Navigating in large hospitals

Navigating around large hospitals can be a stressful and time-consuming experience for all users of the hospital infrastructure. Navigation difficulties encountered by patients and visitors can result in missed appointments or simply create a poor impression of the hospital organisation. When staff encounter navigation difficulties this can lead to cost and efficiency issues and potentially put patient safety at risk. Despite the provision of an array of in-hospital navigational aids, ‘getting lost’ continues to be an everyday problem in these large complex environments. This study aims to to identify factors which affect navigation in hospitals. We do not seek to evaluate the effectiveness of a single navigation aid, instead the objective of this study was to understand the environment in which a new system must operate and the gaps in provision left by existing navigation aids. This study is intended to be used to inform the development of new in hospital navigational aids, be they technological or otherwise. Eleven participants, all users of a large hospital site, were asked to describe specific first hand experiences of navigating in a hospital. The ‘Critical Incidence Technique’ was applied in a series of semi-structured interviews to elicit information about a participants navigation experience. This work presents the results of these interviews, with concepts identified and organised into five themes: The ‘Impact’ of poor navigation, ‘Barriers’ to effective navigation, ‘Enhancers’ for effective navigation, ‘Types of Navigation Aids’ and user groups with ‘Specific Navigational Needs’. The number of navigation aids available to participants was identified as an issue in itself, we found examples of thirty seven distinct sources of information available to a hospital user. We begin by introducing previous work on in-hospital navigation before describing the study design employed in this research. The themes and categories identified from the interview data are enumerated and described, with examples given from the interview transcripts. Finally we go on to give a discussion of some potential navigation solutions in light of the identified factors. This study highlights that a candidate navigation aid must be carefully designed and implemented if it is to compliment the thirty seven other sources of navigation information available to the hospital user

A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England

© 2020, The Author(s). Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8–160.4) and 107.7 (73.8–147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile—IRR = 1.99; 95% CI: 1.88–2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention

Effectiveness of Career and Technology Student Organizations (CTSOs) in Texas

The purpose of this study was to determine the extent to which public school administrators believe that Career and Technology Student Organizations (CTSOs) are providing students the necessary skills for employability and academic success. Objectives focused on whether CTSOs are effective in developing students’ leadership skills, keeping them engaged in school, developing technical skills, and improving academic achievement. School administrators were surveyed via the internet. A 28% response rate was achieved. Ninety-two percent of respondents indicated that their school offered students the opportunity to participate in CTSO activities. Administrators indicated that the FFA was the CTSO that was either most effective or second most effective in teaching leadership skills, keeping students engaged in school, improving technical skills, and improving academic achievement. HOSA and Skills USA also were consistent in being among the top three CTSOs that were effective in providing one of the four characteristics. Considering 80 percent as a benchmark, administrators perceived CTSOs very favorably as being either mostly effective or very effective in meeting students’ needs

What are the pros and cons of electronically monitoring inhaler use in asthma?: a multistakeholder perspective

Introduction Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process. Methods Three rounds of surveys in a Delphi format were used to assess the most important pros and cons of EMDs for asthma care in a sample of 31 stakeholders which included healthcare professionals and members of clinical commissioning groups. Results The respondents identified 29 pros and 32 cons. Pros that were rated as most important included new visual evidence to aid clinical discussions with a patient and an increase in patient involvement and motivation. The cons that were rated as most important included a need for more clinical evidence of the effectiveness of EMDs, as well as better clarity over who has responsibilities in managing, interpreting and discussing data with a patient. Conclusions The research provides a guide for EMD developers by highlighting where these devices may provide the most benefit as well as prioritising the key issues that need addressing if they are to be used effectively in everyday asthma care

Building analytic skills to drive improvements in patient care and organisational decision making: an information analysts’ development programme

