Multidisciplinary Service Research Articles

Redesigning antenatal care: Prospective use of an implementation framework to establish a population-based multidisciplinary first-trimester screening, assessment and prevention service.

Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history-based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population-based screening has failed to be translated into broad clinical practice. This study aimed to redesign antenatal care within an Australian public healthcare centre to align with evidence-based maternity care, including population-based first-trimester screening with early initiation of preventative strategies in high-risk pregnancies. A five-phase action-process model, sharing key elements with implementation science theory, was used to explore barriers to change in antenatal care, co-design a novel service with consumers and establish a population-based antenatal pathway commencing with a multidisciplinary first-trimester screening, assessment and planning visit. The case for change and associated barriers were defined from the perspective of antenatal care stakeholders. Key needs of each group were established, and solutions were created using co-design methodology, allowing the team to create a novel approach to antenatal care which directly addressed identified barriers. Implementation of the service was associated with a fall in the median gestation at first specialist maternity care provider visit from 20 to 13 weeks. This study confirms the feasibility of establishing a comprehensive first-trimester screening program within a public Australian healthcare setting and highlights a co-design process which places individualised assessment at the forefront of antenatal care. This framework may be applicable to most public maternity settings in Australia, with expansion aimed at providing equity of care, including in rural and remote settings.

#2818 Clinical outcomes of a pre-dialysis cohort in a tertiary renal centre in the United Kingdom

Abstract Background and Aims Patients with advanced chronic kidney disease (CKD) require significant resources in order to manage the complications of CKD, and provide education and planning for renal replacement therapy (RRT). To better gauge the clinical trajectory of these patients, we aimed to provide a descriptive overview of patients who attended the multidisciplinary Advanced Kidney Care Service (AKCS) clinic over 8 years in a tertiary renal referral centre in the United Kingdom. Patients are typically referred to this clinic once their estimated glomerular filtration rate (eGFR) drops below 20 ml/min/1.73 m2. Method This was a retrospective study of consecutive patients who first attended the AKCS clinic in our centre between September 2011 and September 2018, and last follow-up was the end of September 2023. Patients with a prior renal transplant, those with acute kidney injury with subsequent recovery of renal function, and those lost to follow-up were excluded. Patient details and outcomes were extracted from the hospital Electronic Patient Record including demographics, decisions regarding active or conservative management, timing of RRT initiation, first modality of RRT, transplantation, and mortality. The primary outcomes of interest included time to RRT, first modality of RRT, and death. Results A total of 1 957 patients were included. Of these 1,136 (58%) were male and 821 (42%) female. Median age was 69 years at the time of first AKCS review. A large proportion (80%) identified as white British, 13% as Asian or Asian British, 2% as Black or Black British, and the remaining as other ethnicities. Median eGFR was 16 ml/min/1.73 m2 (IQR 4-25 ml/min/1.73 m2) at first AKCS clinic. A total of 1 087 patients (56%) initiated RRT during follow-up. The first modality was haemodialysis in 622 (57%), peritoneal dialysis in 298 (27%), and a renal transplant in 167 patients (15%). Median time to RRT commencement was 12.2 months (IQR 6.4-30). A further 240 patients received a transplant after dialysis. Of the 870 patients who did not initiate RRT, 350 (40%) were documented as opting for conservative management. 756 (38.6%) patients died either before RRT initiation (434) or on the conservative care pathway (322). A further 583 (29.8%) who commenced RRT died during follow up. Median time to death from first AKCS review was 38.5 months in the active management group (21.8 months in those who died without RRT and 51.0 months in those on RRT) compared to a median of 29.7 months in the conservative group. Conclusion This study presents a descriptive analysis of long-term outcomes in a high-risk group of patients. Two-thirds of patients died within 5 years of their first AKCS review, demonstrating the high mortality burden in this population. Of those who died prior to RRT, 57.4% had opted for RRT or were undecided, highlighting the substantial competing risk of death prior to reaching end stage kidney disease. We are planning further work with this dataset including risk prediction modelling. The ability to risk-stratify and profile patients, including consideration of co-morbidities and clinical frailty score, would be beneficial for patients and healthcare providers when making decisions regarding RRT and conservative care.

