A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution

Introduction: Patients Know Best (PKB) provide a patient portal with integrated, patient controlled digital care record. Patient controlled personal health records facilitate coordinated management of chronic disease through improved communications among, and about patients across professional and organizational boundaries. An NHS foundation trust hospital has used PKB to support self-management in patients with Inflammatory Bowel disease; this paper presents a case study of usage. Methods: The Stakeholder Empowered Adoption Model provided a framework for consulting variously placed stakeholders. Qualitative interviews with clinical stakeholders and a patient survey. Results: Clinicians reported PKB to have enabled a new way of managing stable patients, this facilitated clinical and cost effective use of specialist nurses; improved two-way communications, and more optimal use of outpatient appointments and consultant time. The portal also facilitated a single, rationalised pathway for stable patients, enabling access to information and pro-active support. For patients, the system was a source of support when unwell and facilitated improved communication with specialists. Three main barriers to adoption were identified, these related to concerns over security; risk averse attitudes of users; and problems with data integration. Conclusions: Patient controlled personal health records offer significant potential in supporting self-management. Digital connection to healthcare can help patients to understand their condition better and access appropriate, timely clinical advice

Using Telemedicine in Practice: Implications for Workforce Development

The aim of this article is to present a discussion of the impact of telemedicine on professional practice, and the implications for the workforce. Telemedicine, or the use of video-conferencing for remote consultations between clinician(s) and patients, is now a mature technology. Many pilot studies have taken place, generally showing positive benefits to patients. There is emerging evidence that the impact on staff is more mixed; with concerns about changes to job role, skills development, and poor understanding of the organisational benefits. Evidence also highlights enablers of successful telemedicine implementation, including senior leadership, peer motivation, understanding of patient benefits, and time for safe experimentation. Following a review of qualitative data from four case study telemedicine projects undertaken within the authors’ research group, evidence from published literature is discussed. The four projects explore telemedicine services provided between an acute hospital service and nursing homes (remote assessment of swallowing difficulties), an acute hospital service and home (video-link to renal patients undergoing home dialysis), between a specialist teaching hospital service and a district general hospital (fetal abnormalities ultrasound telemedicine clinic), and a survey of mental health professionals across acute and community services within a locality. The introduction of telemedicine at scale requires an organisational and system-level approach that recognises the specific challenges and issues for the workforce. Education and training need to be provided at all levels. In conclusion: there are significant opportunities to realise the benefits of remote consultations, to improve the patient experience and staff productivity, if workforce issues are addressed

Use of a Bayesian belief network to predict the impacts of commercializing non-timber forest products on livelihoods

Commercialization of non-timber forest products (NTFPs) has been widely promoted as a means of sustainably developing tropical forest resources, in a way that promotes forest conservation while supporting rural livelihoods. However, in practice, NTFP commercialization has often failed to deliver the expected benefits. Progress in analyzing the causes of such failure has been hindered by the lack of a suitable framework for the analysis of NTFP case studies, and by the lack of predictive theory. We address these needs by developing a probabilistic model based on a livelihood framework, enabling the impact of NTFP commercialization on livelihoods to be predicted. The framework considers five types of capital asset needed to support livelihoods: natural, human, social, physical, and financial. Commercialization of NTFPs is represented in the model as the conversion of one form of capital asset into another, which is influenced by a variety of socio-economic, environmental, and political factors. Impacts on livelihoods are determined by the availability of the five types of assets following commercialization. The model, implemented as a Bayesian Belief Network, was tested using data from participatory research into 19 NTFP case studies undertaken in Mexico and Bolivia. The model provides a novel tool for diagnosing the causes of success and failure in NTFP commercialization, and can be used to explore the potential impacts of policy options and other interventions on livelihoods. The potential value of this approach for the development of NTFP theory is discussed

‘Teleswallowing’: a case study of remote swallowing assessment

Purpose: Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach: The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings: Over a three-month period, six SLTs and 17 patients in five nursing homes participated in teleswallowing assessments. Teleswallowing benefited both patients and participating nursing homes. Better use of therapist time and cost savings were demonstrated and evidence showed that the service could be successfully scaled up. Despite this, a number of barriers to service transformation were identified. Originality/value: This is the first implementation of teleswallowing in the UK, but it has been used in Australia (Ward et al., 2012). The approach to engaging stakeholders to understand and address barriers to adoption is novel. The value lies in the lessons learned for future innovations

Isolated chylopericardium in an infant with hypoplastic left heart syndrome

Isolated chylopericardium is an exceedingly rare complication in any age group. Review of the limited published case series shows the most common cause of isolated chylopericardium to be cardiac surgery. We present a case of isolated chylopericardium after a bidirectional Glenn procedure in an infant with hypoplastic left heart syndrome.

Measurement of Transepithelial Potentials (In Vitro) from the Midgut of the Gulf Coast Tick Amblyomma Maculatum (KOCH)

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Service user and staff acceptance of fetal ultrasound telemedicine

Objective We present qualitative findings from interviews with frontline clinicians and service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were conducted, undertaken as part of a service evaluation. Data collection was undertaken by different teams, using interview schedules aligned to independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation; the requirement to resist scanning intuitively; communications during the scan; and restricted room space. Notwithstanding, all clinicians reported that participating women were accepting of the technology. Service users reported few concerns. The main benefits of fetal telemedicine were identified as upskilled staff, increased access to specialist support and improved management of complex pregnancies. Convenience was identified as the main benefit by service users, including savings in time and money from not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service. Service users reported satisfaction with communications during the consultation and awareness that telemedicine had facilitated local access to clinical expertise. Whilst clinical stakeholders reported challenges, the iterative nature of the evaluation meant that concerns were discussed, responded to, and overcome as the pilot developed. Clinical stakeholders’ perception of benefits for service users encouraged their acceptance. Moreover, the evaluation established that fetal ultrasound telemedicine is a viable method to access expertise safely and remotely. It provided demonstrable evidence of a potential solution to some of the healthcare challenges facing rural hospitals

Kentucky Youth At Risk Transitions: A Report to the Commonwealth

In the Commonwealth of Kentucky, there are over 22,000 youth being educated in programs that are funded, operated or contracted by state agencies. These state agency children come from a variety of socioeconomic backgrounds and bring a multiplicity of social, psychological, behavioral and educational problems that challenge teachers and staffs. These particular Kentucky students, more than any others, are at the greatest risk of not making successful transitions into adulthood. It is critical that all such young people be afforded the highest quality of transition planning and support so that they can become successful and productive adults. This report is a detailed and comprehensive account of a year-long study that identified and described key elements of student transition in education programs for state agency children in Kentucky. The study included all 105 non-traditional education programs funded and supervised by the Kentucky Educational Collaborative for State Agency Children (KECSAC). The study design used a mixed methods approach that included input from state agency youth and administrators