Specialist Nurses Research Articles

Knowledge, Attitudes, and Practice of Master Nursing Specialist Students Toward Catheter-Related Thrombosis: A Cross-Sectional Study.

Evaluating Master of Nursing Specialist (MNS) students' knowledge, attitudes, and practice regarding catheter-related thrombosis (CRT) prevention and treatment is beneficial in developing effective CRT training for them. This study thus aimed to explore their knowledge, attitudes, and practice toward CRT. This was a cross-sectional study that included 1046 MNS students in China. The results revealed that the median scores for the participants' knowledge, attitudes, and practice were 12 (interquartile range: 9-14), 55 (interquartile range: 50-65), and 62 (interquartile range: 51-71), respectively. There was a positive correlation between knowledge and attitudes, as well as attitudes and practice. Age, school level, proactively learning CRT knowledge, gender, enrolment method, participation in clinical practice time, and attendance at CRT training were related to knowledge (p < 0.05). Attendance at CRT training and experience using thrombosis risk assessment forms were related to attitude and practice (p < 0.05). Gender and experience caring for CRT patients were associated with practice (p < 0.05). MNS students have insufficient knowledge of CRT prevention and treatment, and the practice needs to be improved. However, their attitudes are positive.

OGC SO08 - Optimising Analgesia in Sub-total Oesophagectomy: A Dose of Success

Abstract Background Sub-total oesophagectomy (STO) is a complex and major surgery with significant associated burdens for our patients. Our centre in North-East England completes 70-80 STOs annually. In the peri-operative period, good analgesia management and delivery is key. Analgesia strategy has evolved across the UK over the past decade, influenced by multi-modal analgesia, progressing surgical approaches towards minimally invasive operations alongside the ongoing drive for enhanced recovery programmes endorsing early mobilisation. Surgical approach in our patient cohort now comprises a combination of Open-Open, combined Open-Minimally invasive and entirely minimally invasive techniques. Our analgesia strategy combines single shot intrathecal diamorphine and regional anaesthesia. Method We engaged our multi-professional (Acute Pain Specialist Nurses, Anaesthesia Consultants and Surgical Consultants) team in a PDSA cycle. A guidance analgesia package was agreed after review of retrospective cases. This package was delivered to our baseline group of 10 patients. We used subjective patient reported abdominal and thorax pain scores on a 0-10 scale, recorded by our pain team each day for post-operative days 1-5. Following analysis, we implemented a single change to Intrathecal diamorphine dosing - changing from uniform delivery of 1000micrograms intrathecal diamorphine to a dose calculated on Ideal Body Weight of 15-20micrograms/kg up to 1500micrograms maximum dose Results Our baseline group of 10 patients all received 1000micrograms of intrathecal diamorphine - mean dose 15.9mcg/kg. Our intervention group of 12 patients received doses based upon their ideal body weight - mean dose 18.9mcg/kg. Overall, there was a trend of reduced pain scores following our intervention. Thoracic reported overall pain scores were significantly lower (p=0.04) following the intervention. No significant difference was demonstrated specifically in the first 24 or 48hours in overall, abdominal or thoracic pain scores. Importantly, there were no reported adverse events related to our higher dosing regime and no recorded side effects such as pruritis or nausea. Conclusion There is little evidence with regards the use of higher dose intrathecal diamorphine in the literature. The sample sizes in our groups are small but overall reduction in patient reported pain scores appear to be associated with use of the higher dose of intrathecal diamorphine, based upon ideal body weight and importantly without any adverse effect. Continued evolution of our analgesia strategies is essential alongside that of surgical techniques. The next iterations of our guidance and PDSA cycle will consider our regional techniques to identify if further advances can be made.

