Upskilling haematological services for WGS and germline assessments through a regional skin biopsy training programme

NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.

Trends in Postpartum Depression before and during the COVID-19 Pandemic and Correlates of Treatment Choices: A Population-Based Retrospective Cohort Study

Objectives: COVID-19-related stressors - including social distancing, material hardship, increased intimate partner violence, and loss of childcare, among others - may result in a higher prevalence of depression among postpartum individuals. This study examines trends in postpartum depression in the US from 2018 to 2022, as well as correlates of treatment choices among women with postpartum depression. Method(s): 1,108,874 women aged 14-64 in the Komodo Healthcare Map with 1+ live birth between April 2018 and December 2021 and had continuous enrollment 2+ years before and 4+ months after the delivery date were included. Prevalence of depression during postpartum (within 3 months after delivery) was calculated before (April 2018-March 2020) and during (April 2020-March 2022) COVID-19. Multinomial logistic regression was used to investigate correlates of treatment choices (no treatment, medication-only, psychotherapy-only, or both). Result(s): The prevalence of postpartum depression increased from 9.7% pre-pandemic to 12.0% during the pandemic (p < 0.001). Among 119,788 women with postpartum depression in 2018-2022, 47.0% received no treatment, 35.0% received medication-only, 10.0% received psychotherapy-only, and 7.4% received both within one month following their first depression diagnosis. Factors associated with an increase in the odds of receiving medication-psychotherapy treatment (vs. no treatment) included older ages;commercial insurance coverage;lower social vulnerability index;history of anxiety or mood disorder during and before pregnancy;and being diagnosed by a nurse practitioner, physician assistant, or behavioral care practitioner (vs. physician). Similar patterns were observed for medication-only and psychotherapy-only treatments. Conclusion(s): In this large, nationally representative sample of US insured population, the prevalence of postpartum depression increased significantly by 2.3 percentage-points during the pandemic (or a relative increase of 23.7%). Nonetheless, almost half of women with postpartum depression received no treatment, and only 7.5% received both medication and psychotherapy. The study highlighted potential socioeconomic and provider variation in postpartum depression treatment.Copyright © 2023

Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND: The COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention's intrinsic properties. METHODS: Nineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites. RESULTS: Nineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct. CONCLUSION: Successful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.

Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

A collaborative approach to research study recruitment in PLWH during the SARS CoV-2 pandemic

Background: Since COVID there are fewer site investigator meetings for non-CTIMP studies to discuss recruitment barriers. Additionally, literature highlights various research trials that have successfully recruited do not report their strategies, consequently impacting ability to learn from success. The pandemic has had considerable impact on enrolment to clinical research, thus services have needed to revaluate their approach. Following the pandemic, patients report more likely to engage in research if offered remote or combined visits. Method(s): We reviewed recruitment strategies at our clinic for two observational studies with large targets (SCAPE-HIV, Positive Voices). SCAPE-HIV, a prospective study exploring immune responses of PLWH to SARS CoV2 infection and vaccination. Positive Voices, a crosssectional questionnaire study. Minimum recruitment targets, 600 and 262 respectively. SCAPE involves open-offer enrolment, Positive Voices from a defined pre-selected cohort. Initial approaches identified people opportunistically at clinic visits, with research staff offering information. However, reaching our targets through COVID became challenging and a move to virtual appointments condensed our opportunities to approach. To increase recruitment, engagement and training of NHS nursing and clinical staff was undertaken alongside remote patient contact. Result(s): After implementing collaborative methods, Positive Voices recruitment increased to 170 in July/ August 2022 (73 in May/June). SCAPE recruitment also improved. Hybrid nurse practitioners dedicating time to approach people during clinic visits and clinic staff involvement attributed to this rise, representing over half of consents (Table A). The clinic team's substantial knowledge of our cohort, combined with their openness to research, leads to greater understanding of how likely individuals are to accept studies. Conclusion(s): Positive Voices and SCAPE-HIV studies have been successful with recruitment due to a collaborative approach, resulting in our site being the highest current recruiting site involved in Positive Voices. This approach has helped motivate the NHS team to become more involved and has become an exemplar for clinical trial delivery within our Trust. (Table Presented).

Nursing practice and teleconsultations in a pandemic context: A mixed-methods study.

