ABSTRACT
Introduction: IslaCare is a digital platform that allows patients and clinicians to capture, store and securely share images, videos, voice notes and assessments. It facilitates decision making and is approved by NHS digital. COVID- 19 challenged services which demanded innovation in Stroke rehabilitation. Challenges included reduced in-reach access into acute services, orthotics, spasticity clinic, reduced access into care homes and patient's homes through fear of active COVID outbreaks and subsequent impacts on service delivery. IslaCare offered a solution, enabling the team to evidence clinical effectiveness and progress, inform clinical conclusions, facilitate patient in-reach processes and visually support remote assessment and monitoring. Method(s): IslaCare was initially piloted in Community Stroke Team for 12 weeks. Training was provided prior to launch. Secondary engagement with Nottingham University Hospitals NHS Trust (NUH) stroke unit commenced during the pilot period which involved the mobilisation of IslaCare at NUH. Feedback was gained from both clinicians and patients to understand the impact on clinical care and patient experience. Result(s): 63 patients have been included to date. 341 videos or photo submissions to IslaCare. 70% patient response rate. 80% staff agreed/ strongly agreed that IslaCare added value to the assessment process. 100% patients surveyed reported feeling connected with their care. Conclusion(s): IslaCare was easily rolled out across the stroke pathway and embedded into clinical practice. This enhanced effective handover of patients, improved triage and discharge planning. It has enriched patient records, measurement of progress, improved efficiency, reduced waits and chaperone input in clinic settings whilst also increasing quality of care.
ABSTRACT
Aims: To evaluate the effectiveness of an interactive virtual carbohydrate counting course on glycaemic indicators in people with type 1 diabetes. Methods: An observational study of glycaemic management following a virtual carbohydrate counting course, comprising of a weekly two hour session over three weeks on Microsoft Teams. Key metrics monitored from flash glucose monitoring (FGM) at baseline, three and six months: time in range (TIR), time below range (TBR) estimated glycated haemoglobin (eHbA1c) and glucose variability (GV). A paired two sample for means T-test was used to determine statistical significance. Results: 26 participants completed the course (14 male, 12 female). Baseline and three month data was available for 17 participants (11 male, 6 female). Six month data was available for 14 participants, (9 male, 5 female). Significant improvements were observed at six months for GV (p = 0.05). No significant differences were observed at three months. Conclusions: One metric (GV) showed significant improvement at six months. The lack of significant improvements in other parameters and at three months could be related to many factors. There is a paucity of research on virtual carbohydrate counting courses for comparison purposes. The National Institute of Clinical Excellence (NICE) recommends offering structured education to all people with type 1 diabetes. The option of a virtual course has allowed for continuation of education during the covid-19 pandemic, which otherwise would have been absent. Further research is required to inform clinical practice and service development and provide further insight into lack of improvement in some parameters.