RSS 1.0Adult and Older People Health
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Audit on management of sexual assault victims attending an integrated sexual health service in CoventryThe management of victims of sexual assault need a holistic approach. The British Association of Sexual Health and HIV (BASHH) has set up standards for the management of sexual assault victims attending Sexual Health Clinics. We audited the management of victims of sexual assault attending an integrated sexual health service against recommendations from the latest BASHH guidelines. We included the recommendations and implementations already in place following an earlier audit in 2013 using the same guideline. Sixty-seven individuals identified themselves as victims of sexual assault. Most were of white ethnic origin (78%), female (96%) and the commonest age group was 18–25 years (39%). We achieved the 100% target in recording the date of assault, offering baseline sexually transmitted infection (STI) screening, HIV risk assessment, offer of post-exposure prophylaxis (PEP) for HIV where applicable and offer of emergency contraception. We were below the 100% target for other categories but improved compared to the previous audit except in recording the time when the first dose of PEP for HIV was given. The BASHH guideline has 14 auditable standards, all with a target of 100%. Our audit cycle completed in three years showed considerable improvement in achieving the standards in the management of Sexual Assault Victims. We hope this will encourage other centres audit their practice against the standards set by BASHH.
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An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud StudyBackground: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status. Keywords: co-design; condoms; eHealth; internet; intervention development; sexual behavior; sexually transmitted infection; young adult.
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Vitamin D: Pharmacology and Clinical Challenges in Oral Health CareVitamin D is a hormone produced endogenously through cutaneous transformation of 7-dehydrocholesterol by UVB irradiation and exerts its effects through binding to its intracellular receptor. It has skeletal and non-skeletal functions and could be involved in oral health conditions especially periodontitis. In this review, we report the beneficial roles of vitamin D related to oral health. Vitamin D deficiency prevalence is high especially among the elderly and is associated with oral health complications such as periodontitis with a possible role and effects of vitamin D supplementation in the management of oral health conditions. Further research is needed to define vitamin D target levels and establish effective strategies for managing patients suffering from oral health conditions especially periodontitis. Improving the knowledge of dental practitioners, periodontists and pharmacists regarding vitamin D deficiency implications in oral health conditions could guide the management of oral conditions such as periodontitis.
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A visual antiretroviral regimen based tool to support cost-effective prescribing in treatment-naive individuals : defining the baselinePoster abstract P146 from the 23rd Annual Conference of the British HIV Association (BHIVA), Liverpool, UK, 4–7 April 2017.
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Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trialObjective: To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia. Design: Multicentre, pragmatic, investigator masked, randomised controlled trial. Setting: National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. Participants: 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm. Interventions: Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises. Main outcome measures: The primary outcome was score on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention. Results: The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference -1.4, 95% confidence interval -2.6 to -0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer's disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m). Conclusion: A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.
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Association of Low Vitamin D with Complications of HIV and AIDS: A literature ReviewWith the advent of combination antiretroviral therapy (cART), the survival of HIV patients has improved dramatically, but the complications of the disease and treatment have become an important issue in the management of HIV patients. Vitamin-D deficiency is common in HIV patients. Low vitamin-D is associated with different comorbidities in the HIV uninfected general population. In this review, we first briefly describe vitamin D synthesis and mechanism of action and we focus on the epidemiological and clinical data dealing with the relationship between vitamin D deficiency in HIV infection with several comorbidities which has been found to be increasingly common in patients living with HIV infection. We searched the PubMed database using the keywords "HIV," "vitamin D" and other common disorders or conditions that are relatively common in HIV infection. The other conditions included in the search were osteoporosis and fracture, cardiovascular disease, diabetes and insulin resistance, active tuberculosis, hepatitis-C co-infection, and HIV disease progression. Articles presenting original data as well as systematic reviews and met analysis related to HIV population were included in our analysis. Vitamin-D deficiency seems to be associated with several adverse outcomes in HIV patients but a definite cause and effect relationship with vitamin-D is yet to be confirmed in most of the cases. However, the literature supporting the efficacy of vitamin-D supplementation is lacking.
