What constitutes a high quality discharge summary?:A comparison between the views of secondary and primary care doctors

This study aimed to identify any differences in opinion between UK hospital junior doctors and community General Practitioners (GPs) with respect to the ideal content and characteristics of discharge summaries, and to explore junior doctors' training for and awareness of post-discharge requirements of GPs

Utilization of Telephone Outreach and Telemedicine to Improve Diabetic Outcomes

Diabetic adherence is paramount to achieving adequate glycemic control. Telephone outreach and utilization of telemedicine can improve diabetic adherence through closer monitoring and removing barriers to access for care. The goal of the project was to improve the dashboard HbA1c quality metric within the IM office. The office dashboard HbA1c metric initially was in the “red threshold”, which means \u3c70% of patients aged 18-75 years old with diabetes had a HbA1c \u3c8%. This project involved performing telephone outreach to contact diabetic patients who were due for office follow-up to offer telemedicine as a convenient option for patient evaluation. In addition, the secondary goals of the project included identifying social determinants presenting barriers to diabetic care plan adherence. The results indicated telephone outreach and telemedicine use may help achieve better glycemic control in diabetic patients. This project demonstrated improvement in HbA1c dashboard metrics to the “yellow threshold”, indicating 71% of patients (18-75 years old) in the office with diabetes had a HbA1c \u3c8%. Several limitations were identified, including a short implementation window (6 weeks), lack of ability to assess whether providers were instituting project recommendations, staff engagement, and internet bandwidth/technology literacy issues when using telemedicine. From a long-term implementation perspective, the project showed telephone outreach and telemedicine are useful tools that can positively impact poorly controlled diabetic patients to improve glycemic control. However, the limitations of the project will likely need to be addressed to achieve long-term implementation of the project methods

A new approach to handle curved meshes in the Hybrid High-Order method

The hybrid high-order method is a modern numerical framework for the approximation of elliptic PDEs. We present here an extension of the hybrid high-order method to meshes possessing curved edges/faces. Such an extension allows us to enforce boundary conditions exactly on curved domains, and capture curved geometries that appear internally in the domain e.g. discontinuities in a diffusion coefficient. The method makes use of non-polynomial functions on the curved faces and does not require any mappings between reference elements/faces. Such an approach does not require the faces to be polynomial, and has a strict upper bound on the number of degrees of freedom on a curved face for a given polynomial degree. Moreover, this approach of enriching the space of unknowns on the curved faces with non-polynomial functions should extend naturally to other polytopal methods. We show the method to be stable and consistent on curved meshes and derive optimal error estimates in L2 and energy norms. We present numerical examples of the method on a domain with curved boundary, and for a diffusion problem such that the diffusion tensor is discontinuous along a curved arc.Comment: 23 pages, 9 figures, 2 table

An enriched hybrid high-order method for the Stokes problem with application to flow around submerged cylinders

An enriched hybrid high-order method is designed for the Stokes equations of fluid flow and is fully applicable to generic curved meshes. Minimal regularity requirements of the enrichment spaces are given, and an abstract error analysis of the scheme is provided. The method achieves consistency in the enrichment space and is proven to converge optimally in energy error. The scheme is applied to 2D flow around circular cylinders, for which the local behaviour of the velocity and pressure fields are known. By enriching the local spaces with these solutions, superior numerical results near the submerged cylinders are achieved.Comment: 26 pages, 10 figures, 3 table

Exploration of care continuity during the hospital discharge process

Background Communication regarding medicines at hospital discharge via discharge summaries is notoriously poor and negatively impacts on patient care. With the process being dependant on the quality of patient records during admission, junior doctors who write them and General Practitioners (GPs) who receive them, the objectives of this thesis were, with respect to discharge summaries, to:- assess their timeliness, accuracy and quality describe GP preferences explore experiences of junior doctors regarding their preparation. Methods Discharge summaries produced from one district general hospital were audited, as was the impact of changing the format of inpatient drug charts. A combination of observation, think-aloud and ethnographic interviews were conducted to investigate experiences of junior hospital doctors preparing summaries. A survey of GPs and junior doctors was undertaken to compare attitudes towards the discharge process. A pilot Discrete Choice Experiment (DCE) was developed and undertaken with GPs to determine their preferences with respect to the format, quality and timing of discharge summaries. Results A large proportion of discharge summaries were found to be inaccurate, however this was reduced when checked by a pharmacist. Key barriers to summary preparation identified were lack of time, training and knowledge of the patient. GPs perceived medicine changes on discharge summaries to be more important than did junior doctors. The DCE found that GPs were willing to trade timeliness of discharge summaries with accuracy. Discussion and conclusions The error rate within discharge summaries highlights the importance of a pharmacy accuracy check. The national requirement to deliver discharge summaries within 24 hours of discharge results in the pharmacist being bypassed and places additional pressure on junior doctors to prepare them in a timely manner, which might provide explanation for poor quality. Interestingly, GPs were willing to forego receipt of discharge summaries within 24 hours in preference for a reduced error rate. Keywords: patient discharge, discharge summary, patient transfer, interdisciplinary communication, medication errors

