Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients musculoskeletal pain and enablement

Introduction

Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain.

Methods and analysis

A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews.

Ethics approval and dissemination

Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country.

Trial registration number

ISRCTN18010240.

Assessment of linear regression of peripapillary optical coherence tomography retinal nerve fiber layer measurements to forecast glacuoma trajectory

by Chris Bradley, Kaihua Hou, Patrick Herbert, Mathias Unberath, Greg Hager, Michael V. Boland, Pradeep Ramulu, Jithin Yohannan

Linear regression of optical coherence tomography measurements of peripapillary retinal nerve fiber layer thickness is often used to detect glaucoma progression and forecast future disease course. However, current measurement frequencies suggest that clinicians often apply linear regression to a relatively small number of measurements (e.g., less than a handful). In this study, we estimate the accuracy of linear regression in predicting the next reliable measurement of average retinal nerve fiber layer thickness using Zeiss Cirrus optical coherence tomography measurements of average retinal nerve fiber layer thickness from a sample of 6,471 eyes with glaucoma or glaucoma-suspect status. Linear regression is compared to two null models: no glaucoma worsening, and worsening due to aging. Linear regression on the first M ≥ 2 measurements was significantly worse at predicting a reliable M+1^st measurement for 2 ≤ M ≤ 6. This range was reduced to 2 ≤ M ≤ 5 when retinal nerve fiber layer thickness measurements were first “corrected” for scan quality. Simulations based on measurement frequencies in our sample—on average 393 ± 190 days between consecutive measurements—show that linear regression outperforms both null models when M ≥ 5 and the goal is to forecast moderate (75^th percentile) worsening, and when M ≥ 3 for rapid (90^th percentile) worsening. If linear regression is used to assess disease trajectory with a small number of measurements over short time periods (e.g., 1–2 years), as is often the case in clinical practice, the number of optical coherence tomography examinations needs to be increased.

Post‐operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review

Abstract

Aims

To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice.

Design

A scoping review.

Data Sources

Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The ‘Dimensions of the scope of nursing practice’ framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings.

Results

Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently ‘Technical procedure and delegated medical care’ meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal.

Conclusion

The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role.

Impact Statement

Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities.

Implications for the Profession and/or Patient Care

There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication.

Reporting Method

Scoping Reviews (PRISMA-ScR) checklist.

Patient or Public Contribution

A health consumer interpreted the data and prepared the manuscript.

Efeitos da pandemia da covid 19 no trabalho e na saúde dos profissionais atuantes no serviço pré-hospitalar: revisão integrati-va

Objetivo: Identificar os efeitos da pandemia da COVID 19 nos profissionais atuantes no atendimento pré-hospitalar. Método: revisão integrativa, conduzida de acordo com o protocolo prisma, por meio das bases de dados: Medline/PubMed, Lilacs, SciElo, BDENF, CUIDEN, CINAHAL. Adotaram-se os Descritores em Ciências da Saúde (DeCS): “Saúde do trabalhador” “Pandemia” “COVID 19” “Atendimento pré-hospitalar” “Segurança” “Profissionais de saúde” “Trabalho”. Após a aplicação dos critérios de inclusão, foram selecionados treze artigos que compuseram a amostra do estudo. Resultados: dezoito artigos foram analisados e duas categorias foram construídas: risco de contaminação e exposição ocupacional dos profissionais da saúde que cuidam de pacientes acometidos pela COVID-19 e risco de adoecimento psicoemocional dos profissionais da saúde que cuidam pacientes acometidos pela COVID-19. Conclusão: A revisão mostrou os potenciais efeitos sobre a saúde dos profissionais durante o atendimento de pacientes acometidos pela COVID-19. E a importância da implementação de estratégias de intervenção focadas nos riscos ocupacionais.

Percepción del proceso de trabajo de los técnicos de enfermería titulados

Objetive: analizar las percepciones, motivaciones y dificultades de los técnicos de enfermería titulados en enfermería. Metodología: Me-todología: Se trata de una investigación cualitativa, exploratoria descriptiva, la recolección de datos se realizó en un Hospital Municipal del Noroeste de Paraná, durante el primer semestre de 2020, mediante la aplicación de un guión semiestructurado con preguntas orien-tadoras y un cuestionario sociodemográfico. Resultados: El conocimiento adquirido en la graduación de enfermería fue uno de los facto-res facilitadores que contribuyó a una mejor ejecución de la atención brindada, y la mayor dificultad está relacionada con la aceptación de los colegas y supervisores, en relación a las opiniones y sugerencias sobre los procedimientos u organización de la Servicio. Las razones que llevaron a los técnicos de enfermería a cursar una carrera en el área en la que trabajan se deben a la necesidad de cono-cimientos y la búsqueda de un mejor futuro financiero. Conclusión: cuando el profesional tiene un título, se desarrolla con mayor destreza y eficacia en la asistencia proporcionada.

Expediente Electrónico vs Expediente Físico para mejorar la calidad del proceso de atención en pacientes hospitalizados

Objetivo principal: Comparar la eficacia del uso del Expediente Clínico Electrónico (ECE) Vs Expediente Clínico Físico (ECF) en la mejora la calidad en atención de pacientes hospitalizados. Metodología: Se consideraron estudios relacionados con uso del ECE, utilizando los descriptores DeCS y MeSH, operadores booleanos AND, NOT y OR. Criterios inclusión: artículos de revisión con cinco años de publicación; criterios exclusión: pacientes ambulatorios o de consulta externa. Resultados principales: La evidencia establece ventajas del uso ECE como la facilidad de uso, accesibilidad, lectura, calidad en la documentación, control de información sobre los cuidados de los pacientes, cumplimiento normativo y toma de decisiones, lo cual reduce el riesgo de errores médicos; sin embargo, algunas desventajas es el empleo de hardware, software, redes; requiere soporte técnico las 24 horas al día. Conclusión principal: el empleo del ECE establece eficacia en la atención al paciente hospitalizado mediante la minimización de tiempos en registros y el aumento en la seguridad de la información.