A catalyst for transforming health systems and person-centred care: Canadian national position statement on patient-reported outcomes.

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.

The journey to advanced practice: An Interpretative Phenomenological Analysis of reaching destination and beyond for reporting radiographers in Scotland.

INTRODUCTION: Optimising radiographer and radiologist skill-mix is essential to increase efficiency and ensure quality patient care and safety in radiology services. Radiographer reporting, well established within the UK, has been legally and legitimately identified within the scope of radiographer practice for many years. Little research however has focused on perceptions and experiences of practitioners as they journey towards advanced practice in skeletal trauma reporting. METHODS: A two-phase qualitative approach, utilising Interpretative Phenomenological Analysis (IPA), included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries. Phase 2 included one-one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis. RESULTS: Three super-ordinate themes emerged. This paper reflects the IPA generated from Super-ordinate Theme 3; Review upon and action for the role. Participants had reached destination and beyond with a focus on development of role, self and others. As reporting became firmly embedded, there was increased acceptance, educational development and positive impact on service. Reflections indicated motivation, drive, commitment, increased confidence and self-esteem CONCLUSION: This study provides an insight in to the participant journey towards advanced practice and skeletal trauma reporting in Scotland as participants reached destination and beyond. IMPLICATIONS FOR PRACTICE: Developments within the NHS continue to rapidly evolve and diagnostic imaging, with advancing technology, practice and changing policies, continues to remain in a constant state of change. Continued support and investment for role development, framed within a culture of effective teamworking, positive engagement and professional respect is essential.

Theory and application of research principles and philosophical underpinning for a study utilising interpretative phenomenological analysis.

INTRODUCTION: Qualitative research approaches have potential to provide unique and valuable insights intoperceptions, experiences and behaviours. Reports however indicate that papers often fail to sufficiently detail the underlying principles that explain the philosophical assumptions and ontological, epistemological and methodological perspectives. Primarily directed towards radiographers considering a qualitative approach for doctoral research, this paper will also be informative for other health and social care practitioners. METHOD: Part 1 discusses research principles broadly and how philosophical assumptions can be used for selection of the approach and methodology to explore a particular topic. Part 2 provides a worked example applied in context for a qualitative approach utilising Interpretative Phenomenological Analysis (IPA), that explored perceptions and experiences of lived experiences of radiographers on a journey to advanced practice in skeletal trauma reporting. RESULTS: The paper identifies the need for understanding of the theory and application of research principles broadly. Explanation and justification of choice is expected for the selection of research approach, paradigm, philosophical underpinning, underlying assumptions and methodology, to best answer the research question and inform participant selection, data collection, data analysis and interpretation methods CONCLUSION: Coherent research requires synthesis of ontology, epistemology and methodology with the choice of research design based on the most appropriate approach. Qualitative research has greatly enhanced its reputation for methodological rigour and the uptake of IPA is increasing within health and social care. IMPLICATIONS FOR PRACTICE: Future research within the Interpretative paradigm, utilising IPA as a methodology has potential to expand the body of evidence for Radiography research.

Skeletal trauma reporting; perceptions and experiences of radiographer practitioners exposed to the reporting role.

INTRODUCTION: Increased demand for diagnostic imaging and professional body directives have resulted in radiographer reporting which requires postgraduate education due to the associated high degree of autonomy and complex decision making. Little research has focused on the transition from practitioner to the skeletal trauma reporting role. METHODS: Two-phase, qualitative research using Interpretative Phenomenological Analysis (IPA) explored perceptions and experiences. Phase 2, one-one, semi-structured interviews (n = 6) were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis, generating three super-ordinate themes. Researcher reflexivity, ethics and quality assessment were considered. RESULTS: This paper reflects the IPA generated from Super-ordinate Theme 2; Exposure to the reporting role. Participant reflections indicated positive opinion with agreement that combining the reporting role with the diagnostic radiographer role enhanced practice and increased job satisfaction. Potential for stress associated with increased responsibility and accountability was described but there was recognition that skeletal trauma reporting was what they had chosen and been educated to do. CONCLUSION: The interpretative approach and IPA for Super-ordinate Theme 2, fills a gap in existing knowledge, providing a unique and valuable insight into perceptions and experiences of practitioners as they became exposed to the skeletal reporting role. IMPLICATIONS FOR PRACTICE: Participants were on their journey to advanced practice with plans to further develop their role. Excellent clinical practice had been demonstrated as well as facilitating learning with others. If there is expectation to achieve all domains associated with advanced practitioner status then time, commitment and support is essential from employers and management.