AIM: To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID-19 pandemic. BACKGROUND: Teleconsultation use increased rapidly during the COVID-19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. DESIGN: A sequential mixed-methods study. METHODS: Phase 1: A cross-sectional e-survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi-structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. RESULTS: During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work-family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. CONCLUSION: This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. RELEVANCE TO CLINICAL PRACTICE: Findings emphasize the need for updated nursing education, easy-to-use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. IMPLICATIONS FOR THE PROFESSION: This study could promote the sustainable use of teleconsultations in nursing practice. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses.

Novice nurse practitioners' employment decisions and role transition experiences during COVID-19.

BACKGROUND: While it is known how the COVID-19 pandemic affected providers already employed and working in health care settings, there is little data about the effect it may have had on novice nurse practitioners (NPs). PURPOSE: The purpose of this study was to describe novice NPs' employment decisions and role transition experiences during the COVID-19 pandemic. METHOD: Via an online survey, novice NPs were asked open-ended questions about how the pandemic influenced the decision to take their first position and their role transition experience, as well as what employers did well or could have done better to facilitate this transition. FINDINGS: Participants described employment challenges that included a difficult job market with limited employment opportunities, decreased pay and benefits, fewer onboarding and mentorship opportunities, and less primary care experience. However, NPs reported the pandemic positively influenced their role transition experiences with decreased patient workload and greater use of telehealth. CONCLUSION: Novice NPs were impacted by the COVID-19 pandemic in making employment decisions and transitioning into the NP role.

A Virtual Longitudinal Prenatal Standardized Patient Simulation for Nurse Practitioner Students

Prenatal care is a core competency of family nurse practitioners (FNPs). However, it is often difficult for FNP faculty to locate women's health providers to precept FNP students. This problem was exacerbated by the COVID-19 pandemic, as many sites limited the number of students to provide appropriate social distancing. A series of virtual longitudinal standardized patient prenatal scenarios was created for FNP students. The scenarios, 1 per semester, follow a patient through her pregnancy and review core prenatal concepts. The scenarios supplement women's health clinical rotations and provide standardization of experiences for FNP students

Using Active Learning to Evaluate Student Competency Beyond Clinical Skills

Active learning methodologies support the development of higher-order thinking and knowledge application necessary for modern health care environments. Through active learning, nurse practitioner students apply their understanding of population-specific competencies while developing critical thinking and reasoning skills for safe and effective care. Myths regarding student-centric learning, such as cost, time, and design, may create barriers for faculty to incorporate competency-based methods into didactic curricula. This article provides evidence-based strategies and exemplars for active learning as a method to evaluate student competency beyond clinical skills.

Integrating Telehealth: Curricular Mapping to New Standards in Nurse Practitioner Post-baccalaureate Doctor of Nursing Practice Programs

Owing to the increased use of telehealth as a widely accepted means of providing patient care and the movement toward competency-based education, implementation of telehealth teaching, learning, and evaluation strategies into the graduate nursing plan of study is evolving quickly. This report uses Rutledge's "4Ps of Telehealth” framework to provide resources for faculty to incorporate telehealth knowledge, skills, attitudes, core telehealth competencies, and evaluation practices into the bachelor of science nursing to doctor of nursing practice program curriculum based on the National Organization of Nurse Practitioner Faculties Nurse Practitioner Core Competencies. Formal preparation of students ensures future nurse practitioners are able to provide proficient, effective care through telehealth upon graduation.

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, a virtual telephone advanced nurse practitioner (ANP) led chest pain clinic was set up because face-to-face clinic visits had ceased. Methods: This retrospective cohort analysis compared the ANP virtual chest pain clinic to the face-to-face nurse specialist-led clinic. Results: Autonomous nursing management was significantly higher in the virtual clinic, and significantly fewer patients were referred for functional testing. Coronary arterial disease (CAD) diagnosis did not differ. Conclusion: ANP autonomy and experience enabled continued chest pain assessment and CAD diagnosis via a virtual telephone clinic.