#1377 Evaluation of state-wide health system implementation of renal supportive care shows substantial net benefits

Abstract Background and Aims In 2016, the New South Wales (NSW) Health system implemented a service to make the principles and practice of palliative medicine comprehensively available to patients receiving chronic kidney disease (CKD) care across NSW. Summative evaluation of the economic value that this multi-disciplinary State-wide RSC service provided following implementation was prospectively planned in the domains of patient experience and economic value. This abstract reports the first cost-benefit analysis of a RSC service. Method De-identified patient-level data was extracted from the NSW Renal Supportive Care Register (a linked dataset comprising admitted patient, non-admitted patient, emergency department episodes and death registrations). Data was compared between 2015/16, prior to implementation of the State-wide RSC service; and 2018/19, following settled operation of the service. A cost-benefit analysis model was constructed to estimate the economic value of the RSC service between 2015/16 and 2018/19; and the projected value to 2029/30 under different scenarios. Multivariate Cox regressions were estimated to measure survival benefits, and a polynomial regression model was employed to estimate the impact of RSC on the share of patients receiving dialysis. Results Considering the actual impact of the NSW RSC service; in 2015/16, 5% (n = 443) of all ESKD patients, (defined as receiving dialysis >3 months, non-dialysis conservative care or in receipt of a functioning transplant) received any RSC service. By 2018/19, 16% (n = 1460) of all ESKD patients had received RSC within NSW. The proportion of patients receiving RSC from a non-dialysis conservative care or dialysis context remained stable between 2015/16 and 2018/19 at 41% and 29% respectively. Patients receiving RSC were estimated to have increased survival by 3-21 weeks, depending on patient characteristics, compared to the scenario of no RSC service. Considering the projected value of ongoing RSC services; scenarios with different assumptions were modelled. Assuming that the proportion of patients receiving different ESKD modalities and the costs of care remained stable, the RSC service would deliver a net financial benefit to the commissioning health system (avoided costs of service minus RSC costs) of ${\$}$109 million Australian Dollars (AUD), with a return on investment of 212%, compared to the scenario of no RSC service. When the economic value for the whole NSW community from increased survival benefit was included, the projected value was ${\$}$275 million AUD, with return on investment of 535%. The projected economic value of RSC was modelled under scenarios of increasing access to the service by ESKD patients (Figure). Increasing RSC access from the achieved 16% to 20% of ESKD patients was projected to deliver maximal economic value, with a 3% fall in ESKD patients receiving dialysis, increasing survival benefit (${\$}$221 million AUD) and economic value ${\$}$94 million AUD. As access to RSC expands further, modelling indicates that additional dialysis substitution becomes less likely but benefits still accrue from survival up to a maximum viable rollout of 50% of the ESKD population receiving RSC, when survival benefits plateau. Conclusion Economic evaluation of this implementation of the Statewide RSC service across NSW Health shows it has been associated with both a net economic benefit and survival benefits four years after implementation. It is projected to provide an economic value of ${\$}$275 million AUD over ten years, which would increase with greater participation of ESKD patients suitable for RSC.

OUTCOME OF TRANSMETATARSAL AMPUTATIONS IN PATIENTS WITH DIABETES MELLITUS: A MULTIDISCIPLINARY FOOT CARE SERVICE APPROACH

AimThis retrospective case series reports the reoperation, major amputation, survival rates and mobility status in diabetic patients who underwent a trans-metatarsal amputation (TMA) managed within a multi-disciplinary diabetic foot care service.Methods and patientsForty-one consecutive patients (37 men, 4 women) underwent a TMA between January 2008 to December 2017. They were retrospectively reviewed. The mean age at the time of surgery was 63 years (range 39 – 92).ResultsEighty-eight per cent (36/41) of the patients were followed-up. Four (11%) of the 36 patients required reoperation, including three major amputations (8%). All the patients requiring a reoperation were vasculopaths. The four-year patient survival rate following a TMA was 69% (25/36). Ninety-six per cent (21/22) of the surviving patients not requiring revision to a major amputation were fully mobile in bespoke orthoses, of whom a third required a stick.ConclusionThis study shows that transmetatarsal amputation in patients with diabetes, managed in a multi-disciplinary diabetic foot care service, is effective for limb salvage.