The journey to advanced practice and skeletal trauma reporting; an Interpretative Phenomenological Analysis of preparation for the role.

INTRODUCTION: The paper, derived from a professional doctorate thesis explored the perceptions and experiences of diagnostic radiographers who had acquired a post graduate qualification affording them the opportunity to report skeletal trauma images. METHODS: A qualitative approach was deemed appropriate to answer the research question and Interpretative Phenomenological Analysis (IPA) was selected as the research methodology. The two-phase qualitative research study included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries completed during final year of study. Phase 2 included one-one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis. Researcher reflexivity was employed as were issues of ethics, permission and quality assessment. RESULTS: Reflective diary themes informed focus for one-one, semi-structured interviews. IPA of interview transcripts identified three superordinate themes: Preparation for the role; Exposure to the role; Review upon and action for the role. Subsumed within the three superordinate themes were twelve subthemes. The Results section for this paper reflects the IPA generated from Super-ordinate Theme 1. CONCLUSION: This study provides an insight in to the radiographer educational journey towards advanced practice and skeletal trauma reporting in Scotland. IPA identified a range of emotions, personal and professional commitment. Degrees of positivity were reported but perception and experience also identified stress and challenge. Mixed attitudes and a culture of resistance impacted on the lived experience of preparation for the role. This created potential to adversely affect practitioner development and requires ongoing attention from key stakeholders.

Cross-sectional survey of meticillin-resistant Staphylococcus aureus home-based decolonization practices in Scotland.

BACKGROUND: Despite limited evidence of meticillin-resistant Staphylococcus aureus (MRSA) decolonization efficacy, the practice of decolonization for both pre-admission and on-admission patients is growing. Recent research within National Health Service (NHS) Scotland revealed low rates of treatment and consequent low efficacy in home-based decolonization. As no national guidelines on home-based decolonization currently exist, practices within NHS Scotland may be variable. AIM: To establish current pre-admission MRSA home-based decolonization protocols and patient advice within NHS Scotland. Similarities and differences were identified to determine possible sources of variability. METHODS: Cross-sectional survey distributed electronically to MRSA Screening Project Managers within each NHS geographical region in Scotland (N = 15). FINDINGS: Thirteen out of 15 NHS regions responded; one region reported no standard protocol. From the remaining 12 regions, 100% recommended use of mupirocin and antiseptic bodywash daily for five days; this was the only consistent aspect of practice across responding regions. Variation was noted in advice regarding method of mupirocin application, bodywash product and volume of bodywash recommended. Six regions (50%) specified bodywash skin contact time, yet these times varied across regions. Mouth care was advocated by three regions (25%). Daily change of facecloths and clothes was endorsed by five regions (41.7%); four regions (33.3%) promoted daily towel changes. Only one region (8.3%) suggested daily bedroom cleaning; three regions (25%) advised changing bed linen daily. CONCLUSIONS: Variation in protocols and patient advice may influence efficacy of home-based decolonization and further research may inform the development of evidence-based clinical guidelines.

Movement disorder emergencies in childhood.