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

Abstract 4136822: Implementation of a Community-Engaged Amputation Prevention Intervention in Rural Appalachia

Amputation is a devastating complication of diabetes and peripheral artery disease and a marker for health inequity. Implementation Science (IS) and Community Engaged-Research (CenR) allow for real-world adaptation of evidence-based interventions and provide critical frameworks for reproducibility and sustainability. However, few amputation interventions use these approaches. We describe the feasibility and acceptability of an IS and CEnR driven amputation intervention in a high-risk rural community. A Pre-Post mixed methods design was used (Fig 1). Intervention components were mapped to the Social-Ecological Model (Fig 2) and guided by the CFIR. Community and Project Advisory Boards collaborated on needs assessment, mobilizing resources, intervention adaptation, data review and dissemination. A 3-component intervention was implemented in 2 clinics to improve local foot care. Components included diabetic foot exams (DFEs), a multidisciplinary limb preservation team, and a “hot-foot” hotline. Pre-implementation, a retrospective chart review was performed along with focus groups. DFE training was then conducted at each site. After training, a prospective chart review was performed with clinic check-ins for 12 months. Focus groups were held 6- and 12-months post-implementation. Concurrently, monthly multidisciplinary teleconferences were held, and a “hot-foot” phoneline connected providers to specialty nurses. At baseline, 155/224 (69.2%) patients received an annual DFE, 17% had all four exam components, 15.6% had foot abnormalities identified and 3.6% were referred to specialists. At 12-months 212/268 (79.1%) patients received a DFE, 84.7% had all components, 54.9% had abnormalities and 20.1% were referred. All findings were statistically significant. Clinically there was a significant decrease in patients with foot wounds, infection, and foot-related hospitalization/ED visits. There were no changes in amputations. (Table 1) The virtual teleconference completed 12 sessions. The hotline was used once with clinicians reporting they did not need it. We demonstrate successful, sustained implementation of an amputation prevention intervention in a high-risk rural community using IS and CEnR. This approach was crucial for overcoming barriers to intervention implementation in a resource poor environment. Additional research to assess patient experience, understand key components of the intervention and study scalability and clinical effectiveness is planned.

Nursing practice of guidelines for prevention and control of vascular Catheter-Related bloodstream infections.

To apply the Ottawa Model of Research Use to translate the Guidelines for the Prevention and Control of Vascular Catheter-Associated Bloodstream Infections. The Ottawa model of research use is used to provide a framework and guidance. This study was organized by the Nursing Department of the Affiliated Hospital of Hebei Engineering University, and the Intravenous Therapy Group was responsible for the implementation of the study. The hospital's intravenous therapy administrators, members of the sedation team, and specialist nurses will be organized to evaluate the importance, exactness, and clinical practicability of 34 entries. Twelve clinical departments and IV therapy clinics with a high number of central venous catheters were used as sites for translating evidence from this project. The evidence-based team assessed the practice environment, potential practitioners, and clinical status of clinical translation of evidence through symposia, review of relevant systems, operational procedures, on-site inspections, and questionnaires. They compare evidence with existing processes and decide on change strategies. Before and after the application of the evidence, there was a significant increase in the knowledge, belief, and behavior of healthcare workers on CLABSI prevention and control, especially in the acquisition of related knowledge (χ2 = 26.648 p < 0.001). The associated implementation rate was also significantly improved, with a significant decrease in CLABSI incidence from 0.29 per 1000 to 0.11 per 1000 (χ2 = 8.625 p = 0.004). The assessment of the integration of issues showed that 8 aspects, including workflow, knowledge mastery, monitoring reports, and aseptic operations, do not meet the qualified standards. Through this clinical change, a perfect prevention and control system has been established, and the level of knowledge, belief, and behavior of medical staff in preventing CLABSI has been improved, while the incidence of CLABSI has been reduced.

"I'm quite proud of how we've handled it": health professionals' experiences of returning additional findings from the 100,000 genomes project.

