Patient perceptions and preferences about prostate fiducial markers and ultrasound motion monitoring procedures in radiation therapy treatment

Introduction Patient experiences and preferences of image-guidance procedures in prostate cancer radiotherapy are largely unknown. This study explored experiences and preferences of patients undergoing both fiducial marker (FM) insertion and Clarity ultrasound (US) procedures. Methods A sequential explanatory mixed method approach was used. A questionnaire (n = 40) ranked experiences from 0 to 10 (worst) in the domains of invasiveness; pain; physical discomfort; and psychological discomfort. Responses were analysed with descriptive and inferential statistics. Semi-structured interviews (n = 22) obtained further insights into their perspectives and preferences and were thematically analysed. Results Perceptions of invasiveness varied with 46% reporting FMs more invasive than US and 49% the same for the two procedures. The mean score for FM was 3.6 and 2.1 for US. Mean scores for pain, physical and psychological discomfort were higher for FMs with 3.3, 3.2 and 2.9, respectively, and 1.1, 1.2 and 1.7 respectively for US, only pain achieved significance (P < 0.05). Three themes emerged from the interviews: Expectations versus Experience; Preferences linked to Priorities; and Motivations. Eleven patients (50%) preferred US; however, 10 (45%) could not illicit a preference. Conclusion Participants found both of the FM and US image-guidance procedures tolerable and acceptable. Men's preference was elusive, suggesting a more rigorous preference methodology is required to understand preferences in this population

Building Allied Health Research Capacity at a Regional Australian Hospital: A Follow-up Study.

Purpose This study determined if research experience increased among allied health professionals (AHPs) at a regional tertiary hospital following a research capacity building initiative. Methods A cross sectional electronic survey was used to collect data from allied health professionals on their research experience, research support needs, enablers and barriers to research and their perceptions regarding benefits of research. A baseline survey was conducted in 2011 which was compared to a follow up survey in 2015. Comparison of variables between the two surveys used Chi squared tests. Results The response rate for the 2011 survey was 43% (n=248) while the 2015 survey achieved a 37% response rate (n=234). There was a significant increase in allied health professionals research experience as well as need for research support between the 2011 and 2015 surveys in many (but not all) activities on the research continuum. Time availability was the greatest barrier and the perceived benefit of research was to improve clinical care. Conclusions This study demonstrates a significant increase in allied health professionals research experience over the four years of capacity building. However, the increase has not reached the level where it is recorded by traditional research outcome measures such as publication. The greatest barrier to allied health professionals conducting research is time. Therefore, investment in clinician-researcher career pathways may increase research capacity of allied health practitioners to increase publication output. The implication of this research is that allied professionals’ research profile is unlikely to increase without significant input of time or resources to allow them to conduct research

A combined cognitive and exercise program for older adults with mild cognitive impairment: preliminary findings

Background: Fourteen percent of people with mild cognitive impairment may progress to dementia. Dementia is a leading cause of disability worldwide including Australia, meaning effective interventions are urgently needed to prevent or slow the progression of the disease and its overall burden to the person, community and health services. This pilot-study aimed to identify the feasibility and acceptability of a combined cognitive and functional-task based exercise program to delay the onset of dementia in people with mild cognitive impairment. Method: A mixed methods approach was used. Individual interviews were conducted with caregivers and participants of the ten-week intervention program. Quantitative data included cognitive and functional assessments performed pre- and post-intervention such as Neurobehavioral Cognitive Status Examination, Verbal Fluency Test, Verbal Learning Test, Trial Making Test A and B, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. Results: Approximately 80% of the 23 participants completed the program demonstrating its acceptability. Interim results show significant improvements in several cognitive and functional areas. The improvements demonstrate the combined cognitive and exercise program is beneficial for people at risk of dementia. The qualitative findings suggest the program is viewed positively by participants and caregivers. Benefits described by the participants are evident through occupational performance e.g. developing strategies to remember tasks such as taking medication. Conclusion: The combined cognitive and exercise program is acceptable and feasible. However, identifying people with mild cognitive impairment needs substantial research to develop sustainable pathways in primary care in Australia

Substitution, delegation or addition? Implications of workforce skill mix on efficiency and interruptions in computed tomography