The literature on paediatric acute-onset movement disorders is scattered. In a prospective cohort of 52 children (21 male; age range 2mo-15y), the commonest were chorea, dystonia, tremor, myoclonus, and Parkinsonism in descending order of frequency. In this series of mainly previously well children with cryptogenic acute movement disorders, three groups were recognised: (1) Psychogenic disorders (n = 12), typically >10 years of age, more likely to be female and to have tremor and myoclonus (2) Inflammatory or autoimmune disorders (n = 22), including N-methyl-d-aspartate receptor encephalitis, opsoclonus-myoclonus, Sydenham chorea, systemic lupus erythematosus, acute necrotizing encephalopathy (which may be autosomal dominant), and other encephalitides and (3) Non-inflammatory disorders (n = 18), including drug-induced movement disorder, post-pump chorea, metabolic, e.g. glutaric aciduria, and vascular disease, e.g. moyamoya. Other important non-inflammatory movement disorders, typically seen in symptomatic children with underlying aetiologies such as trauma, severe cerebral palsy, epileptic encephalopathy, Down syndrome and Rett syndrome, include dystonic posturing secondary to gastro-oesophageal reflux (Sandifer syndrome) and Paroxysmal Autonomic Instability with Dystonia (PAID) or autonomic 'storming'. Status dystonicus may present in children with known extrapyramidal disorders, such as cerebral palsy or during changes in management e.g. introduction or withdrawal of neuroleptic drugs or failure of intrathecal baclofen infusion; the main risk in terms of mortality is renal failure from rhabdomyolysis. Although the evidence base is weak, as many of the inflammatory/autoimmune conditions are treatable with steroids, immunoglobulin, plasmapheresis, or cyclophosphamide, it is important to make an early diagnosis where possible. Outcome in survivors is variable. Using illustrative case histories, this review draws attention to the practical difficulties in diagnosis and management of this important group of patients.

Early Pseudomonas aeruginosa infection in individuals with cystic fibrosis: is susceptibility testing justified?

OBJECTIVES: To test the presumption that Pseudomonas aeruginosa isolates responsible for initial lung infection in individuals with cystic fibrosis (CF) are invariably susceptible to antipseudomonal agents. METHODS: Antibiotic susceptibility was determined (MIC and Etest) in two populations of P. aeruginosa associated with initial lung infection. Population 1: environmental isolates (n=78). Population 2: clinical isolates responsible for first infection in previously non-infected patients (85 isolates from 85 patients). Susceptibility or resistance was determined using current BSAC guidelines; ninth version (2009). RESULTS: The majority (≥ 90%) of isolates in both bacterial populations were susceptible to the front-line antipseudomonal agents; colistin, ciprofloxacin, tobramycin, ceftazidime, amikacin and meropenem. Up to 10% of isolates were resistant to one or more antibiotics. A single isolate from each population would be defined as resistant to tobramycin based on a breakpoint (>128 mg/L) that has been suggested for use in patients receiving inhaled therapy. CONCLUSIONS: The high prevalence of susceptibility found in P. aeruginosa isolates associated with initial infection contrasts with the high prevalence of resistance found in isolates from chronic CF lung infection. However, susceptibility in early isolates cannot be presumed. Until further data are obtained from clinically based studies, susceptibility tests should continue to be performed to assist the choice of antibiotics for treatment of early infection.

Maximizing the benefit--minimizing the risk: the developing role of radiographers in performing intravenous injections.

Performance of intravenous (iv) injections as part of radiographer role development has become fundamental to the operational management of diagnostic imaging departments in the UK. Through discussion of appropriate areas, this review aims to highlight current issues pertaining to iv injection. More importantly, the framework described could be transposed to other existing or future areas of role development. Within a validated system of delegation, utilization of radiographers' skills in an expanded role improves allocation of resources and may increase radiographer motivation and provide career enhancement. Professional body accreditation as well as civil and employment law provide clear guidelines on medicolegal implications, valid consent and accountability. Implementation of an iv administration policy, based on Royal College of Radiologists guidelines, includes proper delegation of duties and safe administration of substances. This should help ensure acceptance of vicarious liability by an employer. Failure to adhere to these established guidelines could leave employers and radiographers vulnerable to medicolegal action. Furthermore, evaluation of radiographer performance, facilitated by clinical governance and departmental audits, should ensure effective and safe practice whilst minimizing associated risks. Evidence-based radiography will provide the necessary drive for future changes in practice as well as further expansion of the radiographer's role.