Lucy Land

Developing critical appraisal skills amongst staff in a hospital trust

This project was designed to encourage health professionals to use available evidence in their practice by facilitating the development of critical appraisal skills and by making them aware of the practical benefits of using evidence in practice. A partn ership was developed to roll out a workshop programme to enable all members of the health care team within a variety of clinical areas locate, appraise and utilise appropriate evidence in their speciality and to provide the Hospitals professional develo pment team with the necessary experience to conduct subsequent programmes. Six different modules were provided including an introductory session and five other modules each covering a portion of the critical appraisal process. 45 staff including 19 nurse s participated and all were surveyed in the post workshop evaluations. Comments were very positive and the sessions appeared to have enthused the participants. There were some limitations to the project, including fluctuating attendance, but the main out come of this project is that the team realised that in order to be more effective in their approach it would be most appropriate to single out clinical specialities and design workshops entirely applicable to their interests.

Development of a validated patient satisfaction survey for HIV clinic attendees

Patients are becoming more actively involved in decisions about their care and have greater influence to change and improve the quality of services by reporting their experiences. A recent systematic review failed to reveal a method of measuring HIV patient satisfaction that reflects their experience of contemporary treatment and care. The aim of this study was to design a specific HIV patient satisfaction questionnaire that can be used as a patient reported outcome measure. Key themes in the systematic review were identified and used as a topic guide for focus group discussion to confirm their relevance and importance. HIV patients were also interviewed about their motivation to complete a questionnaire. The data from the focus groups and interviews were used to develop an initial questionnaire and cognitive testing was used to provide face validity for the questionnaire design, layout and wording. A revised version was used in a pilot study of 80 respondents, which demonstrated that the questionnaires completion rate and content validity were high.

How to assess quality in your sexual health service.

Previous improvements in NHS have largely focused on increasing service capacity to ensure the provision of universal, comprehensive healthcare at the point of need in the UK. However, public expectations of the NHS are changing, triggered by increased access to information and media coverage of a series of lapses in quality and geographical inequity of care. The NHS also faces the challenges posed by a changing family structure, an ageing population, advancing technology and economic uncertainty. To meet these challenges, improvements in quality rather than just quantity have become a focus of the new NHS. This article provides an overview of quality and how to measure it in sexual health services.

Using patient experience to measure the quality of HIV care

Measurement of health-care quality in the UK is no longer restricted to evaluating the effectiveness of treatments or the cost efficiency of services. There is a drive towards a patient-based agenda which enables them to make a clear contribution to the way services are shaped by expressing their values and sharing experiences. Positive engagement with HIV care has proven benefits to patients and the mandatory use of standardized reported outcome measures provides an opportunity to include HIV patients in the process of creating and refining an evaluation tool which places emphasis on aspects of care that are significant to them. Ultimately, this will provide services users with a stronger voice to guide appropriate service change and support the continuing improvement of HIV care.

P061 Safety of Single Dose Gentamicin Compared with Multiple Dose Regimens

Background Traditionally, gentamicin is given eight hourly, guided by drug levels. Several studies have shown that single-daily dosing of gentamicin offers an equal, if not improved, toxicity profile compared to traditional dosing. Single one-off dose gentamicin has been suggested as treatment for gonorrhoea, but its safety has not been reviewed. Aim Systematically review the frequency and type of adverse events associated with a single dose of intravenous or intramuscular gentamicin in adults, for any indication, in studies where a comparator was available. Methods A review protocol was developed and registered (PROSPERO: CRD42013003229). Studies were eligible for review if they; recruited participants ≥16 years old, used gentamicin intramuscularly or intravenously as a single one-off dose, compared gentamicin to another medication or placebo, and if adverse events were monitored. We searched MEDLINE, EMBASE and other relevant databases. Risk of bias was assessed in included studies. Results 12,116 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 20 studies were included. 3589 participants were analysed across all studies, 2042 received a single one-off dose of gentamicin (doses ranged from 1 mg/kg - 280 mg). Reversible nephrotoxicity/creatinine rise was reported in 37 cases, with one case of irreversible renal impairment. There were three cases of ototoxicity, with similar frequency reported in the comparator group. A meta-analysis was not possible due to heterogeneity. Reporting of adverse events was poor in the majority of studies. Discussion Adverse events with single dose gentamicin are infrequent.

P6.061 Development of a Validated Questionnaire For HIV Attendees

Background Patients are becoming more actively involved in decisions about their care and have greater influence to change and improve the quality of services by reporting their experiences. Within HIV services, positive experiences increase engagement with services and have been linked to higher levels of treatment adherence. A previous systematic review assessing satisfaction with care failed to locate a gold standard method of measuring satisfaction in this setting. Aim to design a specific HIV patient satisfaction questionnaire Methods Four work streams were employed to develop and test a new questionnaire. Firstly, key themes identified in the systematic review were used as a topic guide for focus group discussion to assess their relevance and importance. Four focus groups comprising 32 participants were conducted and revealed the importance of physician knowledge and expertise; dignity, autonomy and respect; and good communication. The second stream involved interviews with ten patients, exploring their motivation to complete a questionnaire. Thirdly, data from the focus groups and interviews were used to develop an initial questionnaire which was cognitively tested on a further ten patients, this provided face validity for the questionnaire design, layout and wording. The final stream employed a pilot study of the questionnaire with 80 clinic attendees. Results The pilot survey demonstrated that there was a high completion rate. Two questions were modified and additional routing instructions were added. Pairwise correlations reflected the thematic structure of the questionnaire and supported good criterion validity. Conclusions The combination of a systematic analysis of previous patient survey tools, focus group discussions and cognitive testing of the questionnaire was used to ensure high content validity. The questionnaire was found to be acceptable to patients and a high completion rate was attained without the use of a financial incentive.