Telehealth and primary care: a special collection from BJGP Open

In this BJGP Open special issue, we explore how increased reliance on telehealth has changed clinical practice. Telehealth, defined as the provision of healthcare remotely through telecommunications technology, has been integrated into health services with varying degrees of success in the past. The COVID-19 pandemic has accelerated this process, with telehealth presenting a solution to care delivery during national lockdowns and social distancing requirements. There has been vast amounts of research examining what has worked, potential improvements, and what should be retained in the post-pandemic world. This collection of articles adds to the discourse and considers telehealth in three broad areas: access to services, quality of care, and conducting consultations

Metabolism, personality and pace of life in the Trinidadian guppy, Poecilia reticulata

This is the author accepted manuscript. The final version is available from Brill Academic Publishers via the DOI in this record.While among-individual variation in behaviour, or personality, is common across taxa, its mechanistic underpinnings are poorly understood. The Pace of Life syndrome (POLS) provides one possible explanation for maintenance of personality differences. POLS predicts that metabolic differences will covary with behavioural variation, with high metabolism associated with risk prone behaviour and ‘faster’ life histories (e.g., high growth, early maturation). We used a repeated measures approach, assaying metabolic traits (rate and scope), behaviour and growth to test these predictions in the Trinidadian guppy, Poecilia reticulata. We found that while individuals varied significantly in their behaviour and growth rate, more risk prone individuals did not grow significantly faster. Furthermore, after accounting for body size there was no support for among-individual variation in metabolic traits. Thus, while personality differences are clearly present in this population, they do not covary with metabolism and the POLS framework is not supported

Agency and the telephone: Patient contributions to the clinical and interactional agendas in telehealth consultations

Objective: Patient-centredness is central to providing safe care and is achieved, in part, through involving patients in developing the agenda of the consultation. Medical consultations have changed significantly over the last two years as a result of COVID-19 and thus understanding how patients contribute to the clinical and interactional agendas within a telehealth consultation is important to supporting quality care. Methods: A collection (15) of consultations (in English) between specialists (3) and patients (14) were recorded in a metropolitan gastrointestinal clinic in Australia. These recordings were closely examined using conversation analysis, which focuses on the structural and sequential organisation of interaction. Results: Patients used a variety of interactional approaches to contribute to the agenda throughout the consultations. This was achieved in collaboration with the doctors, whose responses generally allowed for these contributions. However, there were few doctor-driven, explicit opportunities provided to patients to contribute to the agenda. Conclusion: Many patients and doctors are adept at managing the interactional challenges of telehealth consultations but there are clear opportunities to extend this advantage to those patients with less agency. Practice implications: Providing an explicit space for patients to ask questions within the consultation would support those patients less inclined or able to assert themselves during a telehealth consultation

Measuring the effect of enhanced cleaning in a UK hospital : a prospective cross-over study

Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at handtouch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both handtouch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus infections were identified 2 to 4 weeks after the cleaner left both wards. Enhanced cleaning saved the hospital £30,000 to £70,000.Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection

The Development and Use of A Piloted Flight Simulation Environment for Rotary-Wing Operation to the Queen Elizabeth Class Aircraft Carriers

Flight simulation is being used to inform the First of Class Flight Trials for the UK’s new Queen Elizabeth Class (QEC) aircraft carriers. The carriers will operate with the Lockheed Martin F-35B Lightning II fighter aircraft, i.e. the Advanced Short Take-Off and Vertical Landing variant of the F-35. The rotary wing assets that are expected to operate with QEC include Merlin, Wildcat, Chinook and Apache helicopters. An F-35B flight simulator has been developed and is operated by BAE Systems at Warton Aerodrome. The University of Liverpool is supporting this project by using Computational Fluid Dynamics (CFD) to provide the unsteady air flow field that is required in a realistic flight simulation environment. This paper is concerned with a research project that is being conducted using the University’s research simulator, HELIFLIGHT-R, to create a simulation environment for helicopter operations to the QEC. The paper briefly describes how CFD has been used to model the unsteady airflow over the 280m long aircraft carrier and how this is used to create a realistic flight simulation environment. Results are presented from an initial simulation trial in which test pilots have used the HELIFLIGHT-R simulator to conduct simulated helicopter landings to two landing spots on the carrier, one in a disturbed air flow and the other in clean air. As expected, the landing to the spot in disturbed air flow requires a greater pilot workload, shows greater deviation in its positional accuracy and requires more control activity. This initial trial is the first of a planned series of simulated helicopter deck landings for different wind angles and magnitudes