Delivering a Specialised Best Practice Service for People with Functional Neurological Disorder: An Australian Qualitative Descriptive Study

Specialised functional neurological disorder (FND) clinics are emerging as the preferred way of providing best practice care to people with FND. However, questions remain around optimal care pathways, service provision, and resources. This study aimed to identify (1) service characteristics of Australian FND models of care; (2) barriers and enablers to implementing a specialised FND service; and (3) enablers and barriers to providing best practice management for people living with FND. Clinicians were recruited from Australian public and private healthcare organisations identified as leading best practice for adults with FND. Clinicians completed a structured interview via phone. A descriptive content analysis was used. Five out of 12 healthcare organisations interviewed had a specialised multidisciplinary FND service. All specialised FND services were outpatient programs, but the structure and referral pathways varied. Barriers identified by organisations with an FND service included “funding” and “staff and service fragility,” while enablers included “engaging stakeholders” and having a clear “service driver.” “Diagnosis delay” and “insufficient access to staff” were identified as barriers to implementing best practice by organisations without a specialised FND service. Despite specialised clinics being recognised as a practical way to deliver care to people with FND, only a few services operate in Australia. Timely and educated diagnosis and access to an interdisciplinary team consisting of neurology, physiotherapy, and psychology are central pillars for FND services. Further work to establish clinically and economically effective delivery models is required to facilitate the provision of best practice care for people living with FND.

How do primary care clinicians approach the management of frailty? A qualitative interview study.

Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary care is ad hoc and opportunistic, but there has been little focus on the challenges of frailty management, particularly within the context of recent introduction of primary care networks and an expanding allied health professional workforce. Explore the views of primary care clinicians in England on the management of frailty. Semi-structured interviews were conducted with clinicians across England, including general practitioners (GPs), physician associates, nurse practitioners, paramedics and clinical pharmacists. Thematic analysis was facilitated through NVivo (Version 12). A total of 31 clinicians participated. Frailty management was viewed as complex and outside of clinical guidelines with medication optimisation highlighted as a key example. Senior clinicians, particularly experienced GPs, were more comfortable with managing risk. Relational care was important in prioritising patient wishes and autonomy, for instance to remain at home despite deteriorations in health. In settings where more formalised multidisciplinary frailty services had been established this was viewed as successful by clinicians involved. Primary care clinicians perceive frailty as best managed through trusted relationships with patients, and with support from experienced clinicians. New multidisciplinary working in primary care could enhance frailty services, but must keep continuity in mind. There is a lack of evidence or guidance for specific interventions or management approaches.

THRIVING IN MOTION – YOUTH MOVES: MOVEMENT FOR TRANS AND GENDER DIVERSE YOUNG FOLK

CASE SETTING Gender diverse young people have lower rates of exercise, and higher rates of mental and physical health challenges, perpetuated by a lack of trans-friendly physical activity providers and environments. Our collaborative project aimed to create and support community-based exercise opportunities for trans and gender diverse young people (15-25yrs) to increase participation and improve their physical and mental health outcomes. Alongside feasibility data from 18 months delivery, two case studies will be presented (23 yrs non-binary individual, presenting with disordered eating and exercise, neurodivergence and mental illness; 18yrs transfeminine presenting with neurodivergence and participation barriers). APPROACH AND TREATMENT Through targeted community collaboration with young people and multidisciplinary support services, a supportive and inclusive structured exercise program was created. Specifically, we delivered and evaluated the feasibility of the exercise program for gender diverse young people; and educated the wider exercise and health community on inclusive exercise practices. RESULTS Forty-six gender diverse young people participated across the delivery of 11 x 8-10 week programs in 5 Perth metro locations, totalling 4518 exercise therapy hours. On average 100% of participants reported a score higher than 3/5 for program enjoyment, 79% of participants reported a score higher than 3/5 for motivation to return. Participants on average increased weekly physical activity participation by 50% since commencing the program, and 100% of participants would recommend the program to other trans peers. REFLECTIONS/LEARNINGS In WA, the absence of exercise opportunities for gender diverse young people prompted our tailored program. We prioritized inclusivity, safety, and participant-specific needs. Our proactive approach included health screenings, upskilling staff, and encouraging a supportive environment. Listening to participant expectations, involving a Youth Advisory Group, and engaging a Youth Engagement Officer proved vital for program success. Our reflections incorporate the significance of tailored, inclusive programs and community involvement in fostering active, safe spaces.

Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis

BackgroundTelemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel...

THE EFFECTIVENESS OF PROGRESSIVE RESISTANCE TRAINING IN MANAGING PROGRESSIVE SUPRANUCLEAR PALSY: A CASE STUDY

SETTING The Centre for STRONG Medicine is an outpatient multidisciplinary geriatric service at Concord Hospital, Sydney. An 82-year-old male with a primary diagnosis of Progressive Supranuclear Palsy (PSP) with cardiac and metabolic comorbidities was referred in March 2023. PSP is a rare neurological disorder that affects gait, balance, vision, and cognition. The participant mobilised with a rollator and had previously sustained vertebral and wrist fractures secondary to falls. MANAGEMENT Management was to use progressive resistance training (PRT) to combat mobility decline, prevent falls and provide education to encourage independent exercise. Initial assessment determined current health status using Falls Self Efficacy Scale (FSE-I) and Fried Frailty Phenotype (FFP) questionnaires, and measured function and strength using maximal gait speed, five times sit-to-stand (5xSTS) and one repetition maximum (1RM), respectively. FSE-I determined a high fear of falling and FFP determined frail classification. Outcomes informed the PRT exercise prescription targeting the major muscle groups for 2-3 sets of 7-9 repetitions at 70-85% 1RM progressed gradually and preformed twice weekly in a supervised group. Education regarding breathing, exercise tempo, rest, progression, and risk mitigation were provided. All outcomes were reassessed after 12-weeks of training. RESULTS Attendance was 100% (23 sessions) with improvement in all outcomes. Functional improvements included 0.25metres/second increase in maximal gait speed, 2.5 second reduction in 5xSTS, and safe mobilisation without a rollator. Strength improvements included 101% increase in 1RM leg press, 100% increase in 1RM triceps extension and 72% increase in 1RM seated row. Frailty status improved to pre-frail and fear of falling reduced. Self-reported improvements included increased steadiness and confidence exercising unsupervised. DISCUSSION Although PSP is progressive, PRT resulted in meaningful benefits in strength and function that improved daily task performance and confidence. Further research is needed to investigate the effects of PRT on PSP management in a larger cohort.

Mental health, COVID-19 burden and quality of life of kidney transplant recipients two years after the COVID-19 pandemic.

Few studies have evaluated the psychological distress of COVID-19 in kidney transplantation and the psychological impact that the COVID-19 pandemic has had on kidney transplant recipients is not yet well understood. The present study aimed to investigate the change in symptom burden and health-related quality of life in the two years after initial assessment, by outlining the change over time of symptoms at 12 and 24 months of follow-up. This is a follow-up study. We performed a study published in 2021 (phase 1 of COVID-19); of the 89 kidney transplant recipients evaluated in this study, 60 completed the 12 months follow-up (March 2021 June 2021, phase 2 of COVID-19) and 57 completed the 24 months follow-up (March 2022 June 2022, post COVID-19). The same tools as in previous study were administered: the ad hoc questionnaire on emotional state and psychophysical well-being during COVID-19, the Middlesex Hospital Questionnaire (MHQ) to provide a simple and rapid quantification of the psychological and somatic symptoms and the Short Form Health Survey 36 (SF-36) was used to assess health-related quality of life. Compared to the first and second phase of COVID-19, the mean score of quality of life variables were higher in the post COVID-19 phase; thus the recipients physical health, mental health and their perception of their general health improved. Regarding the psychopathology variables the levels of Anxiety, Depression and Phobia in the Post COVID-19 phase decreased, while the Somatization score was higher. Lastly, burden of COVID-19 scores in the third phase, significantly decreased. Our study highlights a significant association between mental health and the burden of COVID-19 pandemic in kidney transplant recipients. This study showed, a significant worsening, over time, of some specific symptoms, such as somatization and phobias. However, the results showed that depressive symptoms improved during the study period. Long-term monitoring of kidney transplant recipients therefore remains fundamental. These results confirmed the need to provide integrated multidisciplinary services to adequately address the long-term effects of the COVID-19 pandemic on the mental health of the most vulnerable subjects.