Participants in the 100,000 Genomes Project (100kGP) could consent to receive additional finding (AF) results, individual variants relating to genes associated with susceptibility to cancer and familial hypercholesterolemia (FH). In the study reported here, qualitative interviews were used to explore the experiences of National Health Service (NHS) professionals from across England who were tasked with returning over 80,000 "no AF" results and 700 positive AF results to 100kGP participants. Interviews were conducted with 45 professionals from a range of backgrounds, including Genetic Counsellors, Clinical Geneticists, FH Clinical Nurse Specialists and Clinical Scientists. Interviews were analysed using a codebook thematic analysis approach. Returning AF results has been a significant endeavour, with challenges for pathways, administrative processes and clinical and laboratory time when the capacity of NHS services is already stretched. Professionals discussed going "above and beyond" to prioritise patient care through pathway design, additional clinics, overtime, longer appointments and provision of follow-up appointments. Professionals also described facing practical and emotional challenges when returning AFs. Benefits for patients from receiving AFs in the 100kGP were highlighted and professionals were generally positive about offering clinically actionable AFs within routine NHS clinical care. Professionals were, however, cautious around the implementation of AFs into routine care and felt more research and discussion was needed to determine which AFs to offer, approaches to consent and communication of results, costs and the potential strain on NHS capacity and resources. Further consultation is required with careful review of pathways and resources before offering AFs in clinical practice.

Preparing the ground for bespoke nursing training in advanced renal cell carcinoma care (RCC4Nurses): An international prospective study

ObjectivesNurses require specialist knowledge and skills to effectively support an increasing population of people affected by advanced renal cell cancer (aRCC). RCC4Nurses was a three-phase project that aimed to develop bespoke training in aRCC for nurses in Europe. Phase 1 examined pre-existing educational programs in kidney cancer, then developed a curriculum of core education topics in aRCC care to suit generalist and specialist nurses’ education needs. MethodsPhase 1 employed a prospective design that involved two parts. Part 1 was a scoping review of educational programs developed for multidisciplinary health professionals in kidney cancer/RCC. Findings of Part 1 formed the basis for Part 2, which was a three-round Delphi study that involved experts by personal experience or profession in aRCC, who rated the importance of a range of education topics and education methods for inclusion in the developing RCC4Nurses. ResultsThe scoping review identified eight education programs via two published reports and six online resources. Existing programs had limitations in accessibility, recency and target professional groups; none of them was developed specifically for nurses. Program content was primarily focused on diagnostic, treatment and management procedures in kidney cancer. Fourteen educational topics were derived from the review and evaluated during Round 1 of the Delphi by 47 experts. By Round 3, 17 topics had iteratively reached consensus for inclusion within RCC4Nurses. Experts showed preference to problem-solving and clinical-scenario learning methods, but not reflective practice learning. ConclusionsGiven the dearth of up-to-date, evidence-based training for nurses in aRCC, we have prepared the ground to develop a bespoke training course in this area of practice. Implications for Nursing PracticeThe RCC4Nurses project will offer accessible, state-of-the-art education to registered nurses in Europe to help enhance nursing competency in aRCC and enhance the standard of care provided to people affected by aRCC.

Out of the Hospital, Out of the Box: Utilizing the CNS Role in Home Healthcare Settings.

The United States has poorer population health outcomes compared to similar developed nations despite higher healthcare spending. Multiple factors contribute to this problem, including high healthcare costs, insurance coverage limitations, and a lack of focus on preventive care and wellness. Clinical Nurse Specialists (CNSs), primarily known for their impact in acute care settings, increasingly demonstrate their value in outpatient settings like home healthcare. CNSs possess graduate-level training, equipping them with the skills and expertise to develop and implement strategies that improve population health outcomes in home health settings. CNSs provide clinical leadership and support to staff while remaining at the forefront of ensuring the organization delivers high-quality patient care. Understanding the specific skills and competencies of the CNS to support the patient, family, staff, and organization is necessary to improve outcomes for patients in outpatient settings. The CNS delivers care through direct patient care, supporting nurses and nursing practice, and improving organizational systems. This unique skill set allows CNSs to influence home healthcare outcomes across various levels of care positively. This article sheds light on how CNSs enhance patient outcomes in outpatient settings like home healthcare.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Elements Supporting Translation of Evidence Into Practice: A Model for Clinical Nurse Specialist and Nurse Scientist Collaboration.