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QI 1214 Improving Staff Confidence and Competence in Delivering End of Life Care on Acute Dementia Wards (Stanley and Pembleton)Aim: Improve staff's confidence and abilities to care for patients on end-of-life (EOL) pathways. This project ran across Stanley and Pembleton the acute dementia wards. During reflective meetings, staff identified a need around improving confidence in working with people at end of life (EOL). Staff voiced wanting to feel they had done the right thing, despite not being a specialist EOL ward. Staff’s views regarding what they needed to help improve their confidence in working with people at end of life were used to develop training, information and support around the following topics: -Increasing Knowledge and Skills around EOL -MDT Working and a ‘joined up approach’. Providing an appropriate environment and tools to guide interventions (i.e. SOP, pain identification). Tools Used: Staff discussions and feedback. Questionnaires with quantitative and qualitative responses. QI Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Staff report feeling more confident in their abilities to care for patients at end of life (EOL). Service level agreement in place: Mary Ann Evans hospice to offer rapid response to support ward with EOL concerns. Staff report feeling better able to access support from services during/following identifying a patient as approaching EOL. Importance of the need for a SOP identified and development has begun.
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QI 1221 Reducing Urgent Community Response (UCR) Service RejectionsAim: To achieve a 25% reduction in senior clinical reviews from an average of 52 per month in Q1 2023 to a target of 39 in Q3 2023. A clinical audit was undertaken in December 2022 by the Advanced Consultant Clinical Practitioner in the UCR service; SQ1132 Urgent and Emergency Care Clinical Audit Toolkit. The audit highlighted significant discrepancies in the use of the UCR follow-up clinical review process, which allows UCR clinicians to keep patients on the acute medical caseload for up to 72 hours. Consequently, an improvement project was proposed to reduce the burden of clinical reviews with the UCR senior clinicians’ cohort. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagrams - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Project Impact: The average number of senior clinical reviews decreased from 52 in quarter 1 to 26 in quarter 3. A reduction of 50%. 780 minutes of senior clinician patient facing time were freed up each month - 156 hours per year. Cost savings of £290.68 per month and £3488.16 per year.
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QI 117 Improving Physical Health Care Provided by Coventry 11-17 (Psychosis Pathway) TeamAim: By 9 July 2022 for patients open to medical staff only in the Coventry Recovery Team (N=96): 1. 30% will have been offered an appointment to complete the lifestyle screening tool. 2. 20% will have had a physical health and lifestyle screening tool completed. The trust requires that all patients open to the service with psychotic disorders have an annual physical health screening assessment. Prior to this project there was a nurse and health care led process in place which was unable to meet these requirements. Baseline data showed that of those patients only open to the medical team 13.5% had been offered a physical health screen and only 12.5% had a completed assessment over the past 3 years. Tools Used: PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf; Project Impact: Completed physical health assessments increased from baseline by 20% up to 32.5% at week 16. Cycle 2: aimed at non-attendance. Providing generic information improved this by 3.6% but a personalised letter to non-attenders at a 1st appointment (n=3) resulted in them all attending a 2nd appointment.
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QI 1195 Improving Flow of Care Needs Through Urgent Community Response (UCR)Aim: Improve patient flow from UCR Care into Adult Social Care (ASC) and staff to generate referrals to ASC within 3 to 5 days of assessment by October 2023. UCR (Urgent Community Response) is a dedicated crisis response team of Advanced Clinical Practitioners, Nurses, Therapists, Advanced Practitioners, Health Care Assistants and Admin who work with patients to prevent unnecessary admission to hospital by providing a rapid intervention delivered within two hours. The team wanted to use QI tools to improve their service. They wanted to meet their target of 3-5 days for referral to adult social care and they wanted to reduce over-prescription of care. Average length of stay at the start of the project was 6 weeks+; the team aimed to reduce this to 7 days. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf; Mapping the Last 10 Patients - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-last-10-patients.pdf. Project Impact: • Average LOS for UCR Care reduced from 6 weeks in July 2022 to 2 weeks in October 2023. • The average time taken to refer to ASC was within the 3-5 day target by June 2023.
