Threats to safe transitions from hospital to home: a consensus study in North West London primary care.

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise

A systematic review of interventions to improve breast cancer screening health behaviours

Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level

Investigating the implementation of SMS and mobile messaging In Population Screening (The SIPS Study): Protocol for a Delphi Study

Background The use of mobile messaging including Short Message Service (SMS) and Web-based messaging in healthcare has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances including population screening. These programmes, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective This protocol describes the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programmes in England. Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will incorporate a literature review of publications from 1st January 2000 to the present. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used in the consensus generation. Patient and Public Involvement groups will be convened to ensure that a comprehensive item list is generated, which represents the public’s perspective. Each item will then be anonymously voted upon by experts as to its importance and feasibility of implementation in screening, during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible eligible for inclusion into the final recommendation. A list of desirable items (important, but not currently feasible) will be developed to guide future work. Results The Institutional Review Board at Imperial College London has granted ethical approval (20IC6088). Results are expected to involve a list of recommendations to screening services with findings made available to screening services through Public Health England. This study will thus provide a formal guideline for the use of mobile messaging in screening services and provide future directions in this field. Discussion The use of mobile messaging has grown significantly across healthcare services, especially given the COVID-19 pandemic, but its implementation in screening programmes remains challenging. this modified Delphi approach with leading experts, will provide invaluable insights to facilitate incorporating messaging in these programmes, and create awareness of future developments in this area

Mycobacterium avium subsp. paratuberculosis Virulence: A Review

To propose a solution for control of Mycobacterium avium subsp. paratuberculosis (MAP) infections in animals as well as in humans, and develop effective prevention, diagnostic and treatment strategies, it is essential to understand the molecular mechanisms of MAP pathogenesis. In the present review, we discuss the mechanisms utilised by MAP to overcome the host defense system to achieve the virulence status. Putative MAP virulence genes are mentioned and their probable roles in view of other mycobacteria are discussed. This review provides information on MAP strain diversity, putative MAP virulence factors and highlights the knowledge gaps regarding MAP virulence mechanisms that may be important in control and prevention of paratuberculosis

The universal Glivenko-Cantelli property

Let F be a separable uniformly bounded family of measurable functions on a standard measurable space, and let N_{[]}(F,\epsilon,\mu) be the smallest number of \epsilon-brackets in L^1(\mu) needed to cover F. The following are equivalent: 1. F is a universal Glivenko-Cantelli class. 2. N_{[]}(F,\epsilon,\mu)0 and every probability measure \mu. 3. F is totally bounded in L^1(\mu) for every probability measure \mu. 4. F does not contain a Boolean \sigma-independent sequence. It follows that universal Glivenko-Cantelli classes are uniformity classes for general sequences of almost surely convergent random measures.Comment: 26 page

Is practice good enough? Retrieval benefits students with ADHD but does not compensate for poor encoding in unmedicated students

IntroductionA significant proportion of currently enrolled college students receive support for attention deficit/hyperactivity disorder (ADHD) and these students are often at risk of academic failure. Retrieval practice or self-testing is an effective, accessible, and affordable tool for improving academic performance. Three recent studies found conflicting results with regards to the effectiveness of retrieval practice in this population.MethodsThe present study compared 36 individuals with ADHD to 36 controls. Participants studied Swahili-English word pairs that varied in difficulty. Half of the pairs were repeatedly studied, and the other half repeatedly tested.ResultsOn a final test, all participants showed a benefit of retrieval practice relative to restudy and participant status did not moderate the effect. However, unmedicated individuals with ADHD performed worse overall, both during the encoding phase and on the final test, whereas medicated participants were not significantly different from controls.DiscussionAn examination of self-reported encoding strategies found unmedicated participants used fewer deep strategies at encoding, consistent with prior work on ADHD and memory. Although retrieval practice is effective in this group, improved strategy use may be necessary to ensure performance that is fully equivalent to that of students without ADHD