315 Chaperone Documentation in The Breast Clinic: A Closed Loop Audit

Aim Intimate examinations are potentially uncomfortable and embarrassing. In addition to offering chaperones routinely, it is also important to clearly document the circumstances, with implications on patient dignity and safeguarding both patients and staff. We aimed to analyse the quality of chaperone documentation in the breast clinic before and after intervention. Method Audit standards (GMC and Chelsea & Westminster Trust guidelines): [1] Consent [2] Chaperone use/refusal, and [3] Chaperone role and identity should be clearly documented in the notes. We collected breast clinic data prospectively over one week, then re-audited after interventions including teaching sessions to the breast MDT, introduction of electronic (e)-notes (Cerner©), and creation of an instructional video demonstrating how to create an automatic template to easily document the aspects of chaperone use. Results 110 patients’ notes were analysed in the first cycle, and 74 in the second. Documentation improved significantly between cycle 1 and 2 for: consent (0% vs. 38%, p < 0.0001), identity of chaperone (12% vs. 35%, p = 0.0003), and role of chaperone (8% vs. 23%, p = 0.0091). Documentation for chaperone use or refusal improved, but this was not significant (27% vs. 35%, p = 0.3305). Conclusions Documentation improved significantly for most standards, likely due to the template prompting the clinician. However, documentation remains suboptimal. Possible reasons include forgetfulness in a busy clinic, or shortage of staff available to chaperone. Future recommendations include creating a mandatory template on the e-notes for all breast clinic documentation including a section for chaperone use, role, and identity, and providing more staff such as HCAs for the clinic.

Identifying Physician-perceived Barriers to Apragmatictreatment Trial Inrheumatoid Arthritis

Objective: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a RA pragmatic trial of anti-TNF biologic vs. non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate (MTX-IR).Methods: Semi-structured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.Results:Physician perceived patient barriers to the implementation ofa RA pragmatic trial. This theme covers three sub-themes: 1) patients’ personal barriers, 2) patients’ treatment-related factors, and 3) trial-related factors (e.g., patient recruitment, side effects, mode of use, etc.). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four sub-themes: 1) clinic-related factors, 2) patient-related factors, 3) research personnel, and 4) facilitators (positive factors of the clinic). Conclusions: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (e.g., coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patient-centered strategies to implement a pragmatic RA trial.

Graphical User Interface (GUI) of Digital Index Evaluation System for Finger Clubbing Identification

This paper presents the development of a Graphical User Interface (GUI) for calculating the sum of nail-fold (NF) and distal interphalangeal joint (DIP) ratios for all ten fingers. The sum of NF:DIP ratios for all ten fingers leads to the Digital Index (DI) that was used as the measure for identifying and determining the presence of finger clubbing symptom. This GUI system was developed to serve as a simple and user-friendly interface for clinicians to calculate DI value of patients in a busy clinic practice. It is also equipped with the capability to keep the patient’s past diagnosis medical check-up data for future monitoring purposes. The result shows that the developed system helps the clinicians to perform calculation of DI value and identify the presence of finger clubbing in a very short time. The average time taken to measure both NF and DIP circumferences using Finger Clubbing Meter, and to compute DI values using Digital Index Evaluation System (DIES) interface is 6:36 ± 1:24 minutes (Mean ± SD) .This system is expected to contribute in detecting the finger clubbing problem at early stage of so the treatment can be performed immediately.

Graphical User Interface (GUI) of Digital Index Evaluation System for Finger Clubbing Identification

This paper presents the development of a Graphical User Interface (GUI) for calculating the sum of nail-fold (NF) and distal interphalangeal joint (DIP) ratios for all ten fingers. The sum of NF:DIP ratios for all ten fingers leads to the Digital Index (DI) that was used as the measure for identifying and determining the presence of finger clubbing symptom. This GUI system was developed to serve as a simple and user-friendly interface for clinicians to calculate DI value of patients in a busy clinic practice. It is also equipped with the capability to keep the patient’s past diagnosis medical check-up data for future monitoring purposes. The result shows that the developed system helps the clinicians to perform calculation of DI value and identify the presence of finger clubbing in a very short time. The average time taken to measure both NF and DIP circumferences using Finger Clubbing Meter, and to compute DI values using Digital Index Evaluation System (DIES) interface is 6:36 ± 1:24 minutes (Mean ± SD) .This system is expected to contribute in detecting the finger clubbing problem at early stage of so the treatment can be performed immediately.

Development of Portable Finger Clubbing Meter

Finger clubbing, also known as drumstick finger, is the medical symptom that is indicated by the development of the sponginess or swelling in the nail beds of nails and toes. The higher grade of clubbing on the patients can be easily identified with the presence of drumstick finger. The existing available measurement device to identify the early stage of clubbing required much time which is impractical for a busy clinic practice. This paper explains the determination of the finger clubbing by using the Digital Index (DI) measurement, which was deployed by implementing and developing the Portable Finger Clubbing Meter hardware and the Microsoft Visual Basic (VB) Graphical User Interface (GUI). Finger circumference values of nail-fold (NF) and distal interphalangeal joint (DIP) of twenty participants were measured using the developed hardware. Data analysis was then performed using the GUI for DI computation, and the presence of finger clubbing could be determined.

Managing Patients With Psoriasis in the Busy Clinic

Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).