My diabetes My Way: Intelligent delivery of diabetes education and support for self-management

Background: My Diabetes My Way (MDMW) is NHS Scotland's interactive website, offering education, structured eLearning and online records access for people living with diabetes. We aimed to analyse user activity during the last 12 months. Method(s): Data were collected during the period from November 2021 to October 2022. Registration and user audit logs were analysed, observing activity across all website content and features. Result(s): An average of 62,853 pages were accessed on the public website each month. Significant activity increases were observed in December 2021 (n = 81,237). There were increased views in September 2022 (n = 76,502) and October (n = 73,039) The top five pages accessed were;Coronavirus: advice for people living with diabetes (n = 12,478), FreeStyle Libre (n = 4325), Emergency advice (n = 1576), Blood pressure-reducing your risks of complications (n = 1559) and Blood glucose monitoring and HbA1c targets (n = 1485). eLearning: During this period, 382 individuals completed one of 11 QISMET-accredited structured eLearning courses. eLearning course usage increased in relation to patient awareness activity. Social Media: There are currently 3919 Facebook and 3600 Twitter followers. Records Access: 67,655 patients had registered to access their data and 35,157 had actively accessed their records by the end of October 2022. Patient feedback remains highly positive. Conclusion(s): MDMW is a consistent and reliable resource for people with diabetes and their families to access at any time online. User statistics continue to rise, while latest development plans include the addition of new Patient Reported Outcome Measures, risk prediction features, and enhanced sharing of data with the healthcare team.

A qualitative exploration of the implementation of the Prescribing course Designated Prescribing Practitioner role in community pharmacy

Introduction: To alleviate NHS workload pressures Scottish Government wish to train more pharmacist independent prescribers (IPs) for community pharmacy (1). A critical aspect for IP training is the role of Designated Prescribing Practitioner (DPP) for the period of learning in practice. A paucity of work has focussed on implementation of the DPP role with a recent cross-sectional survey (2) indicating that further qualitative exploration is warranted. Aim(s): To explore the implementation of the DPP role in Scottish Community Pharmacy (CP). Method(s): Following a survey (2) participants opted in to qualitative semi-structured online mini-focus groups. This included key stakeholders likely be involved in the implementation of the DPP role (e.g Directors of Pharmacy, Prescribing Leads, Education and Training leads, IP qualified CPs). The topic guide was informed by the survey key findings, Royal Pharmaceutical Society DPP Framework and the Consolidated Framework for Implementation Research and piloted with academic and practice-based stakeholders. All focus groups were conducted using Zoom, recorded, transcribed, and independently analysed thematically, by two researchers, using the Framework Approach. Data generation continued until data saturation. Result(s): Data were generated from six mini-focus groups with 12 key stakeholders across Scottish Health Boards. Key themes derived related to: views on the DPP role, characteristics of potential DPPs, facilitators and barriers to implementation. Participants supported DPP implementation and noted benefits of pharmacists training pharmacists. They noted that potential DPPs need to be confident and competent and be active prescribers. Facilitators for implementation included: new contracted services (e.g. NHS Pharmacy First Plus), growing need for more IPs, and the impact of COVID-19. Barriers included: limited time, capacity, resources, and support to take on the DPP role. Pharmacists were also considered risk averse which could influence role uptake. Conclusion(s): This theory-based work involved a range of key stakeholders and highlights that there is a need to further consider interventions to overcome barriers related to capacity and resource related issues. A limitation relates to the dyadic nature of some focus groups that may have affected data collection. Future research should focus on further theory-based work evaluating structures, processes, and outcomes of DPP role implementation.

A novel cystic fibrosis-pregnancy service: Two-year review after introduction of elexacaftor/tezacaftor/ivacaftor

Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

A feasibility study of a school-based asthma programme in Malaysia conducted during COVID-19 pandemic

Background: Asthma is a common non-communicable disease among children that may require urgent treatment during school hours. We developed a school-based programme to improve children's asthma control. Aim(s): To assess the feasibility of the programme. Method(s): The mixed-methods study was conducted in October 2020 in a Malaysian primary school. Despite COVID19 restrictions we delivered sessions to children with asthma and their parents, and school staff and, measured participation rate and explored views on the programme. Result(s): We identified 34 children with asthma (3.7% of school population). The session for school staff received good participation 55/62 (88.7%) and feedback (>80% scored good/excellent). In mid-October, COVID-19 forced national school closure so sessions for children with asthma and their parents were conducted remotely, and sessions for the whole school were abandoned. Only 14/34 (41.2%) children with asthma attended the remote sessions as 9/34 parents were uncontactable;11/34 of parents declined children's participation because they lacked internet facilities or timing was inconvenient. Children enjoyed the interactive methods (e.g. videos, games) used to deliver messages. Parental participation was minimal (4/14;28.5%). Conclusion(s): The school-based intervention was feasible, though restricted by the pandemic. Although remote health programmes gained popularity during the pandemic, widespread use could disadvantage children from lower socio-economic backgrounds who had limited access to the electronic devices/ and the internet.

