Background The National Health Service (NHS) Long-Term Plan has set out a vision of enabling patients to access digital interactions with health care professionals within 5 years, including by video link. Objective This review aimed to examine the extent and nature of the use of patient-facing teleconsultations within a health care setting in the United Kingdom and what outcome measures have been assessed. Methods We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs Institute methodology. PubMed, Scopus, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched up to the end of December 2018 for publications that reported on the use of patient-facing teleconsultations in a UK health care setting. Results The search retrieved 3132 publications, of which 101 were included for a full review. Overall, the studies were heterogeneous in design, in the specialty assessed, and reported outcome measures. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies, conducted between 1995 and 2005, used this method. Later studies transitioned to Web-based commercial solutions such as Skype. There were five outcome measures that were assessed: (1) technical feasibility, (2) user satisfaction, (3) clinical effectiveness, (4) cost, (5) logistical and operational considerations. Due to the changing nature of technology over time, there were differing technical issues across the studies. Generally, teleconsultations were acceptable to patients, but this was less consistent among health care professionals. However, among both groups, face-to-face consultations were still seen as the gold standard. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical interactions. Due to the wide array of study types and changes in technology over time, it is difficult to draw definitive conclusions on the cost involved. However, cost savings for health care providers have been demonstrated by the goal-directed implementation of teleconsultations. The integration of technology into routine practice represents a complex problem with barriers identified in funding and hospital reimbursement, information technologies infrastructure, and integration into clinicians’ workflow. Conclusions Teleconsultations appear to be safe and effective in the correct clinical situations. Where offered, it is likely that patients will be keen to engage, although teleconsultations should only be offered as an option to support traditional care models rather than replace them outright. Health care staff should be encouraged and supported in using teleconsultations to diversify their practice. Health care organizations need to consider developing a digital technology strategy and implementation groups to assist health care staff to integrate digitally enabled care into routine practice. The introduction of new technologies should be assessed after a set period with service evaluations, including feedback from key stakeholders.
Background: Multiple sclerosis, Parkinson’s disease, and hemiplegia are common disorders that directly cause impairment of balance and gait. Aquatic exercises are used for neurological rehabilitation. It is suggested that the contributing factors of the water setting such as buoyancy, viscosity, and hydrostatic pressure offer an ideal environment for rehabilitative programmes. Objective: To conduct a systematic review of studies that assess the effect of aquatic exercises on balance in neurological patients (i.e., patients with multiple sclerosis, Parkinson’s disease, and hemiplegia). Methods: A systematic literature search of six databases (MEDLINE, PEDro, AMED, CINAHL, Embase, SPORTDiscus) for randomized controlled trials and quasi-experimental trials on aquatic exercises in three different neurological disorders, namely, multiple sclerosis, Parkinson’s disease, and hemiplegia, was performed. Reference lists from identified studies were manually searched for additional studies. Methodological quality was assessed using the Downs and Black checklist. The data were analyzed and synthesized by two independent reviewers. Disagreements in extracted data were resolved by discussion among the reviewers. Results: The methodological quality of eight studies included in this review ranged from fair to good. The findings illustrated that there were statistically significant improvements in static and dynamic balance in patients with multiple sclerosis and hemiplegia. The statistically significant improvements in gait ability were only found in the studies conducted on multiple sclerosis. No conclusions can be drawn in Parkinson’s populations as only two trials conducted with a small sample size were available. Conclusion: Aquatic exercises may be effective at improving balance impairment in patients with hemiplegia and multiple sclerosis. There is a need for further research investigating its effect on Parkinson’s disease before encouraging the use of aquatic exercises.
Background A highly skilled workforce is required to deliver high quality evidence-based care. Clinical academic career training programmes have been developed to build capacity and capabilities of nurses, midwives and allied health professionals (NMAHPs) but it remains unclear how these skills and roles are operationalised in the healthcare context. The aim of this study was to explore the experiences of early career clinical academic NMAHPs who have undertaken, or are undertaking, clinical academic master’s and doctoral studies in the United Kingdom. Methods We conducted 17 in-depth semi-structured interviews with early career clinical academics which included; nurses, midwives and allied health professionals. The data were analysed using thematic analysis. Results Two themes emerged from the data; identity transformation and operationalising transformation. Both these highlighted the challenges and opportunities that early clinical academic training provided to the individual and organisation in which they practiced. This required the reconceptualization of this training from the pure acquisition of skills to one of personal and professional transformation. The findings suggest that individuals, funders, and organisations may need to relinquish the notion that training is purely or largely a transactional exchange in order to establish collaborative initiatives. Conclusion Stakeholders need to recognise that a cultural shift about the purposes of research training from a transactional to transformative approaches is required to facilitate the development of NMAHPS clinical academics, to enable them to contribute to innovative health and patient care.
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