Stephanie Best

Meeting the challenges of implementing rapid genomic testing in acute pediatric care

PurposeThe purpose of the study was to implement and prospectively evaluate the outcomes of a rapid genomic diagnosis program at two pediatric tertiary centers.MethodsRapid singleton whole-exome sequencing (rWES) was performed in acutely unwell pediatric patients with suspected monogenic disorders. Laboratory and clinical barriers to implementation were addressed through continuous multidisciplinary review of process parameters. Diagnostic and clinical utility and cost-effectiveness of rWES were assessed.ResultsOf 40 enrolled patients, 21 (52.5%) received a diagnosis, with median time to report of 16 days (range 9–109 days). A result was provided during the first hospital admission in 28 of 36 inpatients (78%). Clinical management changed in 12 of the 21 diagnosed patients (57%), including the provision of lifesaving treatment, avoidance of invasive biopsies, and palliative care guidance. The cost per diagnosis was AU

Professional identity in interprofessional teams: findings from a scoping review

13,388 (US

Facilitating integrated delivery of services across organisational boundaries: Essential enablers to integration

10,453). Additional cost savings from avoidance of planned tests and procedures and reduced length of stay are estimated to be around AU

Rapid genomic testing in acute paediatric care: Is it worth the trouble?

543,178 (US

Integrated care: mobilising professional identity

424,101). The clear relative advantage of rWES, joint clinical and laboratory leadership, and the creation of a multidisciplinary “rapid team” were key to successful implementation.ConclusionRapid genomic testing in acute pediatrics is not only feasible but also cost-effective, and has high diagnostic and clinical utility. It requires a whole-of-system approach for successful implementation.

Prudence or speed: Health and social care innovation in rural Wales

ABSTRACT Integrated care has been identified as being fundamental to health and social care reforms. How this interprofessional working impacts on professional identity is unclear. There is a lack of reviews synthesising this growing body of literature. It is therefore timely to conduct a scoping study of the literature which explores the intersection between interprofessional care and professional identity. The aim of this study is to identify the factors that impact on professional identity when working in interprofessional teams. A scoping review was conducted; Business Source Complete (EBSCO); CINAHL; Proquest; Medline; Scopus; and Cochrane Reviews (January 1980 to July 2018) were systematically searched for studies focusing on professional identity and interprofessional teams. Inclusion and exclusion criteria were identified and applied, data were charted, and a synthesis of the narrative was conducted. Sixteen papers are identified as central to this scoping review. Analysis of the papers highlights three key areas of interest: the creation of professional identity; challenges and barriers to professional identity; and implications for leadership and management. The significance of this review is considered along with an agenda for future research. Expanding the research to include more empirical studies to consider areas such as the value of interprofessional education programmes and to include the voice of those professionals no longer working or choosing not to work in an interprofessional care setting should also feature within future research.

The need for speed. The role of trust in rural health and social care innovation

Introduction Integrating services is a key tenet to developing services across the United Kingdom. While many aspects of integration have been explored, how to facilitate integration of services remains unclear. Method An exploratory qualitative study was undertaken in 2015 to explore occupational therapists’ perceptions on integrating service provision across health and social care organisational boundaries. The views of practitioners who had experienced integration were sought on a range of aspects of integrating services. This paper focuses on the facilitators for delivering integration and the essential enablers are identified. Findings Numerous factors were noted to facilitate integration and three essential enablers were highlighted. Leadership, communication and joint education were recognised as playing a central role in integrating services across organisational boundaries; without these three essential enablers, integration is liable to fail. Conclusion Integration is a process rather than an event; continued emphasis will be required on leadership, communication and joint education to progress integration achievements made to date.