Objectives: This study evaluated multiple computed tomography (CT) workforce models to identify any implications on efficiency (length of stay, scan frequency and workforce cost) and scanning radiographer interruptions through substituting or supplementing with a trained CT assistant. Methods: The study was conducted in a CT unit of a tertiary Queensland hospital and prospectively compared four workforce models, including usual practice: Model 1 used an administrative assistant (AA) and one radiographer Model 2 substituted a medical imaging assistant (MIA) for the AA Model 3 was usual practice, consisting of two radiographers and Model 4 included two radiographers, with a supplemented MIA. Observational data were collected over 7 days per model and were cross-checked against electronic records. Data for interruption type and frequency, as well as scan type and duration, were collected. Annual workforce costs were calculated as measures of efficiency. Results: Similar scan frequency and parameters (complexity) occurred across all models, averaging 164 scans (interquartile range 160-172 scans) each. The median times from patient arrival to examination completion in Models 1-4 were 47, 35, 46 and 33 min respectively. There were between 34 and 104 interruptions per day across all models, with the 'assistant role' fielding the largest proportion. Model 4 demonstrated the highest workforce cost, and Model 2 the lowest. Conclusion: This study demonstrated that assistant models offer similar patient throughput to usual practice at a reduced cost. Model 2 was the most efficient of all two-staff models (Models 1-3), offering the cheapest workforce, slightly higher throughput and faster examination times. Not surprisingly, the additional staff model (Model 4) offered greater overall examination times and throughput, with fewer interruptions, although workforce cost and possible role ambiguity were both limitations of this model. These findings may assist decision makers in selecting the optimal workforce design for their own individual contexts. What is known about the topic?: Innovative solutions are required to address ongoing health workforce sustainability concerns. Workforce substitution models using trained assistants have demonstrated numerous benefits internationally, with translation to the Australian allied health setting showing promise. What does this paper add?: Building on existing research, this study provides clinical workforce alternatives that maintain patient throughput while offering cost efficiencies. This study also quantified the many daily interruptions that occur within the CT setting, highlighting a potential clinical risk. To the best of our knowledge, this study is the first to empirically test the use of allied health assistants within CT. What are the implications for practitioners?: Role substitution in CT may offer solutions to skills shortages, increasing expenditure and service demand. Incorporating appropriate assistant workforce models can maintain throughput while demonstrating implications for efficiency and interruptions, potentially affecting staff stress and burnout. In addition, the assistant's scope and accepted level of interruptions should be considerations when choosing the most appropriate model

Absence of prostate oedema obviates the need for delay between fiducial marker insertion and radiotherapy simulation

Introduction: Fiducial markers (FMs) are commonly inserted into the prostate for image guided radiation therapy. This study aimed to quantify prostate oedema immediately following FM insertion compared to prostate volumes measured a week later, at the time of simulation for radiation therapy. Methods: Thirty patients underwent a verification computed tomography (VCT) scan in treatment position immediately after the fiducial insertion and their planning computed tomography scan (PCT) one week after. Patient data sets were retrospectively evaluated, comparing prostate volumes and planning target volumes (PTV). Volumes were delineated by a single radiation oncologist, blinded to whether the scan was VCT or PCT. Distances between the FMs were measured on both scans. Descriptive statistics described the data, DICE similarity co-efficient (DSC) calculated, and paired t-tests were used to compare paired data. Results: The median prostate volume was 35.09 cc and 36.31 cc for VCT and PCT data sets, respectively, and median PTV was 118.56 cc and 127.04 cc for VCT and PCT, respectively. There was no significant difference in prostate volumes (P = 0.3037) or PTV (P = 0.1279), with a DSC of 0.87 (range 0.76-0.91) and 0.91 (range 0.85 to 0.95), respectively. Similarly, there was no significant difference in distance between fiducial markers (P > 0.05). Conclusion: This study demonstrates no statistically significant difference in prostate or PTV volumes (P > 0.05) between the CT acquired at fiducial marker insertion compared with the CT acquired a week later. Therefore, oedema is not significant enough to justify a delay between FM insertion and simulation

Pharmacist-Led Education for Final Year Medical Students: A Pilot Study

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills. Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills. Method: Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention. Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions. Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001). Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula

Evaluation of the state-wide implementation of an allied health workforce redesign system: Utilisation of the Calderdale framework

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland. Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state. Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success. Conclusion Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors

Evaluation of an occupational therapy led Paediatric Burns Telehealth Review Clinic: exploring the experience of family/carers and clinicians

Introduction: Children with deep-partial or full-thickness burns often require complicated post-surgical care and rehabilitation, including specialist occupational therapy (OT) intervention, to achieve optimal outcomes. Those from rural and remote areas rarely have access to these services and must travel to a tertiary referral hospital to access follow-up, placing them at higher risk of complications and poorer outcomes. The OT-Led Paediatric Burn Telehealth Review (OTPB) Clinic, based at Townsville University Hospital in northern Queensland, Australia, was set up to address this inequity. The aim of this study was to investigate the experience of both family members and clinicians in using the OTPB Clinic. Methods: A qualitative approach, guided by interpretive phenomenology, was used. Eight family members and six clinicians participated in semi-structured interviews conducted by phone or telehealth. Thematic analysis was used to identify key themes. Results: Four major themes were derived through thematic analysis: continuity of care, family-centred care, technology and building of rural capacity. Conclusion: Family and clinicians confirm benefits of a telehealth service for delivering care to rural and remote children after burn injury. The results show this expanded-scope, OT-led telehealth model provides quality patient-centred and expert clinical advice within local communities and builds the skill and capacity of local clinicians. Areas for service enhancement were uncovered. This telehealth model can be translated to other clinical subspecialties across Australia

Development of an occupational therapy-led paediatric burn telehealth review clinic

Context: Burns are a common injury in children. Rural and remote children with burn injuries are disadvantaged if their burns require hospitalisation and specialist rehabilitation. Most specialist burn rehabilitation is provided in regional or metropolitan cities by a multidisciplinary team. Therefore, rural and remote burn patients are required to travel to access these services. This project aimed to develop an Occupational Therapy (OT)-Led Paediatric Burn Telehealth Review Clinic (OTPB Clinic) at Townsville University Hospital (TUH) to provide ongoing rehabilitation to rural and remote children after burn injury closer to home. Issues: Local audits identified inequitable service delivery to children from rural and remote areas after burn injury. A project officer was appointed to develop the OTPB Clinic, including comprehensive guidelines to support sustainability. An expanded scope role was undertaken by the treating OT, and allied health assistants were engaged to promote efficient service delivery. Lessons learned: The OTPB Clinic commenced in 2017 and was evaluated using patient satisfaction surveys and number of clinical encounters pre- and post-implementation. During the implementation period, 28 rural or remote paediatric burn patients were reviewed. Review frequency increased from 20-week to 8-week intervals. Travel time was reduced by approximately 12 hours per appointment. Families identified numerous benefits of the clinic including continuity of care and reduced time away from work. Less than 4% of patients required re-engagement with paediatric surgeons for surgical intervention. The model has the potential to be transferred to other tertiary referral burns services

"We're not providing the best care if we are not on the cutting edge of research": a research impact evaluation at a regional Australian hospital and health service

Background: Research is central to high functioning health services alongside clinical care and health professional training. The impact of embedded research includes delivery of high-quality care and improved patient outcomes. Evaluations of research impact help health service leadership ensure investments lead to the greatest healthcare benefits for patients. This study aimed to retrospectively evaluate the impact of research investment from 2008 to 2018 at Townsville Hospital and Health Service (THHS), a regional Hospital and Health Service in Queensland, Australia. The evaluation also sought to identify contextual conditions that enable or hinder intended impacts. Methods: A mixed-methods realist-informed evaluation was conducted using documentation, interviews with 15 staff and available databases to identify and measure research investments, impacts and contextual conditions influencing impact outcomes. Results: Between 2008 and 2018, THHS increased resources for research by funding research projects, employing research personnel, building research-enabling facilities, hosting research events, and providing research education and training. Clinical practice, policy and workforce impacts were successful in isolated pockets, championed by individual researchers and facilitated by their policy and community-of-practice networks. However, there was little organisationallevel support for continuity of research and implementation into practice and policy. Availability of research supports varied geographically across THHS, and across disciplines. Conclusion: Definitive steps in the development of THHS as a credible and productive research centre and leading hospital research centre in Northern Australia are evident. Continuing investments should address support for the research continuum through to translation and establish ongoing, systematic processes for evaluating research investment and impact