An exploration of the experiences of respiratory clinical nurse specialists (CNS) and advance nurse practitioners (ANP) in Irish healthcare settings

Background: Nursing practice in Ireland are continually evolving. The introduction of the respiratory CNS/ANP role is one of the most significant changes in recent years. Respiratory CNS/ANP have responsibilities under their scope of practice NMBI (2015) to contribute to the education of their colleagues and patients. The respiratory CNS and ANP brings benefits for patients and consultants, however, raises issues in relation to boundaries affecting identity. Aim(s): Exploring the experience of respiratory CNS/ANP education, knowledge, learning and wellbeing in their clinical health environment. Methodology: This qualitative study is influenced by hermeneutic phenomenology. Ethical approval and permission were obtained, and a gatekeeper forwarded study information to potential participants. Fifteen participants participated in one-to-one semi-structured interviews, via digital media, recorded and transcribed. Result(s): Findings suggest that respiratory CNS/ANP enhance nursing professionalisation which was especially during COVID-19 pandemic and contribute to the empowerment of nursing and nurse education. Respiratory CNS/ANP enhances, compliments nursing practice, enabling a more agentic practitioner, though challenges to this have been identified. Conclusion(s): This study provides an account of the practice and experiences of respiratory CNS/ANP in the Irish health care setting, developing direct knowledge from those experiences. Findings from this research can inform those with direct responsibility for the regulation of respiratory CNS/ANP nursing practice and those responsible for education and research in the nurse context.

Providing Educational Resources during the Pandemic for Advanced Breast Cancer Patients

Significance and Background: Metastatic Breast Cancer (MBC) or Advanced Breast Cancer (ABC) is multifaceted and requires high levels of support and resource utilization. The ABC Program at MD Anderson Cancer Center began in 2014 with a goal to increase the quantity and quality of life for patients living with MBC. It offers emotional support, personalized visits with a nurse practitioner navigator, access to clinical trials, specialty clinics, tailored patient education and innovative care projects. Prior to COVID-19, the ABC Program held a 90-minute quarterly town hall series featuring 2-3 presenters and topics of patient interest. In response to COVID-19, it pivoted to a weekly virtual 60-minute educational series called "ABCs of Healthy Living in Challenging Times" that is for patients with breast cancer, caregivers, faculty, staff, community members and advocates. Purpose(s): To address COVID-19 social-distancing related isolation and changes to healthcare, build community, empower patients, and educate on diverse topics including patient services, treatment, symptom management and quality of life. Interventions and Evaluation: The series was facilitated by a nurse practitioner navigator via Zoom. A distribution list created from town hall meetings was the basis for the series' notices and has grown by referrals, word of mouth and marketing opportunities;it began with less than 150 people and has grown to more than 550 people. The facilitator offered a format where the attendees and speakers could interact visually and verbally with each other. From 4/2020 to 6/2022, 104 webinars were held for 2,546 attendees for an average of 24 attendees each week. Topics covered were side effect management/quality of life/healthy lifestyle (26%), patient education/empowerment (18%), treatment (19%), clinical trials/research (11%), quality of life related to COVID-19 (8%), COVID-19 (7%), innovation projects (4%), palliative/end of life care (7%), and financial/disability concerns (3%). The series was evaluated using the Qualtrics survey software (n=53). Respondents said that the series has positively influenced their interactions with healthcare providers (65%), how patients with MBC think about their cancer experiences (65%) and provided an opportunity to connect with others like themselves (65%). Respondents stated actions taken based on the series: shared the information with family/friends (77%), joined or remained in a support group (34%), spoke with a provider for information and services (32%), requested an appointment with the ABC Program or other specialty clinics (26%), started a new healthy behavior (21%), joined a clinical trial (11%), or started using a patient reported outcome tool (9%). The series served mostly patients living with MBC (70%), established patients at MD Anderson (38%) or patients at MD Anderson as well as a community cancer center (17%). Most respondents indicated that they attended about half of the time, usually or always (60%) and are very or completely satisfied with the series (92%). Demographics of the respondents were White (77%), Black (13%), Asian (4%) and Hispanic (16%). Discussion(s): The ABC Program pivoted to COVID-19 by offering services virtually. The virtual series has allowed for more digestible patient education, varied presentations, and participation for those living outside of Houston, TX. Peer support and continuing education are imperative dynamics for patients to use their voice to impact their overall quality of life. The series has impacted attendees with a change in behavior when speaking with their clinical team, awareness and utilization of support resources, and starting healthy behaviors. While the series was created in response to demands of COVID-19, it effectively addressed psychosocial and educational needs and overall quality of life of MBC patients. The series was an easy intervention to initiate with lasting changes relative to the effort and resources required.