Features of an Aseasonal 2021 Rsv Epidemic in the Uk and Ireland: Analysis of the First 10,000 Patients

Aims Respiratory syncytial virus (RSV) causes annual winter epidemics that usually peak in December in the UK and Ireland. Infants are disproportionately affected, with infection leading to lower respiratory tract disease, most commonly bronchiolitis, that often result in emergency department visits and hospitalisations. Non-pharmaceutical interventions (NPIs) introduced globally to limit the spread of SARS-CoV-2 led to disruption of the typical RSV seasonality. Studies examining the aseasonal resurgence of RSV have been limited by sample size, and lack of information on secondary care episodes and clinical features. The BronchStart study is a prospective multicentre cohort study with the objective to monitor RSV disease in children under two years of age attending emergency departments (EDs) across the UK and Ireland and examine the impact on timing, age and severity of clinical presentations as NPI restrictions are reduced throughout the UK and Ireland in 2021. Methods Paediatric emergency departments (PED) within PERUKI (Paediatric Emergency Research in the UK and Ireland) submit data on all children under 2 years of age who visit a PED with symptoms of an acute lower respiratory tract infection (diagnosed as bronchiolitis, lower respiratory tract infection, or first episode of acute wheeze), to a secure online Research Electronic Data Capture (REDCap) database. Followup information is submitted 7 days later. Here we present initial data for 10,347 infants and children from 44 study sites for the period 1st June to 5th December 2021. Results At the time of submission the aseasonal 2021 RSV epidemic in the UK has now come to an end, with infections having peaked in August (figure 1A). Comparing the age distribution of hospitalised infants <12 months to previous years at two large paediatric centres currently participating in the BronchStart Study (Leicester Children's Hospital and Bristol Royal Hospital for Children), we observed a similar age distribution (figure 1B). This suggests reduced community exposure to RSV during the 15 months preceding the start of the season did not result in a clinically significant lack of protective maternal antibody transfer to those <3 months of age, or that the NPIs introduced were not strong enough to prevent low level transmission. Disease severe enough to require intensive care was 2.5% in our cohort (for those aged 6 weeks to one year), comparable to 4.2% reported in previous studies. We also observed a substantial number of PED visits and admissions for RSV positive 12-23 month old children in BronchStart: 362 out of 1,468 (24.7%) admissions were in this age group. Conclusion We found that the 2021 summer lower respiratory tract infection peak in the UK and Ireland, although temporally disrupted and with an attenuated disease burden, predominantly affected younger age groups as in previous years The overall lower burden of disease in 2021 suggests incomplete infection by RSV of its usual susceptible population, probably due to the effect of ongoing non-pharmaceutical interventions over the study time period, and raises the strong possibility of a further wave of infection in the coming months.

Exploring determinants of antimicrobial prescribing behaviour: a qualitative study using the Theoretical Domains Framework

Introduction Few qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals, and none has made reference to behavioural theories. An understanding of these determinants is required for the successful development and implementation of behaviour change interventions (BCIs) in this area. Aim To explore the determinants of clinicians’ antimicrobial prescribing behaviour, using the Theoretical Domains Framework (TDF;a framework of behavioural theories). Methods This work was part of a multi-phase explanatory, sequential mixed methods PhD programme of research. This qualitative part involved semi-structured, online (video) interviews via a videoconferencing software programme (Zoom) with clinicians (doctors and pharmacists) based in 12 Hamad Medical Corporation hospitals in Qatar. Clinicians were sampled purposively in strata of gender, profession, years of experience and area of practice. The interview schedule was developed based on a review of published literature (1), previous findings of quantitative research (2) and the TDF to ensure comprehensive coverage of key determinants (including barriers and facilitators) related to clinicians’ antimicrobial prescribing behaviour. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and independently analysed by two research team members using the TDF as an initial coding framework. Results Data saturation was achieved after interviewing eight doctors and eight pharmacists from a range of areas of practices and with a variety of experiences. A number of themes, linked to ten TDF domains, were identified as determinants of antimicrobial prescribing behaviour and these determinants were interrelated. In-depth analysis identified several barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. Main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources), gaps in the knowledge in relation to guidelines and appropriate prescribing (knowledge), restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity), uncomfortable antimicrobial prescribing decisions (memory, attention and decision processes), as well as professional hierarchies and poor multidisciplinary teamworking/relationships (social influences). “Sometimes, the barrier would be the ego of senior doctors who refuse our evidence-based recommendation and depend on their clinical judgement or experience” (Pharmacist 470, Cardiology). Key facilitators highlighted included guidelines compliance goals and intentions, and the beliefs of consequences of appropriate or inappropriate prescribing. Further education and training sessions, and some changes to guidelines, including accessibility were also considered essential. “We need to seriously consider getting an antibiotic guidelines app which is downloaded to clinicians’ mobile phones. The mobile app is handy, you can access it anytime even at the patient’s bedside” (Doctor 514, Microbiology). Conclusion This qualitative study, using a theoretically based approach, has identified that antimicrobial prescribing in hospitals is a complex process influenced by a broad range of behavioural determinants that described specific barriers and facilitators. The in-depth understanding of this complexity provided by this phase of the research may contribute to the design and development of theoretically based BCIs to improve clinicians’ antimicrobial prescribing. Limitations include data collected with online interviews due to the Covid-19 restrictions. This may have excluded some clinicians who did not feel comfortable with or have access to the technology required. References (1) Talkhan H, Stewart D, Mcintosh T, Ziglam H, Abdulrouf P, Al-Hail M et al. The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: systematic review. Journal of Antimicrobial Chemotherapy. 2020;75(9):2394-2410. (2) Talkhan H, Stewart D, McIntosh T, Ziglam H, Abdulrouf P, Al-Hail M et al. Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. International Journal of Pharmacy Practice. 2021;29(1):i20-i22.

Co-designing the translation of research into practice to support mentally healthy workplaces in agricultural industries

Introduction: Australian agriculture is vulnerable to an ageing and deceasing workforce, increasing technological demands, global markets, climate change and uncertainty. This poses challenges for work demand/control, workplace support, change management, role clarity/conflict, workplace relationships and environmental conditions—ultimately increasing psychological distress and suicide risk. The Primary Producer Knowledge Network (PPKN) aims to develop practical strategies to prevent work-related mental health risks in agriculture. Method: PPKN engaged in a detailed co-design process with farmers and industry stakeholders—including stakeholder interviews, online development and feedback workshops, and pilot testing, and delivered online due to COVID19 restrictions. Co-design was informed by mental health research, evidence-based co-design strategies for working with vulnerable consumers, and identified work-related risks to health, wellbeing and safety. Results: 9 recommendations were derived via co-design—guiding development of an interactive web platform, roadshow, and complementary resources to meet varying digital access/expertise. Ongoing solution-focused topic development—an iterative process with experts and primary producers—reflects varied needs of industry groups and age cohorts, and drives change in the design/management of work systems. Conclusions: PPKN addresses work-related risk factors via an approach that is relevant, meaningful and empowering for the agriculture workforce. Co-design outcomes, challenges and recommendations are applicable across occupational groups where mental health and safety are of con

Study Pre-protocol for "BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations;a Multi-Centre Prospective Observational Cohort Study"

Background: Bronchiolitis (most frequently caused by respiratory syncytial virus;RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome. Information be released on a weekly basis and used to support clinical decision making.

My Diabetes My Way (MDMW): Offering diversity through intelligent delivery of diabetes education: Reliability during adversity

Background and Aims: My Diabetes My Way (MDMW) is NHS Scotland's interactive website, structured eLearning service and mobile app supporting education and diabetes self-management. covid-19 specific advice was added in March 2020. We analysed use throughout 2020, relating user activity to stages of the pandemic. Methods: Data were collected using registration and audit logs observing user activity across all website content and features accessed. Results: Monthly page accesses for the public website increased to an average of 91,442 from 73,583 in 2019. Significant activity increases were observed in March n = 101,326 when lockdown commenced. Peak months include July (n = 108,811) when restrictions were relaxing, and September (n = 118,698) and October (n = 109,064) when virus rates increased again. The top five pages accessed in 2020 were;Coronavirus: advice for people living with diabetes (n = 66,807), Blood glucose monitoring (n = 22,620), Sick day guidance for type 2 diabetes (n = 13,938), Alcohol (n = 13,168) and Charcot foot (n = 12,940). eLearning: In 2020, 775 individuals (65% of registrants) completed a Massive Open Online Course in diabetes self-management education. 257 individuals completed one of 8 QISMET-accredited structured eLearning courses. eLearning course usage increased in relation to patient awareness activity. Social Media: There are currently 3,096 Facebook and 1,858 Twitter followers. Records Access: 55,605 patients had registered to access their data and 29,752 had actively accessed their records by end 2020. Patient feedback remains highly positive. Conclusion: My Diabetes My Way is a consistent and reliable resource for people with diabetes and their families to access at any time online, particularly relevant during the pandemic.