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QI 102 Implementing a Telephone Triage System in Integrated Sexual Health Service (ISHS)Aim: To reduce in-clinic waiting times for patients attending the open access clinic by 50% by 31st January 2020. Prior to the Covid-19 pandemic a face-to-face triage system was in place. Being a walk-in service, patients were required to queue before entering the department. If clinic capacity was reached, they would have to be turned away. There were frequently long in-clinic wait times (on an average 73 minutes) before first contact with the clinician could occur. In response to the pandemic, a telephone triage system was implemented. The aim of this was to reduce the in-clinic waiting time and provide a safe and effective system during the pandemic. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: 70% of patients said that they had to wait for less time than the previous attendance. •83% of patients felt comfortable sharing information over the telephone. •100% of patients were satisfied with the outcome of the triage. •87% of patients were satisfied with the service offered. •Overall staff preferred the new telephone triage system. The waiting room is quieter and there is less pressure on the reception team.
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QI 148 Improving Patient Flow across Urgent and Reablement TherapyAim: 90% of Reablement patients to be seen with in 48 hours of receiving the referral (Monday – Friday) 100% Urgent Community Response (UCR) Therapy patients to be seen with in 48 hours of receiving the referral (Monday-Sunday). Following the publication of Urgent Community Response (UCR) guidance by NHSE in July 2021 CWPT has responded with the development of their own UCR team. This in turn was predicted to change the utilisation of therapy within the urgent offer. Patients need to be seen within the timescale specified by triage which can be 4-6 hours / 24 hours / 48 hours. The therapy team that responds to the urgent referrals also provides the on-going up to 6 weeks Reablement service. Any changes to the urgent response roster will have a knock-on effect on the reablement offer. Therefore, we needed to explore how to maximise capacity to fulfil the requirements of both Urgent and Reablement Therapy using QI. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Waiting times for Reablement patients January 2022 = 3 weeks. Patient facing activity time during every working shift varied across the team from 42% to 99% against a target of 67%. Developed a way of measuring waiting times for UCR patients. Next Steps: Daily monitoring of: Waiting list /Capacity and demand / Patient flow. Scoping what capacity can be released from both clinical / non clinical perspective to support service improvements and patient flow, followed by, scoping funding for Patient Flow Coordinator to release further clinical capacity. Preparing for AHP job planning. Equitable workload across the services. Plan for future workload for the service e.g., trajectory of wait lists being cleared.
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The NHS and Private HealthcareThe National Health Service was founded in 1948 to provide free healthcare to all citizens, with the anticipation that this would improve the general health of the population, and thus ultimately reduce the cost of ill health on the economy. Unfortunately, healthcare costs have risen continually since the inception of the NHS due to an ageing population, increasing public expectations of the health service and advances in medical technology resulting in increasingly costly interventions. Despite continually rising costs and changes to the structure and management of the NHS, it remains a successful and effective system of healthcare.
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British Thoracic Society quality standards for home oxygen use in adultsIntroduction: The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Methods: Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results: 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion: BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.
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QI 146 Creating a Long COVID Pathway Through Integrated WorkingAim: To establish a Long COVID pathway across UHCW & CWPT. The project sought to establish an integrated pathway across 2 health trusts which use separate staffing teams, IT, operational, & clinical systems. This was achieved through collaborative working across both trusts to establish: • Referral pathway and GP training • Community rehab arm inc. Vocational rehab • Review of MDT attendance Joint Trust MDT meeting, DPAs and DPIAs completed for data sharing • Psychology rehab criteria • Assessment paperwork, • Cross ICB recovery group-face to face and virtual offer Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: This project has increased networking across local Trusts, as well as regional and national bodies. It is continuously contributing to evidence base for this new disease through practise-based research. It has been presented and discussed nationally at events such as RCOT, Adapt Framework, Listen Project and FFT thematic analysis. It has also garnered continuous positive patient feedback which helps shape the continued Long COVID Service. Next steps are; 1. Pro-active case finding work; including a Long COVID workshop. 2. Co-production to develop the cross ICB psychology offer; including rehabilitation intervention. 3. Increase capacity of psychology offer (through group development & recruitment). 4. Develop a recovery group to help patients convalesce. 5. Scope peer support groups in collaboration with the voluntary sector.
