Large-scale curriculum redesign where technology plays a central role

VIDEO RECORDINGS: http://goo.gl/bGTaF Materials from the conference held in Birmingham on 21 May 2012. The event was organised by the Association for Learning Technology (ALT) and the Association of Colleges (AoC). Links to all recordings from the day are now available via http://goo.gl/bGTaF. Note that Donald Clarke's session does not contain video except slides

Improved Healing of Pressure Ulcers Using Dermapulse, A New Electrical Stimulation Device

A double-blind, clinical study of pulsed electrical stimulation using the Dermapulse® device was carried out on 40 pressure ulcers, randomized to receive either active (stim) or sham treatment. Electrodes were placed over saline-moistened gauze on the ulcers. An electrical current of 35mA was delivered to the wound tissues at a frequency of 128 pulses per second. Polarity was negative until the wound debrided, then alternated from .positive to negative every three days. Ulcers were treated for 30 minutes twice daily for four weeks, after which sham patients could cross over to active treatment, and stim patients could continue active treatment. Ulcer healing was determined by measuring the length and width of the ulcer and calculating the L x W product. The same clinicians measured the ulcers each week, were kept blinded to treatment group, and were not the same persons who applied the treatment. Nine centers treated 40 ulcers (19 sham and 21 stim). Analysis of the characteristics of the patients, the ulcers, and concomitant wound care by both univariate and multivariate analyses showed comparability of the groups. After four weeks, the stim ulcers healed more than twice as much as the sham ulcers (49.8% vs. 23.4%; (p = 0.042). The stim ulcers healed 12.5% per week compared to 5.8% for the sham group. In the 15 crossover patients, four weeks of active stimulation caused nearly four times as much healing as their four weeks of sham treatment (47.9% vs. 13.4%; p = 0.012). By the last week of-active stimulation they had healed an average of 64%, and complete healing occurred in 40% of these ulcers after an average of nine weeks. Seventeen of the active treatment ulcers had extended therapy, and by their last week of treatment had healed an average of 75%. Forty-one percent of these ulcers healed completely after an average of 11.8 weeks. There were no significant safety problems identified

Registered care home managers’ experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study

Background: Visiting restrictions in care homes in England and many comparable countries during the Covid-19 pandemic were extensive and prolonged. We examined how care home managers experienced, understood and responded to the national care home visiting guidance in England in developing their visiting policies. Methods: A diverse sample of 121 care home managers across England, recruited through varied sources including the NIHR ENRICH network of care homes, completed a 10-item qualitative survey. Follow-up, in-depth qualitative interviews were conducted with a purposive sub-sample of 40 managers. Data were analysed thematically using Framework, a theoretically and methodologically flexible tool for data analysis in multiple researcher teams. Findings: Some viewed the national guidance positively; as supporting the restrictive measures they felt necessary to protect residents and staff from infection, or as setting a broad policy framework while allowing local discretion. More commonly, however, managers experienced challenges. These included the guidance being issued late; the initial document and frequent, media-led updates not being user-friendly; important gaps, particularly in relation to dementia and the risks and harms associated with restrictions; guidance being unhelpfully open to interpretation while restrictive interpretations by regulators limited apparent scope for discretion; fragmented systems of local governance and poor central-local coordination; inconsistent access and quality of support from local regulators wider sources of information, advice and support that, while often valued, were experienced as uncoordinated, duplicative and sometimes confusing; and insufficient account taken of workforce challenges. Conclusions: Underlying many of the challenges experienced were structural issues, for which there have been longstanding calls for investment and strategic reform. For increasing sector resilience, these should be are urgently addressed. Future guidance would also be significantly strengthened by gathering better data, supporting well-facilitated peer exchange, engaging the sector more fully and dynamically in policy-making and learning from care home managers’ and staff’s experiences, particularly of assessing, managing and mitigating the wider risks and harms associated with visiting restrictions

Towards telemedicine in pulmonary hypertension: assessing the feasibility of remote quality of life and exercise capacity assessment

Patients with pulmonary hypertension (PH) are happy to perform simple exercise capacity tests at home and believe this is feasible. A proportion of patients are able to use an electronic form to complete quality of life questionnaires. These findings are being used to build a telemedicine strategy for PH patients

Impairment of skeletal muscle oxygen extraction and cardiac output are matched in precapillary pulmonary hypertension

In precapillary pulmonary hypertension, exercising muscles extract oxygen to a similar level seen in healthy individuals. Exercise limitation is a result of impaired oxygen delivery, which is matched to any impairment in skeletal muscle oxygen extraction

The MRC Dyspnoea Scale and mortality risk prediction in pulmonary arterial hypertension: a retrospective longitudinal cohort study