COVID-19 Impact on Women's Health

Introduction The COVID-19 pandemic and associated social distancing and/or lockdowns have impacted social and personal interactions. Objective To assess COVID's impact on partner relationships, sexual activity, family planning, and menopause management. Methods C Space online communities were surveyed from April 14 to 28, 2021. C Space is an online community platform;each community is unique to the client for which it is designed. For this study, three communities were surveyed: a 100-member community of healthcare professionals (HCPs) who treat women's health issues, a 300-member community of reproductive-age women, and a 300-member community of women in their menopausal years. Of the 100 HCPs, 78 responded (25% OB/GYNs, 49% primary care providers, and 26% nurse practitioners or physician assistants);of the 300 reproductive age women, 184 responded;of the 300 women in their menopausal years, 215 responded. Results Fifty-four percent of reproductive-age women reported that their relationships with their partners have improved during the pandemic, while nearly a third (31%) reported their relationships have suffered. Conversely, just over a third (38%) of menopausal women claim their relationships with their partners improved, while 45% reported that their relationships have suffered. Among women with sexual partners (n=158 reproductive-age women;n=168 menopausal women), 46% of reproductive-age women and 62% of menopausal women reported having sex with the same frequency as before the pandemic. Of the reproductive-age women, 27% reported having sex with more frequency and 22% with less frequency. Among menopausal women, 10% reported having more sex, and 17% reported having less frequent sex than before the pandemic. Nearly half (46%) of those who were considering or actively trying to get pregnant pre-COVID responded they were less likely to try to conceive now, with 36% saying they have not changed, and 18% responded they are more likely to try to conceive.For birth control, the majority (72%) of HCPs reported no change in prescribing, with 14% citing an increase and 14% citing a decline. Of the 75% of reproductive-age women who were taking birth control (n=138), the majority (70%) reported no change in their use of birth control, 22% reported making a change or starting a new treatment, and 11% (n=15) responded that they stopped taking birth control during the pandemic.For menopause management, the majority of HCPs (62%) reported no change in the use of hormone therapy, and nearly a third (31%) reported a decline in use. Of the 20% of menopausal women (n=42) who were on a menopause hormone therapy, over half (52%) responded that they made no change to their treatment, nearly a third (31%) made a change or started a new therapy;17% (n=7) stopped treatment during the pandemic. Conclusions The COVID pandemic has impacted women differently depending on their reproductive or menopause status including their relationships with their partners, sexual activity, family planning and use of birth control or hormone therapy.

Providing Comprehensive Services to Treat Patients and the Inpatient Psychiatric Bed Crisis

Objectives: A growing mental health crisis and a shortage of inpatient psychiatric beds have resulted in a surge of patients' boarded' in emergency departments awaiting acute inpatient psychiatric placement. This delays care and causes a further burden on already stressed emergency services. In June 2020, the Centers for Disease Control and Prevention (CDC) reported an increased incidence of anxiety and depressive disorders since March of 2020, in comparison to pre-pandemic data. This has further exacerbated the shortage of psychiatric beds nationwide. In addition, staff shortages at state psychiatric hospitals in the Commonwealth of Virginia led to temporary closures to admissions. State facilities in VA provide care for our most vulnerable population, including (involuntary) patients on a temporary detention order (TDO). Carilion Clinic implemented the Comprehensive Psychiatric Emergency Program (CPEP) in August 2020 with the goal of early identification and robust treatment of psychiatric patients while in the ED. Since implementation of the CPEP, providers have been able to redirect patients away from burdened state psychiatric facilities by rapid stabilization of patients in the ED. Patients were able to step down to a less restrictive environment, often no longer meeting criteria for TDO. This study aims to assess the rate of TDO releases pre- and postimplementation of the CPEP at Carilion Clinic. Method(s): A pilot program was launched in August 2020 at Carilion Roanoke Memorial Hospital through a collaboration of the Departments of Emergency Medicine and Psychiatry. The staff was comprised of a psychiatrist, a psychiatric nurse practitioner, and a social worker. Data was collected from May 2020 to June 2021 from the Epic electronic medical record and included all patients in the ED on a TDO, ages six and above. Patients who no longer met criteria for a TDO were released from involuntary status and either redirected as a voluntary patient to an inpatient psychiatric unit or discharged to the community. The rate of TDO releases three months prior to CPEP implementation was assessed and compared to the TDO release rate post-CPEP implementation. Result(s): Prior to CPEP implementation, the TDO release rate was 7%, amounting to four patients released from a TDO per month. After implementation of CPEP, the TDO release rate increased to 19%, equating to thirteen patients released from a TDO per month during the pilot period. This led to a decrease in the number of patients that would have previously been admitted to a state psychiatric facility. Patients who benefitted from implementation of the CPEP were those with conditions in the following categories: chronic mental illness (32%), individual/family crisis (24%), neurocognitive disorders (20%), substance use disorder (18%), autism spectrum disorders and intellectual/developmental disabilities (6%). Conclusion/Implications: Implementation of the Comprehensive Psychiatric Emergency Program (CPEP) in Carilion Clinic' Emergency Department was successful in reducing the number of state psychiatric admissions by redirecting 11% more involuntary patients to voluntary status. The results of this study highlight the benefits of having in-house psychiatry teams dedicated to early triage, rapid treatment, and comprehensive case management for psychiatric patients in the emergency department. References- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics;2020. https:// www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