Attitude to Physiology in Undergraduate Nursing, Midwifery, and Paramedicine Students

Studying introductory human physiology is an essential part of the nursing, midwifery, and paramedicine university curriculum. Academic success is important, although attitude also contributes to an undergraduate’s experience. We measured attitude to physiology using a novel semantic differential purpose-designed diagnostic instrument, in 338 midwifery, nursing, and paramedicine undergraduates studying 2 compulsory courses in human physiology. The courses were a first semester introductory course (HAP 1) and a second semester course (HAP 2). Exploratory factor analysis identified 2 components, described as affective attitude (12 items), and cognitive attitude (8 items). Component scores were not different between the nursing, midwifery, and paramedicine programmes (P>0.05, Kruskall-Wallis 1-way ANOVA). However, the affective attitude score (mean (sd)) for HAP 1 was higher than HAP 2 (4.81 (0.61) versus 4.59 (0.57), P<0.01, Mann-Whitney U test), whereas the cognitive attitude score for HAP 1 was lower than HAP 2 (3.65 (0.45) versus 3.80 (0.45), P<0.01, Mann-Whitney U test). The instrument was simple to both administer and complete, and appeared to have a suitable structure to quantify both affective and cognitive components of attitude - it may be a suitable instrument to measure the effects of curriculum changes on student attitude, and monitor students’ attitude throughout a programme

Confabulation in children with autism

Some children with high-functioning autistic spectrum conditions (ASC) have been noted clinically to produce accounts and responses akin to confabulations in neurological patients. Neurological confabulation is typically associated with abnormalities of the frontal lobes and related structures, and some forms have been linked to poor performance on source monitoring and executive function tasks. ASC has also been linked to atypical development of the frontal lobes, and impaired performance on source monitoring and executive tasks. But confabulation in autism has not to our knowledge previously been examined experimentally. So we investigated whether patterns of confabulation in autism might share similarities with neurologically-based confabulation. Tests of confabulation elicitation, source monitoring (reality monitoring, plus temporal and task context memory) and executive function were administered to four adolescents with ASC who had previously been noted to confabulate spontaneously in everyday life. Scores were compared to a typically developing (TD) and an ASC control group. One confabulating participant was significantly impaired at reality monitoring, and one was significantly worse at a task context test, relative to both the ASC and TD controls. Three of the confabulators showed impairment on measures of executive function (Brixton test; Cognitive Estimates test; Hayling Test B errors) relative to both control groups. Three were significantly poorer than the TD controls on two others (Hayling A and B times), but the ASC control group was also significantly slower at this test than the TD controls. Compared to TD controls, two of the four confabulating participants produced an abnormal number of confabulations during a confabulation elicitation questionnaire, where the ASC controls and TD controls did not differ from each other. These results raise the possibility that in at least some cases, confabulation in autism may be less related to social factors than it is to impaired source memory or poor executive function

A Virtual Engineering Approach to the Ship-Helicopter Dynamic Interface; a decade of modelling and simulation research at The University of Liverpool

This paper reviews some of the research that has been carried out at the University of Liverpool where the Flight Science and Technology Research Group has developed its Heliflight-R full-motion research simulator to create a simulation environment for the launch and recovery of maritime helicopters to ships. HELIFLIGHT-R has been used to conduct flight trials to produce simulated Ship-Helicopter Operating Limits (SHOLs). This virtual engineering approach has led to a much greater understanding of how the dynamic interface between the ship and the helicopter contributes to the pilot's workload and the aircraft's handling qualities and will inform the conduct of future real-world SHOL trials. The paper also describes how modelling and simulation has been applied to the design of a ship's superstructure to improve the aerodynamic flow field in which the helicopter has to operate. The superstructure aerodynamics also affects the placement of the ship's anemometers and the dispersion of the ship's hot exhaust gases, both of which affect the operational envelope of the helicopter, and both of which can be investigated through simulation