Scientific Communication Initiative at a Medical Military Library

Implementation of new scholarly communication library service in the digital age is characterized by the competitive forces between the old library information services and the ambiguity of future information services. This research analyzes the development process of scientific initiative and collaborative partnership in the military medical library environment aimed to enhance the quality of scientific communication and information skills in military residents and clinicians. The hindering internal and external forces and facilitators of developing and implementing scientific initiative service in the military medical library are evaluated. The environmental analysis was conducted to determine the scholarly communication needs in the scholarly military medical environment. The ambassador-based model was used for the development of scientific communication initiative (SCI) at the military medical library. The SCI consisted of two components: library information communication and scientific communication. This implementation in the military medical environment enhanced scholarly communication, research skills development, and information education. A collaborative Scientific Hub, and liaison partnerships with military graduate medical education program directors and clinicians enhanced the scientific communication and information skills in residents. The Ambassador model, used in the development of scientific initiative in academic and military environments, was valuable for developing and implementing specialized interdisciplinary and multidisciplinary information services in the academic and military environment. Higher education hierarchy, educational needs, organizational hierarchy, academic culture, and educational environment influence the implementation of information services in academic and military environments.

Can the introduction of a 12-lead ECG help reduce mortality in those presenting with foot ulceration to multidisciplinary diabetic foot clinics? An observational evaluation of a real-world implementation pilot in England

Aims/hypothesisThe risk of dying within 2 years of presentation with diabetic foot ulceration is over six times the risk of amputation, with CVD the major contributor. Using an observational evaluation of a real-world implementation pilot, we aimed to assess whether for those presenting with diabetic foot ulceration in England, introducing a 12-lead ECG into routine care followed by appropriate clinical action was associated with reduced mortality.MethodsBetween July 2014 and December 2017, ten multidisciplinary diabetic foot services in England participated in a pilot project introducing 12-lead ECGs for new attendees with foot ulceration. Inception coincided with launch of the National Diabetes Footcare Audit (NDFA), whereby all diabetic footcare services in England were invited to enter data on new attendees with foot ulceration. Poisson regression models assessed the mortality RR at 2 and 5 years following first assessment of those receiving care in a participating pilot unit vs those receiving care in any other unit in England, adjusting for age, sex, ethnicity, deprivation, type and duration of diabetes, ulcer severity, and morbidity in the year prior to first assessment.ResultsOf the 3110 people recorded in the NDFA at a participating unit during the pilot, 33% (1015) were recorded as having received an ECG. A further 25,195 people recorded in the NDFA had attended another English footcare service. Unadjusted mortality in the pilot units was 16.3% (165) at 2 years and 37.4% (380) at 5 years for those who received an ECG, and 20.5% (430) and 45.2% (950), respectively, for those who did not receive an ECG. For people included in the NDFA at other units, unadjusted mortality was 20.1% (5075) and 42.6% (10,745), respectively. In the fully adjusted model, mortality was not significantly lower for those attending participating units at 2 (RR 0.93 [95% CI 0.85, 1.01]) or 5 years (RR 0.95 [95% CI 0.90, 1.01]). At participating units, mortality in those who received an ECG vs those who did not was lower at 5 years (RR 0.86 [95% CI 0.76, 0.97]), but not at 2 years (RR 0.87 [95% CI 0.72, 1.04]). Comparing just those that received an ECG with attendees at all other centres in England, mortality was lower at 5 years (RR 0.87 [95% CI 0.78, 0.96]), but not at 2 years (RR 0.86 [95% CI 0.74, 1.01]).Conclusions/interpretationThe evaluation confirms the high mortality seen in those presenting with diabetic foot ulceration. Overall mortality at the participating units was not significantly reduced at 2 or 5 years, with confidence intervals just crossing parity. Implementation of the 12-lead ECG into the routine care pathway proved challenging for clinical teams—overall a third of attendees had one, although some units delivered the intervention to over 60% of attendees—and the evaluation was therefore underpowered. Nonetheless, the signals of potential mortality benefit among those who had an ECG suggest that units in a position to operationalise implementation may wish to consider this.Data availabilityData from the National Diabetes Audit can be requested through the National Health Service Digital Data Access Request Service process at: https://digital.nhs.uk/services/data-access-request-service-dars/dars-products-and-services/data-set-catalogue/national-diabetes-audit-ndaGraphical