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A prospective mixed-methods pilot study of a novel group structured education programme for adults with cystic fibrosis diabetesBackground: Cystic fibrosis diabetes (CFD) is associated with increased morbidity and mortality in adults with cystic fibrosis (CF). In addition, poor glycaemic control can result in microvascular complications. Group educational programmes for people with type 1 and 2 diabetes have been shown to improve diabetes outcomes. The national guidelines recommend that people with CFD should receive education regarding diabetes; however, specific CFD group education programmes have not been evaluated. Aims: This study aimed to test whether this novel diabetes contents and intervention for CFD based on the Beta Cell Education Resources for Training in Insulin and Eating (BERTIE) type 1 diabetes education programme was beneficial for adults with CFD. The adapted course, Improved Diabetes Education in Adults with Cystic Fibrosis (IDEA-CF ), incorporated CFD-specific topics and was delivered virtually via videoconference group sessions to facilitate peer learning and support without the risk of cross-infection. A pilot study was conducted utilising this novel IDEA-CF virtual structured program to ensure that the intervention met the patients’ educational needs. Methods: This randomised controlled multimethods pilot study recruited adults with CFD taking insulin therapy and cared for by a large regional CF centre. After providing written informed consent, the participants completed all the study forms and questionnaires before randomisation. Randomisation was performed using a computerised randomisation system that allocated adults with CFD into the intervention group (IDEA-CF) or routine care group for the 12-week study period. Participants who were randomised into the routine group continued to receive one-on-one education as before. Using the CF quality-of-life (QoL) questionnaire (revised Cystic Fibrosis Questionnaire [CFQ-R]), outcomes were measured at baseline and 12-week visits in both groups. The participants in the intervention group were asked to take part in a semistructured qualitative interview after the completion of the intervention, which was performed by a CF psychologist. Results: A total of 20 participants were recruited, with 18 completing the intervention and study follow-up visits. In the CFQ-R domains, physical functioning, emotional functioning, eating, role functioning and respiratory symptoms were significantly improved in the intervention group compared with the routine care group. The IDEA-CF Knowledge Assessing Questionnaire (IDEA-CF KAQ) scores in the intervention group improved compared with the IDEA-CF KAQ scores in the control group, suggesting that education improves knowledge and understanding. The IDEA-CF structured virtual group education group was well received, with participants valuing the educational content and the ability to interact with each other and to learn from their peers’ experiences constructively. Conclusions: Our study demonstrated that the IDEA-CF education programme improved health-related QoL and diabetes knowledge, as evidenced by the results of the IDEA-CF KAQ. The participants valued the educational contents of the programme and reported a positive experience interacting with their peers.
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Parkrun practice: more than a run in a park"Parkrun" is a weekly walk, jog or run over 5 km in public open spaces across the UK, led by volunteers on Saturday mornings at 9 am.
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Cold agglutinin disease: a case report.Abstract This case report is to help raise awareness of a rare autoimmune disorder, cold agglutinin disease (CAD), which is characterised by the premature destruction of red blood cells (haemolysis)(National Organisation for Rare Disorders [NORD],(2020). It can have a severe physical and psychological impact on those suffering with it. Caring for patients with CAD can also be extremely challenging and even traumatic for clinicians. The importance of good multidisciplinary team (MDT) working both within hospital and when discharging a patient to a community healthcare setting is also highlighted (NORD, 2020), as well as the importance of clear communication for the patient from medical staff on the expectations of treatment and prognosis. Approximately one person in 300,000 gets CAD, which is more prevalent in those aged 60 years and older. Women are also more likely to get it than men (Smith, 2021).
