Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

Background: Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences. Methods: A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total. Results: Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally). All years also noted that the sessions had increased their confidence, particularly through practice. Conclusions: Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism

Improving identification and audit of disability within Child Health Services

This project was commissioned by the Department of Health to survey existing data collections regarding childhood disability across the domains of education, health and social care and to collect definitions of disability from across three domains. A systematic review was conducted which addressed the two aims. The findings were discussed in consultation of findings with key professionals from across the UK and with some contacts in Europe, both electronically and in a professional working focus group. The review of published academic and grey literature identified vast disparities between the way that data is collected, coded and used across the three domains. The disparities between the definitions of disability used across the domains further prevent the data being drawn together in a cohesive manner that may then be used to facilitate effective planning of services both locally and nationally. The project did, however, identify one coding system that may potentially offer a solution to these difficulties, the International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY, World Health Organisation, 2007). This coding system has demonstrated a capacity to resolve issues with data collections in Europe and has been the subject of policy recommendations presented to the European Parliament on the 16th September 2008. It is proposed that while immediate change is not possible, a staged approach, beginning with a pilot study of the utility of the ICF-CY, should be conducted to test its efficiency in providing effective harmonisation of data collections across the three domains and its applicability in the identification of childhood disability. Alongside this, it is important for the ICF-CY considered by the project group overseeing the implementation of the Child Health, Maternity and CAMHS Care Records

Estimating the burden of minor ailment consultations in general practices and emergency departments through retrospective review of routine data in North East Scotland

Minor ailment attendances in general practices and emergency departments (EDs) place significant burden on health care resources

Home-based reach-to-grasp training for people after stroke: study protocol for a feasibility randomized controlled trial

BackgroundThis feasibility study is intended to assess the acceptability of home-based task-specific reach-to-grasp (RTG) training for people with stroke, and to gather data to inform recruitment, retention, and sample size for a definitive randomized controlled trial. Methods/designThis is to be a randomized controlled feasibility trial recruiting 50 individuals with upper-limb motor impairment after stroke. Participants will be recruited after discharge from hospital and up to 12 months post-stroke from hospital stroke services and community therapy-provider services. Participants will be assessed at baseline, and then electronically randomized and allocated to group by minimization, based on the time post-stroke and extent of upper-limb impairment. The intervention group will receive 14 training sessions, each 1 hour long, with a physiotherapist over 6 weeks and will be encouraged to practice independently for 1 hour/day to give a total of 56 hours of training time per participant. Participants allocated to the control group will receive arm therapy in accordance with usual care. Participants will be measured at 7 weeks post-randomization, and followed-up at 3 and 6 months post-randomization. Primary outcome measures for assessment of arm function are the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). Secondary measures are the Motor Activity Log, Stroke Impact Scale, Carer Strain Index, and health and social care resource use. All assessments will be conducted by a trained assessor blinded to treatment allocation. Recruitment, adherence, withdrawals, adverse events (AEs), and completeness of data will be recorded and reported. DiscussionThis study will determine the acceptability of the intervention, the characteristics of the population recruited, recruitment and retention rates, descriptive statistics of outcomes, and incidence of AEs. It will provide the information needed for planning a definitive trial to test home-based RTG training. Trial registrationISRCTN: ISRCTN5671658

Single Point of Entry Long-Term Living Resource System Team Report

Pursuant to House File 451 the Single Point of Entry Long-Term Living Resources System Team, involving several state agencies as well as interested associations, submitted a report to the legislature on recommendations to establish a single point of entry system

Feasibiity and acceptability of tele-neurology services at a regional tertiary referral centre: a prospective study.

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access. Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden. Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from the Association of British Neurology to fit the tele-consultation profile or not. Follow-up patients were triaged by the nurse for the same. Recruited participants had a pre tele-neurology questionnaire capturing their demographic data, email address, mobile number, time, travel distance and the cost of coming to clinic on a normal day sent electronically. The patients then underwent a tele-consult with a post tele- neurology survey sent thereafter. A prescription and lab request was emailed to the patient or an AKU outreach clinic near them. Results: From 219 enrolled patients, 66.7% (146/219) responded [74% (108/146) had both F2F and TNC]: age 40.9 (30.6-55.20 years; 63.0% (92/146) female ;2.7% (4/146) from neighboring countries; follow up period with neurologist (DSS) 6.8 (1.5-29.8) months. The most common presentations were headache [26.0% (38/146)], seizures [26.0% (38/146)] and neurodegenerative [15.1% (22/146) disorders. For TNC \u3e90%;(i) found it as comfortable as F2F (p=0.35) with no violation of their privacy; (ii)saved time [3.0 (2.0-4.0) hours], travel [11.0 (7.2-21.1) km] and cost [$10.5-20]; (iii)were iv satisfied with their neurological concerns addressed; and (iv) would use TNC again. Conversely,15.1$6,125, 1,143 hours and 25,506 km of travel, equating to 3.5 tons (21 trees) of carbon dioxide emissions. Conclusion: Our regionally unique study demonstrated that TNC service is an acceptable, efficient, effective and environmentally-friendly care delivery model in our resource poor setting

The development and implementation of e-health services for the Libyan NHS: case studies of hospitals and clinics in both urban and rural areas

This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future