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

Youths with type 2 diabetes are at higher risk for complications compared with peers with type 1 diabetes, though few studies have evaluated differences in access to specialty care. To compare claims with diabetes specialists for youths with type 1 vs type 2 diabetes and the association between specialist claims with multidisciplinary and acute care utilization. This cross-sectional study used Optum Clinformatics Data Mart commercial claims. Individuals included in the study were youths younger than 19 years with type 1 or 2 diabetes as determined by a validated algorithm and prescription claims. Data were collected for youths with at least 80% enrollment in a commercial health plan from December 1, 2018, to December 31, 2019. Statistical analysis was performed from September 2022 to January 2024. The primary outcome was the number of ambulatory claims from an endocrine and/or diabetes physician or advanced practice clinician associated with a diabetes diagnosis code; secondary outcomes included multidisciplinary and acute care claims. Claims were analyzed for 4772 youths (mean [SD] age, 13.6 [3.7] years; 4300 [90.1%] type 1 diabetes; 472 [9.9%] type 2 diabetes; 2465 [51.7%] male; 128 [2.7%] Asian, 303 [6.4] Black or African American, 429 [9.0%] Hispanic or Latino, 3366 [70.5%] non-Hispanic White, and 546 [11.4%] unknown race and ethnicity). Specialist claims were lower in type 2 compared with type 1 diabetes (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]; P < .001) in propensity score-weighted analyses. The presence of a comorbidity was associated with increased specialist claims for type 1 diabetes (IRR, 1.07 [95% CI, 1.03-1.10]) and decreased claims for type 2 diabetes (IRR, 0.77 [95% CI, 0.67-0.87]). Pooling diagnosis groups and adjusted for covariates, each additional specialist claim was associated with increased odds of a claim with a diabetes care and education specialist (odds ratio [OR], 1.31 [95% CI, 1.25-1.36]), dietitian (OR, 1.14 [95% CI, 1.09-1.19]), and behavioral health clinician (OR, 1.16 [95% CI, 1.12-1.20]). For acute care claims, each additional specialist claim was associated with increased odds of admission (OR, 1.17 [95% CI, 1.11-1.24]) but not for emergency claims (OR, 1.03 [95% CI, 0.98-1.82]). This cross-sectional study found that youths with type 2 diabetes were significantly less likely to have specialist claims despite insurance coverage, indicating other barriers to care, which may include medical complexity. Access to diabetes specialists influences engagement with multidisciplinary services. The association between increasing ambulatory clinician services and admissions suggests high utilization by a subgroup of patients at greater risk for poor outcomes.

Community mental health services in Europe: the state of art

AbstractIn Europe there is significant variability of attitudes, procedure and strategies in clinical care between psychiatrists and settings across different regions and countries. However, there is a significant overrepresentation of data from mental health services from Western and Northern European countries, due a lack of data from Eastern and Central European countries as it has been suggested the Eastern and Central European regions are a “blind spot on the global mental health map”. In respect to community mental health services, Northern and Western countries introduced a large array of multidisciplinary community-based services for people with mental health problems and reorganized the mental health care services towards the community mental health care, replacing largely large hospitals and hospital-based care following recovery-oriented care models with introduction of numerous services which supported full recovery, including supported employment and housing. This process is only in the beginning in the majority of countries in the South and East of Europe. Here we present the data from these countries including the results of the RECOVER-E study (Large-scale implementation of community based mental health care for people with severe and enduring mental ill health in Europe), which incorporated the implementation of community mental health services in five South-eastern European countries.Disclosure of InterestNone Declared

The impact analysis of multidisciplinary integrated postabortion care services on contraceptive compliance and fertility preservation in patients undergoing induced abortion

The impact analysis of multidisciplinary integrated postabortion care services on contraceptive compliance and fertility preservation in patients undergoing induced abortion

Enhancing the provision of cancer nutrition information to support care through experience-based co-design: a mixed-methods study.

Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it "took too much time to find evidence-based nutrition and cancer information", and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.