Robust Hybrid High-Order method on polytopal meshes with small faces

We design a Hybrid High-Order (HHO) scheme for the Poisson problem that is fully robust on polytopal meshes in the presence of small edges/faces. We state general assumptions on the stabilisation terms involved in the scheme, under which optimal error estimates (in discrete and continuous energy norms, as well as $L^2$-norm) are established with multiplicative constants that do not depend on the maximum number of faces in each element, or the relative size between an element and its faces. We illustrate the error estimates through numerical simulations in 2D and 3D on meshes designed by agglomeration techniques (such meshes naturally have elements with a very large numbers of faces, and very small faces)

A novel behaviour change learning activity for pharmacy undergraduate students

Objectives: To engage students in a ‘behaviour change’ learning activity, applying health psychology theory to pharmacy practice in order to help students appreciate the challenges of behaviour change. Methods: Year 2 pharmacy students selected one behaviour to change and kept a diary for one-week before making changes. Students then received a health psychology lecture on behaviour change models. They instigated their behaviour change and continued to document this in the diary over a further one-week. Diaries were collected after the two-week activity for thematic analysis. Results: Of the 99 students, 61 (62%) submitted their completed diary, of whom 55 (90%) successfully implemented their behaviour change. These were categorised into four areas: diet, exercise, liquid consumption, and other. The remaining 10% provided reasons for not changing. Ten students (16%) described their behaviour using a psychological theory. Conclusions: Students engaged well with this novel learning activity, indicated by a high percentage diary completion. They demonstrated a clear appreciation of behaviour change within a real life context and its perceived relevance to pharmacy practice

Immigration, Race, and Local Media in the Midlands: 1960-­‐1985

The passing of the Television Act in 1954 introduced commercial television to British screens for the first time; ITV was formed as a network of regional channels that broadcast content aimed specially at the regions they served. The arrival of regional television also coincided with mass immigration from Britain’s former colonies, a significant proportion of which settled in the Midlands. Scholars of both twentieth-century British history and media history have tended to underplay regional variation. There is a growing but small field of historians who have examined race and media in the same frame but even they have generally not acknowledged the important role of local and regional media in shaping the public response to post-war immigration. This study addresses this absence by examining depictions of immigrants on ATV, ITV’s regional Midlands channel, from 1960 to 1985, focusing primarily on ATV’s news programme through a series of case studies, as well as the production of Here and Now, an ethnic minority arts and culture magazine programme broadcast by ATV (later Central Television) throughout the 1980s. It also examines the previously underexplored role of the local press in the formation of public responses to immigration, highlighting significant links between different forms of local and regional media in post-war Britain by arguing that ATV was, at times, influenced by local press reporting of immigration. ATV and the local press played a crucial role in forming local responses to immigration within the region, one that differed at times to that of the national press, television news and current affairs programming. Unlike the national television news, which reported immigration from a national perspective, ATV broadcast local content which focused specifically on local issues, for example the impact of immigration on local services, employment and housing. This content also crucially provided images of immigrants within the audience’s towns, neighbourhoods and streets. Despite the large immigrant community in the Midlands during the period, ATV failed to properly represent black and Asian people. In doing so, ATV played an important role in defining the boundaries of exclusion and inclusion within Midlands communities. A comparison of regional and national television news and current affairs programming also indicates that ATV understood neutrality differently than the BBC and ITV, often resulting in far more negative representations of race and immigration. By examining the role of local and regional media in public responses to post-war immigration, this study adds depth to our existing understanding of the uneven development of race relations in post-war Britain