Adaptive inverse control for helicopter vibration reduction

The reduction or alleviation of helicopter vibration will reduce maintenance requirements while at the same time increase ride quality and helicopter reliability. In forward flight, the helicopter's fuselage vibration spectrum tends to be dominated by multiples of the N/REV component. A way to use the method of adaptive inverse control to identify, in real-time, a controller capable of generating N/REV vibration of opposite phase to cancel the uncontrolled N/REV component is presented. Multicyclic feathering of blade pitch is the control considered

Design and performance of a multicentre, randomized controlled trial of teleconsulting.

We have designed and performed a multicentre, randomized controlled trial of teleconsulting. The trial investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing as an alternative to general practitioner referral to a hospital specialist. The participating general practitioners referred a total of 3170 patients who satisfied the entry criteria. Of these, 1040 (33%) failed to provide consent or otherwise refused to participate in the trial. Of the patients recruited to the trial, a total of 1902 (91%) completed and returned the baseline questionnaire. Although the trial was successful in recruiting sufficient patients and in obtaining high questionnaire response rates, the findings will require careful interpretation to take account of the limits which the protocol placed on the ability of general practitioners to select patients for referral

Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland

Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy & Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement. References 1. Maidment, I; Young, E; MacPhee, M; Booth, A; Zaman, H; Breen, J; Hilton, A; Kelly, T; Wong, G. Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ Open [Internet] 2021 [cited 2023 Apr 17];11:e050043. Available at: https://doi.org/10.1136/bmjopen-2021-050043 2. Piraux, A; Cavillon, M; Ramond-Roquin, A; Faure, S. Assessment of Satisfaction with Pharmacist-Administered COVID-19 Vaccinations in France: PharmaCoVax. Vaccines [Internet] 2022 [cited 2023 Apr 17];10, 440. Available at: https://doi.org/10.3390/vaccines10030440 3. Watson, M; Silver, K; Watkins, R. How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study. BMJ Open [Internet] 2019 [cited 2023 Apr 17];9:e027198. Available at https://doi.org/10.1136/bmjopen-2018-02719

Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial.

BACKGROUND: The current model of general practitioner referral of patients to hospital specialists in the UK is sometimes associated with unnecessary duplication of investigations and treatments. We aimed to compare joint teleconsultations between general practitioners, specialists, and patients (virtual outreach) with standard outpatient referral. METHODS: Virtual outreach services were established in London and Shrewsbury. The general practitioners referred 3170 patients, of whom 2094 consented to participate in the study and were eligible for inclusion. 1051 patients were randomly assigned virtual outreach, and 1043 standard outpatient appointments. We followed up the patients for 6 months after their index consultation. The primary outcome measure was the offer of a follow-up outpatient appointment. Analysis was by intention to treat. FINDINGS: More patients in the virtual outreach group than the standard group were offered a follow-up appointment (502 [52%] vs 400 [41%], odds ratio 1.52 [95% CI 1.27-1.82], p<0.0001). Significant differences in effects were observed between the two sites (p=0.009) and across different specialties (p<0.0001). Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ear, nose, and throat surgery and orthopaedics than in the other specialties. Fewer tests and investigations were ordered in the virtual outreach group by an average of 0.79 per patient (0.37-1.21, p=0.0002). Patients' satisfaction (analysed per protocol) was greater after a virtual outreach consultation than after a standard outpatient consultation (mean difference 0.33 scale points [95% CI 0.23-0.43], p<0.0001), with no heterogeneity between specialties or sites. INTERPRETATION: The trial showed that allocation of patients to virtual outreach consultations is variably associated with increased offers of follow-up appointments according to site and specialty, but leads to significant increases in patients' satisfaction and substantial reductions in tests and investigations. Efficient operation of such services will require appropriate selection of patients, significant service reorganisation, and provision of logistical support

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.Design Cost consequences study alongside randomised controlled trial.Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments.Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction.Results Overall six month costs were greater for the virtual outreach consultations (pound724 per patient) than for conventional outpatient appointments (pound625): difference in means pound99 ($162; is not an element of138) (95% confidence interval pound10 to pound187, P=0.03). if the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound108 (pound73 to pound142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost 8 pound (5 pound to 10 pound, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound11 (pound10 to pound12, P < 0.0001).Condusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported

Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool.

BACKGROUND: Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. OBJECTIVE: The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. METHODS: We employed a multistep design process drawing on patient and expert involvement. RESULTS: A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. CONCLUSIONS: It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity

A new approach to treatment of resistant gram-positive infections: potential impact of targeted IV to oral switch on length of stay.

Patients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment. Some of these patients could be discharged earlier if a switch to an oral antibiotic was made. This study was designed to identify the percentage of inpatients currently prescribed IV glycopeptides who could be discharged earlier if a switch to an oral agent was used, and to estimate the number of bed days that could be saved. We also aimed to identify the patient group(s) most likely to benefit, and to estimate the number of days of IV therapy that could be prevented in patients who remained in hospital

Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study.

BACKGROUND: Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient's informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. OBJECTIVE: This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. METHODS: Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants' views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants' experience of using the VP. RESULTS: The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. CONCLUSIONS: The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice