ABSTRACT
Introduction: Due to an increase in heroin use and subsequent high demand for treatment services, community pharmacies are nearing saturation for opioid supervision services for patients on buprenorphine. The Covid-19 pandemic exacerbated this issue, highlighting the need for alternative forms of opioid substitution therapy (OST). Buvidal is a long-acting injectable form of buprenorphine for the treatment of opioid dependence. It comes in two formulations - weekly or monthly subcutaneous injection. The availability and use of Buvidal would help to reduce pressure on community pharmacy and provide an alternative treatment option to assist patients in their recovery journey. Aim(s): To provide safe and consistent service for the administration of Buvidal across Northern Ireland (NI). Objective(s): The development of a regional pathway to provide a framework to: ** Better support clinicians to initiate and use Buvidal safely and effectively. ** To ensure adequate physical health checks are carried out at initiation. ** To improve documentation. ** To ensure equitable care for all patients prescribed Buvidal across Northern Ireland. Method(s): ** Mental Health Pharmacists from each trust in NI met to determine the feasibility of introducing Buvidal . ** The group met with the Department of Health regarding the CD regulatory requirements in outpatient settings. ** The group met with the Health and Social Care Board (HSCB) to secure funding for Buvidal ** A regional pathway and kardex were developed to ensure consistency of prescribing across trusts. ** The pathway was shared with the addiction teams and prison services across NI for agreement. ** Adjustments were made and the pathway was piloted in different regions. Result(s): ** An agreed regional pathway for Buvidal developed. ** A regional kardex for Buvidal was developed. ** Funding was approved for each trust. ** A mixture of stock orders and individual patient prescriptions are used for the ordering of Buvidal across trusts. ** An electronic care record alert was developed for all forms of OST. ** Feedback was requested from those prescribed Buvidal and of those who responded 95% stated their life has improved on Buvidal and would recommend it to a friend. Discussion(s): Following initial reluctance for the need of a regional pathway and kardex it has now been established ensuring consistency across all trusts with regards to prescribing, baseline tests and advice a patient receives prior to the commencement of Buvidal . Staff have fed back that Buvidal use has been a positive service development and particularly beneficial for chaotic patients who struggled to go to the community pharmacy each day. They find the assessment page useful but the kardex can cumbersome at initiation and as such work is ongoing to streamline this. Conclusion(s): Buvidal is now prescribed across NI providing an alternative form of OST to patients. The regional mental health pharmacist group played a strategic role in developing this new service. This has exposed the addictions teams to the potential a pharmacist can play within their team resulting in the recruitment of addictions pharmacists in some trusts. The initial forecasted numbers were quickly exceeded resulting in ongoing service expansion. Consideration is now being given to the administration of Buvidal by community pharmacies in NI. The OST alert now available on NIECR improves communication at interfaces to highlight those patients prescribed OST.
ABSTRACT
This paper contains the research proposal of Samantha O'Sullivan that was presented at the MMSys 2022 doctoral symposium. The use of wearable sensors for the understanding and quantification of movement within research communities working on Parkinson's Disease (PD) has increased significantly in recent years with a motivation to objectively diagnose, assess and then understand the progression of the disease. Most studies taking this approach for PD have stated that there is a need for a long-term solution, due to varying symptoms at different stages of the disease. COVID-19 has brought further limitations in the delivery of clinical care, reducing time with therapists and doctors whilst increasing the preference for at-home care. The necessity for a system for patients with PD is extremely significant. There is no clinically available long-term assessment for tremors, which is an issue highlighted in the literature. By using wireless sensors to track tremor severity continuously, and telehealth to create communication between patient and clinician, this proposed system will allow for better targeted therapy, accurate statistics, and constant accessible data. In this context, this work will design, build, and evaluate a novel system that would allow for constant monitoring of a patient with tremors. By using wireless sensors and telehealth, it will provide more detailed data that may enable directed and informed physical therapy. It will also improve communication creating a data flow constantly between clinician and patient to improve person-centered feedback, and aid towards the diagnosis and assessment of disease progression. The incorporation of a mobile/cloud-based application to assist this is due to the current heightened preference for home-based healthcare, long-term evaluation of tremors and personalized physical therapy. The primary focus of the PhD will be on capturing tremor activity and progression through a telehealth-based system. This proposed system will obtain real-time readings of tremors using wireless sensors and an application that will communicate consistently with healthcare professionals. The aim will be to provide better home-based care, person-centered physical therapy and improve quality of life. © 2022 ACM.
ABSTRACT
Wearable sensors are worn by subjects to allow for continuous physiological monitoring. The use of wearable sensors for the quantification of movement within research communities has increased in recent years, with the purpose of objectively assessing and diagnosing the progression of Parkinson's Disease (PD). Most studies taking this approach for PD have stated that there is a need for a long-term solution, due to individuals having varying symptoms at different stages of the disease. Furthermore, a preference for home-based care has increased in recent times due to COVID-19, with clinical care being highly effected due to cancellations, delayed appointments, or a reduction of time spent with patients. The necessity for a system for patients with Parkinson's is extremely significant. There is no clinically available long-term assessment for tremors, and how these systems can be used to assess and aid in a clinical environment is still underdeveloped. The proposed system which includes wireless sensors, and results based off the clinical scale used currently for tremor assessment, may allow for constant, real-time, and accurate monitoring of a subject with tremors. This will provide more detailed medical data to enable long-term assessment, diagnosis, as well as person-centered physical therapy. © 2022 ACM.
ABSTRACT
Objective: This survey is the first part of a regional improvement project for Gynaecological surgical training in Ireland. Initial step to ascertain current opinions and confidence levels of trainees in gynaecological surgery and develop an understanding of their career goals. Design: Many surveys have been conducted on training within Obstetrics & Gynaecology. However, with the devastating impact on gynaecological surgical training from the COVID-19 Pandemic, a new vigour has emerged to assess this area, enhanced via the publication of the RCOG Gynaecological Surgery Recovery Plan. Ireland equally has felt the impact to surgical training and our project hopes to start to address this. This survey was designed with specific focus on gynaecological surgical training and to identify the key areas to focus the recovery process on. Designed using the SurveyMonkeyR platform and distributed via email. Methods: The survey was circulated to all O&G trainees in Ireland. The 34 questions focused on the number of procedures performed over last 12 months, confidence levels on performing these procedures alongside management of complications. Questions also assessed future career aspirations. The returned results were anonymised and analysis performed using a password protected ExcelR database. Results: We received 76 respondents, with 46% (n = 35) having worked in O&G for more than 5 years. A concerning 51% of trainees had contemplated leaving the specialty in the last 12 months. Only 20% (n = 16) of trainees had access to a Laparoscopic box trainer in their hospital and of these, only 38% (n = 29) received dedicated teaching on the trainer. The only laparoscopic procedure in which >50% of trainees felt comfortable performing was Veres entry at laparoscopy. Two thirds of respondents (n = 51) believed that the lack of gynaecological surgery training has impacted decisions on future career choices. 43% of SpR (ST4-8) trainees experienced difficulty in annual training progression due to a lack of surgical numbers. 95% felt a forum for surgical education and career guidance was needed. Conclusions: Trainees are significantly impacted by a lack of surgical exposure and training. This has understandably affected their confidence but also career planning, which may in turn affect national workforce structure and patient care. Our project design has moved forward using this survey information to develop a regional laparoscopic simulation hub in Dublin following the award of funding from the Mater Hospital Foundation and SPARK initiative. A pilot programme for trainees will be offered from January 2022.