Facilitating adjustments : evaluating a series of reasonable adjustments workshops for mainstream healthcare professionals

Introduction: Having experienced several nationally reported clinical incidents East Kent Hospitals (EKH) developed data that indicated that people with Intellectual Disability (ID) were at greater risk of being admitted via A&E, and repeatedly admitting, compared to the general population. Health Education England supported EKH to undertake workshops for doctors and other local non -ID specialist professionals on making adjustments for people with ID. Methods: A team of three experts by experience – including people with ID and family carers- and three ID Nurses were employed to develop and co-facilitate a series of workshops. Practice Development methods such as Fourth Generation Evaluation were employed and included in the learning outcomes and educational methods. Results: Nine workshops were held over a two years; 120 participants attended, only 10% had a medical background. A thematic analysis of participant’s data indicated an emerging concept, preparedness. Participants wished to be better prepared to make adjustments before the patient’s arrival. Implications: This evaluation is prescient as UK parliament is due to consult on education for all healthcare professionals on ID in light of #Oliverscampaign. It is recommended that responsibility for ID education resides with service providers, employing local experts, reflecting local data, and be experiential with a work-based project component. Local informatics systems ought to flag and alert staff of people with learning disabilities using services

An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid.

BACKGROUND: Around one in ten people who contract Covid-19 report ongoing symptoms or 'Long Covid'. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition. METHODS: Forming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis. RESULTS: Eighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants' Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating 'experts' and the 'true colour' of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants' unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of 'safe' ideas, building in pleasure and comfort, and prioritising 'me'. CONCLUSIONS: Among this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live 'better' and regain some sense of identity whilst facing the impact of a debilitating, episodic condition. TRIAL REGISTRATION: LISTEN ISRCTN36407216

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Training staff on dietary approaches for Metabolic Syndrome, obesity and improved nutrition in people with a learning disability

Health inequalities are known to be prevalent in people with a learning disability (Heslop et al, 2013). This in part is thought to be due to increased lifestyle risk factors including poor diet and increased sedentary behaviours (de Winter et al, 2015). The National Institute for Health and Care Excellence endorse that improving these lifestyle choices can reduce likelihood of Metabolic Syndrome (MetS) which includes the presence of obesity, high cholesterol / dyslipidemia, insulin resistance or diabetes and high blood pressure. Limited research looks at MetS in people with a learning disability despite the high prevalence rates of up to 46% being reported (Room et al, 2016). This is corroborated by evidence that more than one of every three people with a learning disability are clinically obese which is significantly higher than the general population. MetS has been linked to morbidity from coronary heart disease, stroke, type 2 diabetes, sleep problems, liver disease, cancer and asthma. Resources and training were developed to support staff teams working with individuals who have a learning disability to prepare and eat a healthy, balanced diet. Findings from the evaluation as well as links to access the resources developed will be shared with delegates. Individuals with a learning disability, their staff, family and carers are able to access and use the resources and emergent themes from the training in order to promote health and wellbeing

Long-term conditions: innovative education for HCAs

Kingston University and St George's, University of London are running an exciting new Foundation Degree in Long Term Conditions within the framework of the new South West London Academic Network (SWan) Interprofessional Institute. Based at the Faculty of Health and Social Care Sciences, the course is ideal for heath and social care staff working with people who may be living with a long-term condition such as the effects of a stroke, diabetes or heart problems. Colin-Thome (2007) has identified that over 15million people in this country report living with a long-term condition. They are conditions that cannot currently be cured, but can be managed by medication and other therapies; they can limit an individual's ability to cope with everyday activities (Colin-Thome, 2007). This foundation degree aims to educate healthcare support workers (HCSWs) to take on a new associate practitioner role with a unique skills set and specifically to enable them to care effectively for people living with long-term conditions and their carers in a variety of health and social care settings

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease