ABSTRACT
Managing the increasing number of 2-week wait (2WW) suspected skin cancer referrals to specialist National Health Service (NHS) dermatology services is challenging. Currently, once received, these referrals cannot be redirected back to the referrer and data show that around only 6% of these referrals are relevant skin cancers. The use of teledermatology, including dermoscopic images, for pre-2WW triage has therefore been advocated. Current recommendations expect that these images will be taken in a primary care setting by a member of the primary care team as part of a face-to-face interaction. In response to the COVID-19 pandemic, NHS England now recommends that all general practices should be using a total triage model, using telephone or online consultation systems for all patients contacting the practice, to reduce footfall and thereby protect patients and staff. It is speculated that this change in primary care practice will continue for the foreseeable future. The aim of this study was to review the impact of primary care remote consultation activity on 2WW skin cancer referrals. A simple questionnaire was designed to ask patients attending a 2WW appointment of the nature of their interaction in primary care prior to their 2WW referral, including the type of consultation and the responsible healthcare professional. Data were obtained from 347 consecutive patients, and 206 (59 4%) had been seen face to face. Of these, 135 (65 5%) were seen by a doctor and 71 (34 5%) by a nurse. The remaining 141 (40 6%) did not have a face-to-face consultation prior to referral. Of these 86 (61 0) were referred based on either a video consultation with an image from the patient and 55 (39 0%) following a telephone consultation only. These data are important as they show that the increasing emphasis on remote consultations in primary care means that large numbers of patients with suspected skin cancer are being referred without a face-to-face interaction and one in six were referred based on a telephone consultation only. There are two important potential implications of this. Firstly, this is likely to lead to an increase in 2WW referrals and, secondly, proposed models of pre-2WW triage using teledermatology with appropriate images (including dermoscopic) that currently require patients to attend a general practice surgery for appropriate image taking may need to be rethought. Alternative innovative approaches such as the use of community hubs for image taking or rapid-access community-based skin lesion diagnosis clinics ('spot clinics') may need to be considered.
ABSTRACT
During the initial stages of the COVID-19 pandemic a major concern was the shortage of ventilators. Engineering initiatives were started to mitigate this concern. This article details the response at the National Physical Laboratory (NPL) to this potential shortage. The technologies and product development behind NPL's PocketVent ventilator, by a team working remotely amidst a crisis, are explored. Underpinning the product was the creation of a traceable test facility, that allowed the initial three prototype devices to be narrowed to one. PocketVent was created within five months and offers pressure and volume controlled ventilation, with a clear road-map to implement constant-pressure mode, alongside a comprehensive documentation pack. The team were recipients of the Royal Academy of Engineering's President's Special Award for Pandemic Service. © 2022 IOP Publishing Ltd.
ABSTRACT
In 2019 the hospice was contacted to provide easy-read literature explaining what hospice care is for a person with a learning disability. As an organisation we didn't have this kind of documentation and we couldn't source it from elsewhere. This set us on a journey of collaborative working and service co-design with our local Community Learning Disabilities Team and Learning Disabilities Patient Experience Group (LDPEG). The first draft of the leaflet was utterly 'trashed' by the group;they were particularly critical of the images we had used as none of them were of our hospice building and none of them contained people with a learning disability. As a result, a number of the LDPEG visited the hospice and met with staff. They proved very insightful and challenging in their questioning of the work we do as well as about death and dying. We were in the process of finalising the leaflet, using members of the LDPEG in the photographs as well as piloting a wellbeing group when COVID-19 hit and everything had to be postponed. We are now in a position to re-commence that work. We have an afternoon tea event scheduled for 23 June to celebrate Learning Disability Week and will hopefully be in a position to complete the easyread literature before Hospice UK's conference in November. In talking to professionals and carers we are aware how challenging advance care planning discussions can be, and we hope to pilot a group for people with learning disabilities and their families/carers to introduce hospice care and advance care planning discussions. This will hopefully address some of the shocking inequalities in end-of-life care people with a learning disability can experience. We also plan to provide bereavement support, not only to families and informal carers. but also to paid carers who may have had a longstanding relationship with an individual prior to their death.
ABSTRACT
Introduction: Community pharmacies are key in the delivery of care to people who use drugs (PWUD), providing specialist harm reduction, and treatment interventions such as naloxone, Injecting Equipment Provision and opiate replacement treatment. PWUD are disproportionately burdened with mental ill-health and frequently report trauma history which impacts on engagement. A successful approach in the homeless sector, is that of Psychologically Informed Environments (PIE). The core elements of a PIE are: creating a space which engenders a sense of safety and wellbeing;reflective practice so staff can develop a shared model of working;training and support for staff;and considering the therapeutic aspects of service provision to vulnerable people (1). Aim: This pilot study tested training pharmacy staff in applying a psychologically informed environments approach to improve the delivery of care to PWUD. Methods: Three pharmacies were recruited from those with high involvement with PWUD. A range of location and type of pharmacy were included. Whole pharmacy teams were invited to an evening training session. Bespoke training was provided by clinical psychologists with PIE expertise. Training was assessed by anonymous quantitative questionnaires using rating scales. Changes in the attitudes of staff were assessed by questionnaire before and 6 months after training. Descriptive statistics were applied. Qualitative interviews with staff at 6 months (planned for 3 months) explored what changes, were made after PIE training to adapt the delivery of care. The study used peer researcher-led telephone interviews for patient/client feedback on observed changes and experiences in participating pharmacies. Recruitment was via the three pharmacy teams due to covid restrictions. Thematic analysis was applied to qualitative data. Normalisation Process Theory provided a framework for assessing change. Results: Three pharmacies (16 staff) participated. Training evaluation was positive;all participants rating training structure and delivery as very good or excellent. Covid-19 lockdowns restricted follow-up data collection which took place at six months rather than three. Attitude scores were positive (>0) for all participants at baseline (median 15.0) increasing to 20.0 at 6 months. This was not statistically significant (S=4, p=0.549). Staff interviews revealed training had encouraged staff to reflect on communication and considered the impact of current practice which could be discriminatory e.g. their use of first names, use of private areas and level of explanation to people. The increased mental health challenges for patients from Covid-19 restrictions gave an opportunity for staff to apply their new skills to this patient group and others who were struggling with isolation, as staff across pharmacies noted mental health challenges for patients. Five patients from two pharmacies were interviewed but time delays in data collection meant changes in delivery of care were difficult to recall. Conclusion: The study was limited by small sample size and covid-related delays. However, findings indicated that training whole pharmacy teams in PIE was well received and justifies a larger study. The approach allowed staff to reflect on practice and identify previous, potentially discriminatory practice. The importance of clear and compassionate communication was evident.