The education needs of health professionals conservatively managing genital oedema: UK survey findings

Background: Adults and children report genital oedema but prevalence is unknown. Pre-registration nurse training rarely includes genital oedema and postgraduate training opportunities are rare. Aim: To identify the education needs of health professionals regarding management of genital oedema. Method: An electronic survey was cascaded to health professionals through relevant professional groups and social media. Findings: Of 149 UK respondents, most manage patients with genital oedema but only 2% felt current training was sufficient. Of 138 responding regarding supplemental training, only a half had completed genital oedema specific education, usually of 1–4 hours' duration. Confidence in knowledge was up to 22.5% higher in those with genital oedema education, even accounting for years of experience. The most common top three individual needs were compression, contemporary surgical and medical management and patient assessment. Educational resources are needed and both offline and online formats were suggested; collaborative events with urology/pelvic health are essential. Conclusion: Health professionals working in lymphoedema care have (unmet) specific education needs regarding genital oedema management. The desire for both offline and online resources reflects the necessity of accessing learning at a distance and on an ‘as needed’ basis

Nurse-led medicines’ monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study

This study investigated the implementation and clinical impact of an Adverse Drug Reaction Profile (ADRe) used to assess the prescription regimes of older residents of nursing and care homes. Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales.Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation

Evaluation of an intervention to promote walking during the commute to work: a cluster randomised controlled trial

Background: Opportunities for working adults to accumulate recommended physical activity levels (at least 150min of moderate intensity physical activity in bouts of at least 10 min throughout the week) may include the commute to work. Systematic reviews of interventions to increase active transport suggest studies have tended to be of poor quality, relying on self-report and lacking robust statistical analyses. Methods: We conducted a multi-centre parallel-arm cluster randomised controlled trial, in workplaces in south-west England and south Wales, to assess the effectiveness of a behavioural intervention to increase walking during the commute. Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behavioural change techniques: providing information; encouraging intention formation; identifying barriers and solutions; goal setting; self-monitoring; providing general encouragement; identifying social support; reviewing goals, and; relapse prevention. Physical activity outcomes were objectively measured using accelerometers and GPS receivers at baseline and 12-month follow-up. The primary outcome was daily minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included overall levels of physical activity and modal shift (from private car to walking). Cost-consequences analysis included employer, employee and health service costs and outcomes. Results: Six hundred fifty-four participants were recruited across 87 workplaces: 10 micro (5–9 employees); 35 small(10–49); 22 medium (50–250); 20 large (250+). The majority of participants lived more than two kilometres from their place of work (89%) and travelled to work by car (65%). At 12-month follow-up, 84 workplaces (41 intervention,43 control) and 477 employees (73% of those originally recruited) took part in data collection activities. There was no evidence of an intervention effect on MVPA or overall physical activity at 12-month follow-up. The intervention cost on average £181.97 per workplace and £24.19 per participating employee. Conclusions: The intervention, focusing primarily on individual behaviour change, was insufficient to change travel behaviour. Our findings contribute to the argument that attention should be directed towards a whole systems approach, focusing on interactions between the correlates of travel behaviour. Trial registration: ISRCTN15009100. Prospectively registered. (Date assigned: 10/12/2014). Keywords: Walking, Active travel, Workplace, Behavioural intervention, Randomised controlled trial, Physical activit

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.Five UK private sector care homes.41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.Problems addressed and changes in medicines prescribed.Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.ISRCTN 48133332

Challenges and opportunities identified for lymphoedema services in Wales during the COVID-19 pandemic

Background: During the COVID-19 pandemic, lymphoedema staff adapted services, providing care remotely, and worked in other NHS sectors. The impact on services and staff must be understood in order to safeguard patient care and foster workforce resilience. Aims: To evaluate the experiences of clinical and non-clinical lymphoedema staff in Wales during the COVID-19 pandemic. Methods: An anonymous online survey, based on scoping work, was sent out via the Welsh lymphoedema services mailing list. Findings: 71% (68/96) of eligible lymphoedema staff completed the survey. More than half supported lymphoedema services (40/68) with the remaining staff deployed elsewhere. Overall, staff and services felt prepared for new ways of working. Concerns about others and the future burden on services when life returned to normal were reported. Opportunities identified included education initiatives and virtual services. Conclusion: Lymphoedema services were well prepared to deliver virtually, enable effective care and share knowledge. Co-ordinated efforts to uphold patient advocacy will support virtual services to meet their needs

Lymphoedema care in the mobile unit: a service evaluation of patient experience and attendance rates

Background/aims: Lymphoedema can be a life-long burden to patients. Value-based lymphoedema services should aim to empower patients and meet expectations of care. This study evaluated the attendance rates and experiences of patients accessing a mobile health unit for lymphoedema care. Methods: A questionnaire was shared with all adult patients with lymphoedema at 16 mobile unit clinics in south Wales over 3 months in 2019. Attendance rates and questionnaire data were explored descriptively. Results: Out of 417 patients, 175 (37%) participated in the study. Of these, a considerable majority (132/148, 89%) expressed a preference for the mobile unit compared to hospital-based services. Reasons for this preference included ease of access, excellent staff and parking facilities. Non-attendance rates of 8% were observed at the mobile unit. Conclusions: Patients favoured attending the mobile unit, suggesting that mobile care is a key aspect of value-based healthcare, allowing services to be planned around patient needs. However, this did not fully resolve the issue of non-attendance. The impact of such community-based services on health outcomes, costs and staff experiences should be explored before widespread adoption is implemented

Contextual factors aff ecting the education needs of lymphoedema health professionals regarding genital oedema

The impact of the care context on education needs of health professionals who conservatively manage patients with genital oedema is unknown. This study aimed to explore the contextual factors surrounding the treatment of patients with genital oedema that affect the education needs of lymphoedema practitioners, and identify interventions that might support both practitioners and patients. Following scoping groups in Australia and the US, formal focus groups were held with lymphoedema practitioners in England, Wales and the US, as part of an international mixed-method project in 2019. Ethics review from Swansea Bay University Health Board Research and Development Department found ethics approval unnecessary. This project was funded by Tenovus Cancer Care. A total of 69 lymphoedema practitioners (21 from England, 20 from Wales and 28 from the US) self-identified a personal education need and a need in other health workers who should be identifying and referring patients to their services. Genital oedema was considered to be under recognised, of complex aetiology and psychosocially challenging. A need for specific assessment tools, outcome measures and a diagnostic algorithm was identified. In addition, improved availability of acceptable compression products was suggested to possibly help normalise discourse around genital oedema with patients and its management. The payer model in the US means an early intervention/ risk reduction approach is more difficult. Importantly, learning support resources need to be readily accessible. The focus groups provided contextual understanding regarding the genital oedema education needs of lymphoedema practitioners and the factors affecting patient treatment

Total number of problems addressed per participant at each step in each site.

<p>Bold text indicates roll-out of medicines’ monitoring and Profile administration 1 month before these data collection points (occasions when researchers extracted data from participants’ records). n = number of service users in the site. One participant from site 4 passed away between steps 3 & 4. One participant from site 5 was hospitalised between steps 3 & 4. Participants joined site 5 at steps 2 and 3. Problems explored are listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.t005" target="_blank">Table 5</a> and on the Profile, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s001" target="_blank">S1 appendix</a>. Fuller versions of these tables, including medians and 25^th = 75^th centiles are in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s005" target="_blank">S1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s006" target="_blank">S2</a> tables.</p