To present evidence-based elements supporting the synergistic relationship between nurse scientists and clinical nurse specialists to improve the translation of evidence into practice. Using best-practice elements to support the improvement of evidence-based translation, we define the roles and synergies between nurse scientists and clinical nurse specialists within clinical environments. Five themes were identified in the literature review:● Although clinical nurse specialists and nurse scientists differ in focus and competencies, they are in key positions to collaborate to meet healthcare demands.● Clinical nurse specialists are well-equipped to implement the science developed by nurse scientists.● To meet the increased demands and complexity of the healthcare system and patient needs, organizational leadership must lend support to clinical nurse specialists and nurse scientist collaboration.● Clinical nurse specialists are well-positioned to foster interprofessional partnerships and generate opportunities for evidence-based project initiatives across healthcare disciplines.● Clinical nurse specialists should utilize professional models to inform practice to improve the review, translation, and implementation of research into practice. Projects conducted using a collaborative structure had a system-level impact and long-term sustainability capabilities. Additionally, projects were more likely to be disseminated by clinical nurse specialists within a formal structure.

Construction of a Competency Evaluation Indicator System for Specialist Nurses in Liver Transplantation: A Delphi Study.

Liver transplantation specialist nurses provide comprehensive and safe care for liver transplant patients, which requires them to have a wide range of competencies. However, at present, there is no comprehensive understanding of the competency of liver transplantation specialist nurses in China, and there is a lack of comprehensive evaluation indicators. The purpose of this study was to construct a competency evaluation indicator system for specialist nurses in liver transplantation. Utilizing the "Iceberg model" of competency, the indicator system for evaluating the competency of liver transplant specialist nurses was developed through literature review, semi-structured interviews, and two rounds of Delphi expert consultation. Twenty nursing and medical experts in liver transplantation were consulted over two rounds. The effective response rates for the expert consultation questionnaires were 90.91% and 100.00% for the first and second rounds, respectively. The coefficient of expert judgment was 0.920, the coefficient of familiarity was 0.880, and the authority coefficient was 0.900. The value range of the coefficient of variation in the second round was 0.00-0.16, both <0.25, indicating that the degree of coordination of expert opinions was high. The final competency evaluation index system for liver transplant specialist nurses encompassed 6 primary indicators, 17 secondary indicators, and 59 tertiary indicators, including professional knowledge, professional skills, social role, self-concept, personality quality, and motivation. The developed competency evaluation indicator system for liver transplant specialist nurses possesses scientific validity and reliability, offering a reference for the training and assessment of liver transplant specialist nurses.

Enhancing training transfer among stroke specialist nurses: Insights from latent profile analysis

AimUsing Latent Profile Analysis (LPA) to identify distinct categories within stroke specialist nurses training transfer and to explore the factors influencing these categories. BackgroundStroke represents a significant worldwide health challenge. During the treatment and rehabilitation of stroke, stroke specialist nurses play an essential role. However, despite significant resources devoted in the training of stroke specialist nurses, the effectiveness of training transfer is still at a moderate or low level. Therefore, there is an urgent need to identify the factors affecting the training transfer of stroke specialist nurses and to formulate effective strategies for improvement based on these findings. DesignThis is a cross-sectional study. MethodFrom August to September 2023, demographic questionnaires, stroke specialist nurses training transfer scales, nursing work environment scales, and job crafting questionnaire were used to survey 413 stroke specialist nurses in 5 tertiary hospitals in Henan Province, China. LPA was used to analyze the latent characteristics of nurse training transfer and to explore the predictive factors of different categories using univariate analysis and logistic regression. ResultsA total of 397 stroke specialist nurses were included, identifying three categories of training transfer: "low training transfer group" (20.40 %), "medium training transfer group" (31.74 %), and "high training transfer group" (47.86 %). Work experience, employment type, training duration, nursing work environment, and job crafting significantly influence the training transfer categories. ConclusionThe majority of stroke specialist nurses fall into medium and low training transfer group. Contract employment and less work experience are the main reasons for medium and low levels of training transfer. Enhancing work experience, designing effective training courses, ensuring equal pay, improving the nursing environment, and implementing job crafting strategies could effectively improve training transfer for various types of stroke specialist nurses.