Risk stratification models in pulmonary arterial hypertension (PAH) rely on World Health Organisation Functional Class (WHO FC). A high proportion of patients are classified as WHO FC III, a heterogenous group which limits the stratification abilities of risk models. The Medical Research Council (MRC) Dyspnoea Scale may allow a more precise assessment of functional status and improve current risk models. We investigated the ability of the MRC Dyspnoea Scale to assess survival in PAH and compared performance to WHO FC and the COMPERA 2.0 models. Patients with Idiopathic, Hereditary or Drug-induced PAH who were diagnosed between 2010 and 2021 were included. The MRC Dyspnoea Scale was retrospectively applied as derived from a combination of patient notes, 6MWD tests results and WHO functional status using a purpose-designed algorithm. Survival was assessed using Kaplan–Meier analyses, log rank testing and Cox proportional hazard ratios. Model performance was compared with Harrell's C Statistic. Data from 216 patients were retrospectively analyzed. At baseline, of 120 patients classified as WHO FC III, 8% were MRC Dyspnoea Scale 2, 12% Scale 3, 71% Scale 4 and 10% Scale 5. The MRC Dyspnoea Scale performed well compared to the WHO FC and COMPERA models at follow up (respectively, C-statistic 0.74 vs. 0.69 vs. 0.75). It was possible to use the MRC Dyspnoea Scale to subdivide patients in WHO FC III into groups which had distinct survival estimates. We conclude that at follow-up, the MRC Dyspnoea Scale may be a valid tool for the assessment of risk stratification in pulmonary arterial hypertension

Predicting Group II pulmonary hypertension: diagnostic accuracy of the H2FPEF and OPTICS scores in Scotland

Objective: Group II pulmonary hypertension (PH) can be challenging to distinguish from Group I PH without proceeding to right heart catheterisation (RHC). The diagnostic accuracy of the H2FPEF and OPTICS scores was investigated in Scotland. Methods: Patients were included in the study if they were referred to the Scottish Pulmonary Vascular Unit between 2016 and 2020 and subsequently diagnosed with Group II PH or Group I PH which was either idiopathic, heritable or pulmonary veno-occlusive disease. The established cut offs for the H2FPEF and for the OPTICS scores were applied retrospectively to predict the presence of Group II PH. The diagnosis from the scores were compared with the MDT consensus diagnosis following RHC. Results: 107 patients with Group I PH and 86 patients with Group II PH were included. Retrospective application of the OPTICS score demonstrated that pretest scoring would detect 28% of cases with Group II PH yet at the cost of misdiagnosing 4% of patients with Group I as Group II PH (specificity 0.96). The H2FPEF score had a far greater sensitivity (0.70) yet reduced specificity (0.91), leading to misdiagnosis of 9% of Group I PH cases. Conclusion: While the specificity of these scores was high, the lack of perfect specificity limits their utility as it results in missed patients with Group I PH. As a consequence, they cannot replace RHC as the means of diagnosing the aetiology of PH in their current form. The scores may still be used to support clinical judgement or to indicate the advisability for further provocative testing at RHC

Remote exercise testing in pulmonary hypertension (PHRET)

Remote exercise tests for patients with pulmonary hypertension (PH) would improve the telemedicine strategies in this disease. The PHRET study assessed the validity and feasibility of four remote exercise tests performed by PH patients at home. Participants undergoing diagnostic assessment for PH were included. At baseline, patients completed a 6MWT followed by a range of study tests including a Timed Up and Go (TUG) test, a Sit-to-Stand (STS), a Step Test (ST), and a tele-6MWT (T6MWT) performed outside using a GPS-enabled smartphone. Patients performed these tests at home following discharge and at first follow-up. Analysis focused on comparing the results of study tests to the standard 6MWT. The discontinuation rate was 15%. Ninety-seven percent of patients were able to complete a TUG, 92% a STS, 73% a ST, and 49% a T6MWT. At baseline, correlation between the standard 6MWT and study tests, respectively, was T6MWT 0.93, ST 0.78, STS 0.71, and TUG −0.76 (p < 0.001). Direction of change in the study test agreed with the standard 6MWT in 68% of the follow-up ST, 68% of the STS, 71% of the TUG, and 79% of the T6MWT. Patients were able to complete the tests at home, there were no adverse incidents and ≥92% of patients were happy to continue performing home tests. Remote exercise testing is feasible. The T6MWT was a valid remote measure of exercise capacity, but could only be performed by a limited number of patients. The high discontinuation rate may impact the utility of remote tests

Hospital specialist palliative care team influence on end-of-life care in Coronavirus disease 2019? A retrospective observational cohort study

Objectives: The coronavirus 19 disease (COVID-19) pandemic has led to a renewed focus on end-of-life care. The majority of COVID-19 deaths occur in hospital, with patients cared for by generalists and hospital specialist pal- liative care teams (HSPCTs). This project aims at exploring the potential influences of HSPCTs on end-of-life care in COVID-19. Methods: A retrospective observational study was carried out by exploring four end-of-life care themes in a Scot- tish hospital population who died from COVID-19. Comparison was made between cohorts seen by HSPCTs ver- sus generalist clinicians. Results: Analysis of 119 patients across NHS Greater Glasgow and Clyde (NHSGGC) health board demonstrated that COVID-19 patients seen by HSPCTs were more likely to be younger (median 77 vs. 81 years; p = 0.02), have a cancer diagnosis (21.7% vs. 5.4%; p = 0.01), die sooner after admission (median four vs. six days; p < 0.01), and be commenced on a syringe driver (89.1% vs. 42.5%; p < 0.01). Differences detected across four end-of-life care themes comparing HSPCTs with generalist teams were minimal with documentation and prescribing in keeping with available guidance. Conclusion: Consistencies in end-of-life care observed across NHSGGC cohorts draw attention to the potential wider impact of HSPCT roles, including education, guideline development, and mentoring. Understanding such diverse effects is important to support funding and development of HSPCTs. Further research is required to bet- ter quantify the impact and heterogenous influences of HSPCTs in general