) and local healthcare librarians. The workshop was developed by the author and an information scientist and included guidance and demonstration of a systematic evidence search covering both traditional and grey literature, and a brief look at quality of evidence including a critical appraisal activity. Participants were asked to evaluate the workshop on the day and to indicate an intended action they would take as a result of the workshop; a short follow-up interview was carried out with a sample of participants between 3 and 6 months later, to identify any longer term impact of the training. A total of 63 staff in a variety of commissioning-related roles attended the workshops between March and September 2016. 95% rated the workshop overall as either 'excellent' or 'good'. Of particular value was the involvement of the local healthcare librarian, helping to promote their expertise and services; and the discussion of grey literature as a valuable source of evidence. A variety of intended actions as a result of the training included initiating a thorough search for evidence for new projects, use of bibliographic databases, and making use of local library services for evidence searching. Follow-up interviews with nine staff revealed a positive impact in the longer-term. This ranged from simply triggering an interest in using evidence, boosting motivation and sharing information with colleagues; to changes in processes such as broadening the responsibility for finding and filtering evidence for business cases; to one clear case of financial savings resulting from a search for evidence by a senior commissioning manager. Offering short, interactive training workshops is valued by healthcare commissioners and can make a difference to their approach to and use of evidence in decision-making. There is a need for a flexible approach to the concept of evidence in healthcare commissioning, which includes the use of grey literature, and training can encourage and support the systematic search for an appraisal of this type of evidence. Tools for improving and sustaining this aspect of evidence use by commissioners are included here.

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few?

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few? Abstract. Objective: "Child and adolescent psychiatric ward-equivalent treatment" (= stationsäquivalente Behandlung, StäB) is an intensive daily home treatment that has now become available in Germany. Conditions for StäB services were negotiated were negotiated, authorized and came into force by German healthcare commissioners and hospitals on 1 January 2018. However, to date few hospitals in Germany offer StäB, and its feasibility has been questioned. This study evaluates the first 58 cases of StäB in the Department of Child and Adolescent Psychiatry, ZfP Südwürttemberg (2018-2019). Method: All patients admitted consecutively to StäB from 1 January 2018 to 15 August 2019 were included and evaluated solely using descriptive analyses in SPSS.25. Results: The average length of stay in StäB was 37.95 days (SD 15.35). 86.2 % of the families completed treatment, with 3 patients discontinuing treatment and 5 patients needing inpatient admission. Unlike in the literature, internalising disorders predominated (70.7 %), whereas externalizing disorders were diagnosed in only 27.8 % of the patients. The cost of treatment in StäB was on average 8779.25 €. Conclusions: StäB is a viable and well-accepted new treatment alternative for patients requiring inpatient admission. The multiprofessionality of treatment as well as daily contacts are required. Feasibility under the conditions set is given. The average length of stay is slightly longer, but the costs are lower than those of inpatient treatment.

4:12 PM Abstract No. 125 The impact of physician exposure to organized political advocacy in the Society of Interventional Radiology

Political advocacy is critical to the survival and advancement of our field. The Society of Interventional Radiology (SIR) Grassroots program acts as an introductory vehicle to organized political advocacy for many clinicians. The purpose of this study is to report how the grassroots affected the participants’ perceptions regarding legislative activity as well as evaluate its effect on SIR political action committee (SIRPAC) education and participation. A seven question survey was created by the SIR RFS Advocacy, Healthcare, and Economics committee and distributed to Grassroots alumni via email. The survey addressed participant training level, SIRPAC donation pre and post participation, understanding of legislative process, understanding of SIRPAC role, and likelihood to educate peers and promote SIRPAC in the future. Survey data was compiled with QUALTRICS and statistical analysis was performed using Chi-square test. The survey was distributed to 52 Grassroots alumni. 42% (n = 22) completed the survey including 5 attendings and 17 trainees. 100% of respondents indicated that the Grassroots program was effective in improving understanding of current political issues facing IR, increasing understanding of the legislative process and endorse a greater understanding of the political process. 91% reported that they are more likely to educate peers regarding the importance of SIRPAC and participation in the legislative process and 91% reported that they are more likely to promote SIRPAC donation among their peers. More respondents donated to SIRPAC after attending SIR Grassroots (36% vs. 86%; P = 0.002). Participants of the SIR Grassroots program self-report a greater understanding of the legislative process and increased propensity to advocate for IR among their peers. Most importantly Grassroots participants are more likely to donate following their experience further affirming their commitment to advocacy.

Nursing workforce—fit for practice: an overview of the RCN education and training directory

In October 2019, the UK Government responded to the Health and Social Care Committee report on sexual health. The response focused on five key areas; a new national strategy, funding...

Application of new innovations/technology for care of end-stage renal disease in a resource-limited environment.

The costs involved in the management of end-stage renal disease (ESRD) patients are overwhelming the healthcare commitments of countries worldwide and even more so in resource-limited settings. Some countries have intelligently managed to implement universal healthcare coverage for their citizens. Many others, unable to achieve this, have sensibly concentrated on spending their limited resources on less expensive but more important healthcare issues, such as preventive care especially in the areas of waterborne diseases and implementation of universal vaccination. This however leaves a large section of the population with ESRD vulnerable, and it is up to the various stakeholders, including the medical professions, to innovate and partly alleviate their suffering as a social responsibility.

Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews.

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

Development of a Dental School Strategic Plan to Inform Interprofessional Education.