Cultural perspectives and experiences of mental healthcare in Kwa-Zulu Natal, South Africa

Background: Healthcare systems reflect worldviews, specifically in mental health, where norms dictate what is normal and abnormal. The era of coloniality promoted Western dogma over collectivist cultures, which were marginalised. This study explored the perspectives and experiences of Black, isiZulu-speaking, South Africans who utilised multidisciplinary services, based on a Western-based therapy model at a private psychiatric facility in KwaZulu Natal. Methods: A qualitative descriptive design was utilised. Purposive sampling was utilised to recruit 10 participants. Data was collected through semi-structured interviews. Braun and Clarke’s six phases of thematic analysis were used to guide the data analysis. Findings: Three themes with sub-themes emerged from the data: personal perceptions, which explored how isiZulu-speaking people made sense of mental health and mental illnesses. Cultural perceptions were the collectivist method of problem-solving, which stressed the importance of spiritual beliefs. Health-seeking behaviour considered the experience of the isiZulu-speaking mental health care user. Cognitive dissonance prevailed due to the difference between westernised mental health treatment and traditional healing systems. Conclusion: The family and community are intertwined in participation, reputation, and healing. There is an emphasis on enduring hardship and following traditions, which are preserved by valued elders. Disregarding these norms can outcast the Zulu individual who strives toward inclusion within the community. Implications for practice: Intervention cannot only be at individual level but also community level. Including the family in psychoeducation and therapeutic goal settingwould be beneficial to the Zulu MHCU. Group programmes should address gender-specific issues. Occupational therapists must recognise the importance of participating in spirituality for the healing of the Zulu MHCU and appropriately include it in intervention. Mental health resources and awareness programmes need to be disseminated atcommunity level. Competency in the isiZulu language is recommended.

Wide-ranging needs and recommendations following holistic sleep assessment and intervention, for children and young people with neurodevelopmental and psychosocial vulnerabilities

A service evaluation was conducted on a community-based, multidisciplinary sleep service for children and young people (CYP) with neurodevelopmental disorders (NDD) and psychosocial vulnerabilities. Referrals for 200 children were received over an 11-month period from two inner-city boroughs. 85.5% (171) of CYP presented with at least one neurodevelopmental disorder; most commonly Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactive Disorder (ADHD). 55% (111) CYP also experienced at least one external psychosocial complexity such as: suboptimal housing conditions, safeguarding concerns, medical conditions, and social support. Each referral received a one-hour paediatrician-led holistic sleep assessment. Following this, 136 families were referred for psychologist-led psychoeducational parent workshop, and follow-up telephone contacts to support implementation of behavioural interventions or 1:1 psychologist-led support. 95% of families who engaged with the psychoeducational workshop reported improvement in sleep problems, and 86% of families that engaged with 1:1 psychologist-led support reported improved sleep. We believe the model could be easily replicated, adapting for local needs where necessary.

Resistance Exercise Program Is Feasible and Effective in Improving Functional Strength in Post-COVID Survivors.

Background: Evidence suggests that COVID-19 infection can cause lasting health consequences. Multidisciplinary rehabilitation services have been recommended to reduce the sequalae. However, the effectiveness of physical exercise interventions remains insufficiently documented. The aim of this study was to develop and implement a specific and well-tolerated protocol-based intervention to reduce muscle weakness in older adults impacted by COVID-19. Methods: Forty-six older adults were randomized into intervention and control groups. Isometric and isokinetic strength assessments were conducted for selected muscle groups using a JBA Staniak® torquemeter and Biodex System 3 dynamometer. Functional abilities were evaluated with the Time Up and Go test and Chair Stand Tests. Results: Men in the intervention group demonstrated a significant improvement in static conditions for knee flexors (KFs), trunk extensors (TEs) and trunk flexors (TFs) and in dynamic conditions for knee extensors (KEs). Women in the intervention group showed a significant improvement in static conditions for EFs, KFs, TEs and TFs and in dynamic conditions for a KE and a KF. The interaction GROUP × TESTING SESSION was significant for the Chair Test (s) and Chair Test (n). Conclusions: Our results demonstrate the effectiveness of a well-tolerated, protocol-based approach that can be used to diminish long-lasting functional deficits in post-COVID survivors.

Gap analysis of diabetes-related foot disease management systems in Pacific Islands Countries and Territories

BackgroundPacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region.MethodsA cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks.ResultsSeven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development.ConclusionDespite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.