Purpose This paper briefly outlines a development programme designed to improve the skills of NHS Information Analysts and assesses the extent these skills have been developed. There are significant opportunities for the NHS to utilise information more effectively, and Analysts have a key role. However, training opportunities prior to the development of this programme have been limited for this professional group. The purpose of this paper is to explore the potential benefits to the organisations, patients and the NHS as a whole,that improvements in the quality of analysis can deliver. Design/methodology/approach The authors compared pre-course and post-course self-assessment of skill levels of Analysts who attended the programme. The authors also considered general feedback and comments from participants. Findings All of the 40 skills areas assessed demonstrated an increase in mean competency score. In cohorts 1 and 2, 38 of these were statistically significant (p < 0.001-0.041, mean increase in score 1.0). For cohorts 3-5, 37 were statistically significant (p < 0.001-0.012; mean increase 1.2). These findings were supported by the positive feedback from participants. Practical implication The programme develops skills for NHS Information Analysts which can improve the quality of analysis in the NHS, offering significant potential to improve the effectiveness and efficiency of healthcare. Originality/value The Information Analysts’ Development Programme provides the only training programme available for NHS Information Analysts, contributing to the development of data driven service improvement within the NHS. This may harness the power contained within data to drive improvement and ensure patients receive the highest quality of care

Electronic monitoring of adherence to inhaled medication in asthma

The main treatment of asthma is inhaled corticosteroids. However adherence to these medications in asthma is often poor, with low adherence associated with excessive health care costs and an increased risk of emergency room visits and mortality. Although various methods are used to indirectly assess adherence, all have significant limitations whether used in clinical or research practice. The recent development of electronic monitoring devices (EMDs) for use with inhalers presents an exciting opportunity to easily and accurately measure inhaler adherence. This article summarises the current devices available; for each device features and limitations are considered, followed by a review of both the current clinical literature and data on reliability and accuracy. An overall summary is also provided to aid comparison of capabilities between devices and future issues pertaining to the use of EMDs are discussed, including barriers to adoption, stakeholder involvement, novel methods of communicating adherence data, recording of data and cloud storage. Finally key areas that still require investigation are highlighted

Expression of polycomb protein BMI-1 1 maintains the plasticity of basal 2 bronchial epithelial cells

The airway epithelium is altered in respiratory disease and is thought to contribute to disease aetiology. A caveat to disease research is that the technique of isolation of bronchial epithelial cells from patients is invasive and cells have a limited lifespan. The aim of the current study was to extensively characterise the plasticity of primary human bronchial epithelial cells that have been engineered to delay cell senescence including the ability of these cells to differentiate. Cells were engineered to express BMI-1 or hTERT using viral vector systems. Cells were characterised at passage (p) early (p5), mid (p10) and late (p15) stage for; BMI-1, p16 and CK14 protein expression, viability and the ability to differentiate at air-liquid interface (ALI), using a range of techniques including immunohistochemistry (IHC), immunofluorescence (IF), transepithelial electrical resistance (TEER), Scanning Electron Microscopy (SEM), (MUC5AC and beta tubulin (BTUB) staining). BMI-1 expressing cells maintained elevated levels of the BMI-1 protein and the epithelial marker CK14 and showed a suppression of p16. BMI-1 expressing cells had a viability advantage, differentiated at ALI and had a normal karyotype. In contrast hTERT expressing cells had a reduced viability, showed limited differentiation and had an abnormal karyotype. We therefore provide extensive characterisation of the plasticity of BMI-1 expression cells in the context of the ALI model. These cells retain properties of wild-type cells and may be useful to characterise respiratory disease mechanisms in vitro over sustained periods

Changes in Asthma Mortality in England and Wales since 2001

The number of deaths from asthma in England and Wales has not changed significantly over the last decade. This lack of improvement has received attention from both national asthma guidelines and the media. We examined asthma death data from the Office for National Statistics, stratified by age band. Every 5-year age band below the age of 80 years has seen a large reduction in mortality between 2001 and 2017, whereas numbers of asthma deaths have increased by 81% for people aged 80 years or above. This increase in older people dying from asthma requires explanation

Step 4: stick or twist? A review of asthma therapy

Many people with asthma do not achieve disease control, despite bronchodilators and inhaled corticosteroid therapy. People with uncontrolled asthma are at higher risk of an asthma attack and death, with mortality rates estimated at 1000 deaths/ year in England and Wales. The recent National Review of Asthma Deaths (NRAD) report, ‘Why asthma still kills’, recommended that patients at step 4 or 5 of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidance must be referred to a specialist asthma service. This article reviews the 2014 evidence base for therapy of asthma patients at BTS/SIGN step 4 of the treatment cascade, in response to key findings of the NRAD report and lack of preferred treatment option at this step