Changes in U.S. health care delivery systems and Commission on Dental Accreditation standards provide impetus for interprofessional education (IPE) and collaborative practice, but roadmaps for engaging dental and dental hygiene faculty to incorporate IPE in a systematic manner are limited. The purpose of this report is to describe the process for creating a strategy and gathering a variety of baseline data to use for determining objectives and metrics and the subsequent development of an IPE strategic plan at the University of North Carolina (UNC) at Chapel Hill Adams School of Dentistry (SOD). SOD IPE committee members included representation from the UNC Schools of Dentistry, Medicine, Pharmacy, and Business. A three-phase framework was developed. Phase 1 (IPE assessment) was an internal environmental scan including a 2017 faculty survey, departmental mapping of IPE activities, comparison of UNC with national results on the IPE component of the American Dental Education Association (ADEA) survey of dental school seniors (2016 graduating class), identification of faculty joint/adjunct appointments at other UNC schools, and a strengths, weaknesses, opportunities, threats (SWOT) analysis. Phase 2 (visioning) consisted of development of IPE mission, vision, and priorities. In Phase 3 (implementation), priorities were developed. Data-gathering led to a strategic plan with three objectives: 1) increase faculty engagement and recognition, 2) develop predoctoral dentistry and dental hygiene IPE curricula, and 3) develop an infrastructure that supports IPE. Specific initiatives and activities, supporting metrics, and estimated costs were developed for each objective. The framework guided a systematic, transparent, and organized process for collecting and monitoring the evidence and directing activities. A three-year strategic plan for IPE was developed in 2017, and implementation is ongoing.

Enhancing primary care support for informal carers: A scoping study with professional stakeholders.

Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long‐term conditions. Caring negatively impacts on carers’ health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty‐four semi‐structured interviews, with 25 participants were conducted, audio‐recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self‐identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers’ needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.

Health-related street outreach: Exploring the perceptions of homeless people with experience of sleeping rough.

To understand how health-related street outreach is perceived by homeless people with experience of sleeping rough. Specialist nursing and primary care services are expected to provide street outreach but there is no specific guidance on how to deliver it. A qualitative description study. Purposive opportunistic sampling was used to recruit participants from three drop-in centres in London. Ten semi-structured interviews were conducted between 4 June 2018 - 28 June 2018 and Braun and Clarke's thematic analysis was used. Health-related street outreach was perceived as being able to offer a human connection that reduced the sense of isolation and exclusion commonly experienced on the street. People with experience of sleeping rough felt it could overcome access barriers and provide a bridge to healthcare services. Crucially the right approach was deemed to be essential and was defined by participants in terms of location, timing, the outreach team, and the verbal and non-verbal styles used by outreach workers. Health-related street outreach is a valuable health promotion tool for people experiencing homelessness that should be financially supported by healthcare commissioners and employers. Providers of health-related street outreach must adopt the right approach and the development of guidelines could assist services to achieve this. The findings of this study can inform planning and review of health-related street outreach to ensure that the approach taken by healthcare workers is acceptable to, and based on the views of, the people these services are provided for.

Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2019.

Since 2010, the Women's Health Care Committee has continuously addressed issues closely linked to women's quality of life. The five agendas this committee has engaged for this academic year are as follows: (i) clinical study of urinary complications in perinatal and post-partum women's health care; (ii) enlightenment of infectious diseases in Obstetrics and Gynecology in Japan; (iii) educational activities regarding management guidelines for health care in female athletes; (iv) training program for women's health-care advisers; and (v) pregnancy- and lactation-associated osteoporosis (PLOP). The detailed activities of the five subcommittees are described herein. This report is based on the Japanese version of our annual report (Acta Obst Gynaec Jpn 2019;71(6): 889-898), which publicizes the activities of our committee.

Defining medical information privacy in China: a quantitative and qualitative study

BackgroundThe potential value of big data in health care is huge. The Chinese State Council issued the Guides on Promoting and Regulating the Development of Big Data Applications in Health Care to encourage opening and sharing of health data. However, some data controllers in China are unwilling to open and share data because of privacy risks. We aimed to identify medical information that should be removed or processed before sharing of health data, so to ensure that data are shared in a safe and controlled manner. MethodsUsing cluster sampling, we selected ten departments in a hospital in Shanghai between March 5, 2018, and May 1, 2018. 456 patients in the departments were administered a questionnaire that included requests to provide basic personal information and questions on awareness of privacy, control over data, and willingness to share data. In addition, a convenience sample of 50 medical staff, 25 patients, and six management personnel was selected for one-to-one interviews about issues related to medical information privacy. Feedback from patients, doctors, and management personnel was summarised and used in consultation with experts to define categories of medical data that should be considered when opening and sharing health data in China. All analyses were descriptive. FindingsWe defined five categories of identifiable characteristics, including name, identity document number (eg, identification card number and driver's license number), contact information (eg, telephone number and home address), accounts number (eg, social security number and medical record file number), and biometric identification (eg, fingerprint and DNA). We identified eight types of diseases, including reproduction-related diseases, infectious diseases, mental diseases, malignant tumours, hereditary diseases, anal diseases, rare diseases, and other incurable diseases. Finally, we defined three identities, including mother, patient with malignant tumour, and government personnel. Health data were classified by privacy level as summary datasets, limited datasets, and identifiable datasets. InterpretationThe Health Care Commission in China should set regulations to define the content and scope of privacy data in health care. The five categories of identifiable characteristics, eight types of diseases, and three types of identities we have defined could be referred to when setting these regulations so that secondary use of data is possible. FundingNational Natural Science Foundation (grant number 71473164).