Integrated, person-centred care for patients with complex cardiovascular disease, diabetes mellitus and chronic kidney disease; a randomized trial

Abstract Background Patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic kidney disease (CKD) often experience fragmented care, which negatively impacts outcomes and health-related quality of life (HRQoL). This study assessed whether multidisciplinary, person-centred care at an integrated clinic improves clinical outcomes and HRQoL. Methods This prospective, open, blinded-endpoint trial (CareHND; NCT03362983) included 131 patients with CVD, DM, and CKD stages 3–4, most of whom were enrolled during or shortly after acute hospitalization. The intervention group received person-centred care from cardiologists, nephrologists, endocrinologists, and specialist nurses at an integrated clinic; the control group received traditional care from separate specialists. Primary disease progression outcome was the composite of major adverse renal and cardiovascular events (MARCE) including death, heart failure (HF) readmission, myocardial infarction, PCI/CABG, acute or end-stage kidney failure, or TIA/stroke at 2 years. Co-primary person-centred outcomes was self-reported HRQoL by RAND-36. Results In a pre-specified interim analysis, patients randomized to integrated care had lower eGFR and higher NT-proBNP than traditional care. Follow-up ranged from 2.0 to 5.7 years. Kaplan-Meier analysis showed no difference in MARCE between groups. Cox-regression adjusting for baseline differences, indicated a trend towards reduced HF hospitalisations for integrated care (HR 0.53; CI 0.28–1.01; P = 0.054). Integrated care improved Role Physical and Social Function scores, and self-rated health (P = 0.021, P = 0.019, and P = 0.011, respectively). Conclusions Integrated care improved several dimensions of HRQoL but did not improve MARCE compared to traditional care in this small trial. We observed a trend towards reduced HF hospitalizations. Overall, integrated care presents a promising alternative.

ISCO-08 Classification and scope of practice of nurses: Survey among WHO-Europe member states

Abstract Background The expansion of nurse’s roles in the delivery of care needs transparent defining of roles, extra education/training opportunities, and complementary legislative regulations. Methods This cross-sectional study was planned to explore status of nursing and midwifery workforce in WHO Europe member states. Data were collected from December 2020 until September 2023. Results ISCO-08 2221 is used to classify for only bachelor prepared-nurses in 2 of countries (Bulgaria and Spain). Besides, it is used only for vocational prepared-nurses in 2 of countries (Kyrgyzstan and Tajikistan). Those countries only have vocational or bachelor education. ISCO-08 2221 is used in 1 of countries which have two entry levels with vocational and bachelor prepared-nurses (Georgia). ISCO-08 3221 is referred to vocational training in 5 (20%) countries (Armenia, Finland, the UK, Croatia, Hungary). ISCO-08 2221 is main classification for all levels prepared nurses in 18 countries including Switzerland, Cyprus, Czechia, Germany, Denmark, Ireland, Israel, Iceland, Kazakhstan, Lithuania Latvia, Malta, Poland, Portugal, Romania, Sweden, Slovakia, Türkiye. Scope of practice of vocational and bachelor prepared nurses is defined by law/legislation in 25 of member states. Scope of practice vocational versus bachelor depends on conduct scientific tasks (Switzerland), being broader (Kazakhstan), competency level (Hungary, Croatia, Portugal) exceptionally there is no difference in Malta. Scope of Registered Nurse, Specialist Nurse and Advanced Nurse Practitioner differ in 22 of countries of those which on activities/practice/roles, expanded authority, working with determined care group. As a result, while scope of practice of professional nurses varies in line with their education level, ISCO-08 2221 is used for nurses’ classification from all education levels in member states. Key messages • There is no classification for postgraduate trained nurses (as is the case for physicians), even though scope of practice is different across education levels. • When revising the ISCO-08 classification, it should be recommended that a common terminology is needed to define postgraduate nurses in region.