Evaluation of an online social learning environment in type 1 diabetes self-management education

Aims: Self-management education is an essential component of type 1 diabetes care which improves health outcomes. Online mediums of education delivery are growing in popularity, offering a flexible alternative to traditional group education. Interest in online education has increased as healthcare restructuring secondary to covid-19 has restricted face-to- face offerings. We delivered and evaluated a free open online course in type 1 diabetes self-management education. Methods: Understanding type 1 diabetes was a free open online course accessible via registration on an online platform. The course was delivered over a 2-day period in December 2020 and focused on key self-management concepts featuring videos, quizzes and moderated comment sections accompanied by a daily live Q&A session. The course was evaluated via a post-course questionnaire to establish user feedback and experience. Results: 216 users started the course, with 106 users completing >75% of the course steps (completion rate 49.1%). Among the 103 users who completed the optional post-course questionnaire, 69 had type 1 diabetes and 21 were healthcare professionals. Most users agreed that the course was easy to follow (95.1%), improved their knowledge of diabetes (76.2%), motivated them to manage their diabetes (79.7%) and improved their self-management confidence (79.4%). Thematic analysis of free-text responses identified appreciation of the peer-learning environment provided with minimal technical difficulties experienced. Conclusions: Open online courses offer a remotely accessible, engaging and scalable method of self-management education delivery that motivated and improved the self-management confidence of their user base.

‘Demand’ for culture and ‘allied’ industries: policy insights from multi-site creative economy research

This paper draws policy insights from the first comparative analysis of multiple hotspots of regional cultural and creative activity across Australia. Focussing on the state of Queensland, it provides three interlinked findings relevant to international cultural policy debates. The first–municipal agency–goes to the crux of the value of studying small regions. We examine the degree to which Cairns, an isolated, small regional city, can exercise effective cultural agency in a tripartite system of government, demonstrating that policy ambition and asset management at the local level can deliver outsized cultural infrastructure benefits through a focus on demand from the local community. The second further illuminates the question of demand for cultural infrastructure as a critical enabler, in conjunction with allied infrastructure, in a very remote, distressed community–the Central West region. Cultural tourism’s surprising prominence as support for mainstream tourism on the Gold Coast, an international mecca for surf, sand and sun, is the third example, deepening the significance of allied industry connectivity. Drawing on fieldwork conducted in 2019, the trend data and analysis offered here will be significantly impacted by the global COVID-19 pandemic of 2020. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Massive open online course for type 2 diabetes self-management: Adapting education in the COVID-19 era

Introduction: Type 2 diabetes self-management education is an essential component of type 2 diabetes care that is traditionally delivered in a face-to-face setting. In response to the recent COVID-19 pandemic, innovative solutions are urgently needed, allowing provision of self-management education that can be delivered in compliance with social distancing policies. Innovations that are self-service and can deliver education efficiently at low cost are particularly appealing to healthcare providers and commissioners. Methods: We aimed to evaluate user uptake, dropout, acceptability, satisfaction, perceived short-term knowledge gain and health benefits/behaviour changes in relation to a free massive open online course (MOOC) in diabetes self-management education, created and delivered during the COVID-19 pandemic. This course, focusing on addressing knowledge and self-management needs for people with type 2 diabetes, made use of online interactive content including expert and patient videos, quizzes, moderated discussion boards and live social media that encouraged personal reflection and goal setting. User expectations and experiences were explored via survey-based methods. Here, we present our experience of developing the course and describe users' experiences. Results: 1991 users registered interest in the course over a 2-week period, with 976 users starting the course and 640 (65.6%) users completing the course in full. Users engaged well, finding the course educational, user-friendly and motivating, demonstrating high completion rates and user satisfaction. A statistically significant (p<0.001) increase in self-reported self-management ability and health knowledge was observed among participants with type 2 diabetes. Discussion: MOOCs in type 2 diabetes self-management education have great potential for delivering education efficiently at scale and low cost. Although engagement can be limited by digital literacy, benefits include flexible and remote access to up-to-date, evidence-based education delivered by a multidisciplinary team of healthcare professionals. © 2020 Author(s) (or their employer(s)).