Journal of evaluation in clinical practice
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Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken. ⋯ Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments.
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Total knee arthroplasty is a common surgical procedure but not appropriate for all patients with knee osteoarthritis. Patient decision aids (PtDAs) can promote shared decision making and enhance understanding and expectations of procedures among patients, resulting in better discussions between patients and healthcare providers about whether total knee arthroplasty is the most appropriate option. ⋯ Although we were not able to detect statistically significant benefits associated with implementing this PROMs-based PtDA, there was no apparent negative effect on these outcomes 1 year after baseline. We anticipate there may be benefit to implementing this PtDA earlier in the osteoarthritis care pathway where patients have more opportunities to manage their disease non-surgically.
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Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services. ⋯ Provision of GPST correlated with shorter waits for discharge from ED. Patient and staff experiences of GPST were positive.
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The UK National Health Service (NHS) employs a group of 14 separate allied health professions. Prosthetics and orthotics are the smallest of these professions. ⋯ There is still a paucity of relevant data or initiatives to support the service provision. The work within this paper has taken the first step to address this gap, presenting a summary of the information relating to appointments and costs, and provides a discussion on the implications of variations across the NHS orthotic services within England in terms of spend, staffing and skill mix for orthotic services and service users and the need for further data on service users and the UK prosthetic and orthotic workforce.
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Coronavirus (COVID-19)-related stressors precipitated the mental health crisis and increased substance use in Canada and worldwide. As the pandemic continues to evolve, monitoring and updating substance use-related ED visit trends is essential to ensure the stability and quality of ED services under the prolonged pandemic timeline. ⋯ Our findings indicate unmet substance use treatment needs due to the limited accessibility and heightened threshold for ED visits during the pandemic. Providing access to substance treatment/programs outside ED is critical to reducing substance use-related complications presenting in the ED. Also, policies addressing the pandemic-related complexities in the ED and Health Human Resource challenges are warranted.