Teledermatology reduces waiting times for skin cancer diagnosis

Teledermatology triages large volumes of general practitioner (GP) referrals for suspicious lesions to outpatient services. A commercial, National Health Service (NHS) compliant teledermatology service was supported and evaluated in 12 GP practices during the COVID-19 pandemic. Images from a GP were transferred for review by a dermatology consultant via a mobile phone, a customized dermatoscope, mobile application and web platform. This platform, untested in the UK, showed benefits to both patients and GP services in reducing waiting times for dermatology diagnosis. Between January 2020 and May 2021, a mixed-method evaluation assessed whether this teledermatology platform was fit for purpose, provided benefits to patients and primary care, and reduced unnecessary referrals to secondary care. Data sources were surveys, patient questionnaires, informant interviews and NHS activity. Activity outcomes during teledermatology implementation were compared to those expected in the original pathway (no teledermatology). Avoided face-to-face activity was used as a surrogate assessment to estimate economic impact. Successful implementation across GP practices diverted patients away from the urgent 2-week wait outpatient appointment straight to biopsy, if necessary. This reduced waiting times from between 10 and 47 days to < 1 day between GP referral and lesion review. Eighty-eight per cent of referrals using teledermatology were associated with avoided face-to-face appointments. Most patients (92%) welcomed the ease, simplicity, speed of diagnosis and follow-up information, finding the new pathway 'excellent' and 'quick'. Some previously treated patients were less happy with photographing their lesion vs. those not previously treated (85% vs. 92%). Some patients still prefer to see a consultant dermatologist. Professionals reported patients were receptive, but not all understood the remote management of their skin lesion. Staff across GP practices found teledermatology worked well, but greater familiarity would normalize use. Technical issues were resolved promptly by the supplier;however, local NHS provider teledermatology configuration requires careful consideration. Pathway adaptions included use of eConsult to triage patient images to an advanced nurse practitioner-led skin clinic, creating additional efficiencies. Images were used at secondary care multidisciplinary team meetings to agree treatment plans. Inexperienced GPs had an opportunity to improve their diagnostic skills. However, teledermatology does not offer the opportunity for a full body scan. An estimated 63% reduction in future outpatient appointments was predicted from the results of this teledermatology. Future economic assessment of teledermatology vs. the benefits achieved, especially avoidance of unnecessary dermatologist consultations, would validate these estimated avoided appointment numbers. Teledermatology had a positive impact on patients and NHS services.

Underused Physical Therapy Services in Primary Care Settings: An Overview

The combined effects of longer life, noncommunicable diseases, and injuries increase the need for rehabilitation services. Although physical therapists' unique skill set on movement-related dysfunction allows for broad contributions to health care, physical therapy (PT) remains underutilized. This article situates the problem within the broader primary care context, focusing on PT's ability to mitigate disability and dysfunction in complex syndromes including pelvic floor incontinence, vertigo, cancer, chronic neuromusculoskeletal pain, and long coronavirus disease (ie, lingering effects after acute coronavirus disease infection passes). The path from PT research to clinical implementation remains dependent on factors beyond research evidence. This overview underscores the need to address this evidence to practice gap.

Pediatric Primary Care Mental Health Specialist Examination: Job Task Analysis

Developmental, behavioral, and mental health (DBMH) conditions among pediatric populations have increased in prevalence in primary care. Approximately 1 in 5 children have mental health conditions, but only 20% receive care. In October 2021, a national emergency in children's mental health was declared. The Pediatric Nursing Certification Board offers a pediatric primary care mental health specialist (PMHS) examination that validates the knowledge, skills, and abilities of certified nurse practitioners caring for children, adolescents, and young adults with DBMH conditions. This review describes the methodology, data analysis, and results of the job task analysis that ensures examination quality measuring preparedness to practice as a certified PMHS.