The impact and value of the Parkinson’s nurse specialist to people with Parkinson’s and their care partners: a grounded theory qualitative study

BackgroundWhere available, Parkinson’s Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson’s (PwP), and, where appropriate, their care partners (CP). Parkinson’s is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals.MethodsA social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified.Results46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson’s. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, ‘working together’; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being.ConclusionWhere a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson’s with negative impacts on health and well-being.

Artificial intelligence versus human touch: can artificial intelligence accurately generate a literature review on laser technologies?

To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser. Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the "ground truth") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: "write a systematic review on pulsed-Thulium:YAG laser for lithotripsy" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 "checkpoint" proforma. A subjective assessment was recorded using a composite score including quality (0-10), clarity (0-10) and overall manuscript rank (1-5). The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively). LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice.

Knowledge, attitudes, and practice of primary care professionals regarding community activities: a descriptive study.

Promoting health via a community approach is one of the most effective strategies for reducing the current incidence of chronic diseases. Primary care (PC), through the implementation of community activities (CA), has the potential to achieve this goal. Yet the implementation of CA at health centers is not standardized and is often thanks only to the voluntariness of health professionals. To ascertain the knowledge, attitudes, and practices of PC professionals regarding the implementation of CA. We carried out a cross-sectional study by circulating a self-administered online questionnaire on CA, across the period December 2022 through June 2023 in Galicia (Spain). All health professionals working in the Galician Health Service PC setting were invited to participate. A total of 521 health professionals participated in the study. They included all types of PC health professionals (physicians, general and specialist nurses -midwives, pediatrics, family and community, mental health- and social workers), including residents in training. Only 14.8% and 12.5% of professionals correctly identified CAs and social prescription (SPr) interventions, respectively. Furthermore, 93.9% recognized that the development of CA in health centers was deficient. Despite this, 76.5% showed a good attitude toward participation in CA. PC professionals find it difficult to identify CA and SPr interventions. Therefore, it is necessary to improve the training of these professionals in the implementation of CA with a view to enhancing population health, reducing the incidence of chronic diseases, and helping lessen the healthcare burden of the health system.

Using nominal group technique to compare patients’ and clinicians’ perspectives on symptoms in multiple myeloma to inform the development of a self management tool for patients with relapsed myeloma

Background The nominal group technique (NGT) allows stakeholders to directly generate items for needs assessment. The objective was to demonstrate the use of NGT to inform the development of a healthcare app in patients with relapsed myeloma. Healthcare professionals with experience in the care of patients with relapsed/refractory myeloma were invited to participate. Methods One NGT group was conducted. In the group, health care professionals working in haematology were asked to vote anonymously in order of highest priority, on symptoms previously highlighted by relapsed/refractory myeloma patients in four focus groups. Results A total of 18 healthcare professionals working in the area of haematology participated in the NGT discussion; consultants (n=6), haematology registrars (n=2), specialist nurses [Advanced Nurse Practitioner/Clinical Nurse Specialist] (haematology) (n=3), staff nurse (n=1), and “other” health care professionals (n=6). Participants ranged in experience of working with myeloma patients from 2 years to over 27 years. The symptoms voted in highest priority were: Pain, Fatigue, Peripheral Neuropathy, Infection Risk and Steroid Induced Side Effects. Conclusions The NGT was an efficient method for obtaining information to inform a healthcare app.