Training needs and development of online AT training for healthcare professionals in UK and France

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK=167; FR=262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; Vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p<0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p<0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p<0.001). Also, more French HCPs considered that AT refers exclusively to technologically-advanced electronic devices (71.8%, UK 28.8%, p<0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards

Self care programs and multiple sclerosis: Physical therapeutics treatment - literature review

AbstractObjectiveTo clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy.MethodA non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: “multiple sclerosis”, “self-care”, “self-management” and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed.ResultsCounseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms’ diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms’ impact and to improve treatment access are the aims of educational therapy.ConclusionTherapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary

A literature review of the challenges encountered in the adoption of assistive technology (AT) and training of healthcare professionals

Background: Long-term disabilities often result in loss of autonomy and social interaction. Accordingly, there is a demand for Assistive Technology (AT) devices to enable individuals to live independently for as long as possible. However, many people experience difficulties in obtaining and using AT. This paper presents findings from a narrative literature review undertaken as part of the development of AT training for healthcare professionals, one of the work areas of the ADAPT project (Assistive Devices for Empowering Disabled People through Robotic Technologies), funded by EU INTERREG France (Channel) England. The results of the review informed the design of a survey of healthcare professionals regarding their views and experiences of AT and the development of AT training. Method: The review sought to understand challenges encountered in the adoption and use of AT as well as how training of healthcare professionals in AT takes place. A narrative approach was adopted as the most appropriate way to synthesise published literature on this topic and describe its current state-of-art. Narrative reviews are considered an important educational tool in continuing professional development. An initial search was conducted via databases in the UK and France, including CINAHL, Academic Search Index, Social Sciences Citation Index, BDSP (Base de données en Santé Publique), Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Cairn, Google Scholar and Pubmed. Inclusion criteria for the review included: covering issues relating to AT provision and training, English or French language, and published from 1990 onwards. Application of these criteria elicited 79 sources, including journal papers (48), reports (11), online sources (11), books (6) and conference papers (3). Sources were thematically analysed to draw out key themes. Key results: The majority of papers were from USA and Canada (27), then UK (20) and France (19). Others were from Europe (7), Australia (3), country unknown (2), and one joint UK/France publication. The main source of literature was journal papers (48), of which the most common types were practice reports (18), evaluation surveys (10) and qualitative studies (9). The review uncovered a number of key challenges related to the adoption of devices, including: difficulty defining AT across disciplines, lack of knowledge of healthcare professionals and users, obtrusiveness and stigmatisation AT users can experience when using devices, and shortfalls in communication amongst professional groups and between professionals and users. These issues can lead to abandonment of AT devices. Furthermore, substantial barriers to healthcare professionals exist, including inconsistent provision and quality of training, lack of evaluation of training, lack of resources and funding, shortage of qualified professionals to teach, and the increasingly rapid development of the technologies. Conclusion: Support, training and education for prescribers, distributors, users, and their carers is vital in the adoption and use of AT. Evidence indicates a need for comprehensive education in the AT field, as well as ongoing assessment, updates and evaluation which is embedded in programmes

Chronic wounds consultation by telemedicine between a rehabilitation healthcare center and nursing home or home

Saint-Hélier Rehabilitation Center (pôle MPR Saint-Hélier), located in Rennes, has been selected for a regional telemedicine project in 2014 about chronic wounds.AimTo make care access easier for heavy disabilities patients in nursing homes or at home with chronic wounds.MethodThe members of TLM Pl@ies chronic team are specialist doctors and nurses for wounds. On request, the occupational therapist or dietician involve in the consultation (multidisciplinary approach). A secure videoconference (web) is used.ResultsSince July 2014, over 100 teleconsultations have been done. Targeted population is constituted by patients:– whose access to care is decreased due to moving difficulties;– of which the health care team is crossing difficulties in the care process (wound care but also disability, nutrition..).Seventy percent of requests come from the nursing home, 30% from homes (pressure ulcers stages 3 and 4, arterial ulcers, venous or mixed). Middle age: 78 years (20–101 years). Only 3 patients refused. Time to organize the teleconsultation is on average 13 days. Consultations last on average 25 minutes. In 30% of cases the teleconsultation is extended by a real live training time for the nurse at home guided by the TLM Pl@ies chroniques team. We evaluate professional satisfaction and technical satisfaction. Without teleconsultation, in 77% of cases transportation request for consultation would be made, in 5% hospitalization. In 18% no request would be done.Discussion/conclusionThese first results, encouraging, confirms the interest of specialized consultations in medico-social settings, and telemedicine can be an effective solution

Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique

Early diagnosis of the human immunodeficiency virus (HIV) among infants born to HIV-infected mothers is critical because roughly 50% of untreated infected infants die before the age of two years. Yet most countries in sub-Saharan Africa experience significant delays in diagnosis because of operational inefficiencies in early infant diagnosis (EID) networks. We develop a two-part modeling framework relying on optimization and simulation to generate operational improvements in the assignment of clinics to laboratories and the allocation of capacity across laboratories, and to evaluate the associated impact on the number of infants initiating treatment. Applying our methodology to EID program data from Mozambique, we validate our simulation model and estimate that optimally reassigning clinics to labs would decrease the average sample turnaround time (TAT) by 11% and increase the number of infected infants starting treatment by about 4% relative to the current system. Furthermore, consolidating all diagnostic capacity in one centralized lab would decrease average TATs by an estimated 22% and increase the number of infected infants initiating treatment by 7%. Our sensitivity analysis suggests that the consolidation of capacity in a single location would remain near optimal across a wide range of laboratory utilization levels in Mozambique. However, this full consolidation solution is dominated by configurations with two or more labs for EID networks with average transportation times larger than those currently observed in Mozambique by at least 15%

Medicosocial outcome after admission in post-intensive care unit at PRM St-Hélier, Rennes

IntroductionPost-Intensive Care Units (PICU) are PRM structures aiming to start the appropriated rehabilitative care as early as possible even though persistent complex medical issues.ObjectiveTo assess medicosocial outcomes of patients away from their admission in PICU.MethodsA retrospective descriptive study that included 81 consecutive patients (mean age 51 years) admitted from 2008 to 2012 in the PICU of Pôle St-Helier Rennes based on called semi-structured interviews between March 2014 and March 2015. Exhaustive data (only 4 lost, 5%) by the patient himself and/or a member of family on autonomy, place of life, structures since the release and reintegration, of patients for 85% of them brain damaged.ResultsThere is 29% (21/77) of death (post-exit life: 1,6 years±1.18). Eighty percent live at home (46/56) of which only 5 without family environment, 10% (5/56) in medicosocial structures (foster or nursing homes…), 10% in hospital (hospital at home, persistent vegetative units…). Fourteen percent (8/56) are completely autonomous and work, all with adaptations. Twenty-three percent (13/56) had a significant dependence for activities of daily life and instrumental ones. Forty percent (22/56) have no hobby. Use of different downstream structures, long-term readaptative monitoring, legal and families’ feelings were also analyzed.Discussion and ConclusionMedical and social outcome of patients in the aftermath of a stay in PICU is disparate, depending on the pathology involved, but also the pre-social situation that seems to be the main predictor of returning home. Most patients have regained a relatively large autonomy for the daily life activities but are embarrassed to complex instrumental activities impeding social inclusion. These results are consistent with those of the literature on head trauma patients but no other study has focused for the moment on the specific population of patients admitted to the PICU. We see the value of such early rehabilitative care units with a real impact on the subsequent independence and opportunities back home