David Gallagher M.D.’s Post

This is the gist of my response posted in the HSJ article reporting that virtual wards are more expensive than standard care. I urge colleagues to read the original article and decide for yourselves. Let's have a proper debate. For me, the key is designing high quality research projects to answer the important questions. "At Virtue Healthcare we applaud colleagues seeking to add to what is, a relatively sparse body of literature describing the outcomes and benefits of virtual ward patients. In my opinion, the recent BMJ Open article by Jalien et al https://lnkd.in/gWZ_yz7i , reported in the HSJ does not help the debate. The study methodology is seriously flawed. The study population was too heterogeneous; in effect a composite of many small individual patient groups. The study and control populations were only matched on 4 criteria, gender, age, frailty score and diagnosis. Undeclared bias within these groups will interfere with outcomes analysis. Inexplicably, patients were not matched on the number or severity of their comorbidities, their previous admission behaviour, nor indeed the severity of their matched diagnoses, making the data impossible to interpret. Their financial analysis, criticised by Dr Keenan and myself in a published rapid response, https://lnkd.in/gWZ_yz7i, fails to take account of the bed-releasing savings (e.g. closing surge beds to allow for elective care pathways), improved hospital flow created by the 3 day average LOS reduction and calculates VH costs without allowing for their disappointingly low occupancy. Further, no information was offered on whether they adopted intelligent staffing models to mitigate their 24% VH use. This study rather misses the point that the UK has a low population: bed ratio in comparison to most similar European countries. The creation of 40-50 virtual beds/100,000 population is far more cost-effective than building new wards and hospitals. At Virtue Health Group Ltd we are passionate about improving patients' lives. Virtual Hospitals, when delivered effectively with digital platforms that provide command & control facilities, intelligent staff conveyancing while hosting stringent governance and decision-making, can deliver highly effective care. They are transformative, challenge anachronistic views of health systems, create a bridge between hospital and community and host ambitious new models where single systems can proactively care for patients and focus on optimisation and crisis prevention. As a community of virtual hospital providers, we have a duty to collaborate, agree and standardise outcome metrics and coalesce around clear methodology and terminology. We desperately need high quality data to plan our healthcare services and this study is I’m afraid, non-contributory." Dr ANDREW BARLOW  Chief Medical Officer, Virtue Health Group Ltd

A great response to some unwelcome noise around Virtual Wards 👏 Many of the potential benefits of VWs will spring from their ability to provide acute care in the community - as such, the £cost of a VW service will have to be measured against a host of ICS-wide metrics that VWs should impact. VWs should deliver equivalent acute care to a hospital, but crucially it’s a different model, supporting integrated, personalised healthcare. As the NHS moves towards providing more out of hospital care and greater integration at system level, measurement of these changes will need to keep up to accurately demonstrate their impact. NICE, NIHR (National Institute for Health and Care Research), Health Innovation Network & academia will all be required to support if the NHS is going to offer truly evidence based healthcare fit for the future.

The first leg of our study is live on BMJ Open. It is the protocol of an umbrella review that seek to provide evidence on the effectiveness of available educational interventions on the management of hypertensive patients. The second leg of the work will be the actual work, the interesting part. You can read the protocol on BMJ via this link: https://lnkd.in/d4Qn92YM Special mention to AbdulMuminu Isah, PharmD, PhD, FPCPharm (Infec. Dis.) CSCA who has been incredible.

Ophthopedia Update:Retrospective analysis on the outcomes of contact lens-associated keratitis in a tertiary centre: an evidence-based management protocol to optimise resource allocation: Background/aims Contact lens-associated keratitis (CLAK) is a common sight-threatening complication of contact lens use. Current management protocols in the UK are based on historical practice and necessitate a review for every patient within 48 hours regardless of severity, increasing the treatment burden on a resource-limited healthcare service. Our study aims to identify the different risk factors associated with CLAK, categorise CLAK using a novel grading system and recommend modifications to current management protocols based on the outcomes in the individual subgroups.Methods The retrospective cohort study identified 161 eyes from 153 patients with CLAK from the electronic patient records of a tertiary eye centre between 1 July 2021 and 28 February 2022. Patients were categorised based on epithelial defect size (grade 1: 2.0 mm) and their risk factors, clinical features, treatments and outcomes were analysed.Results The most significant risk factors for CLAK include extended-wear contact lens, poor hygiene and prolonged duration of wear. Grades 1 and 2 CLAKs have excellent outcomes following an empirical treatment regime with topical moxifloxacin with 96% discharged within 48 hours and 94.1% discharged in 2 weeks, respectively. Grade 3 CLAKs require prolonged average duration of treatment.Conclusion We recommend typical grade 1 and 2 CLAKs can be discharged with empirical fluoroquinolone treatment. Grade 3 and all CLAKs with atypical features require monitoring for resolution, further diagnostics or treatment. We provide an evidence-based approach to reduce unnecessary patient visits and optimise resource allocation in an urban setting. #Ophthalmology #Ophthotwitter #BJO

Want to get started in Emergency Medicine research? A great place to start is to find out what the research priorities are. Following the initial priority setting partnership process in 2017, the research priorities for Emergency Medicine were recently refreshed through a collaboration with Royal College of Emergency Medicine and the James Lind Alliance and today are published in the Emergency Medicine Journal👇 As someone starting out in research I used the original priorities back in 2017 to help shape a project looking into fatigue and need for recovery in Emergency Medicine and it has been brilliant to be involved in the refresh process. This article details the steps taken and hopefully will help as a guide for other specialities looking to refresh or set research priorities. https://lnkd.in/egw83xsV

A new report from the @NASEM Health and Medicine Division explores lessons learned from COVID-19 and the mpox multi-country outbreak to inform an evaluation of #smallpox research, development, and stockpiling of medical countermeasures (MCM). Read here: https://ow.ly/zNAG50QYNUK #NationalStockpile

EAHP has been investigating and advocating on the issue of medicine shortages since 2013. Five surveys were conducted by EAHP in 2013, 2014, 2018, 2019 and 2020, with the last one focusing also on the pandemic preparedness of pharmacists. Between March and May 2023, EAHP collected data for the 2023 Shortage Survey. This Survey also investigated on medical devices and targeted the impact of both medicine and medical device shortages in the hospital environment. In addition to hospital pharmacists, EAHP sought input from patients and all healthcare professionals working in hospitals. An article has been published in the European Journal of Hospital Pharmacy summarising the results. Thanks to all that participates on this important project and who answered to the Survey. https://lnkd.in/eHN7XrFh

Full read BMJ ovverview of PMR - PMR Clinically recognized 1957 - Is it a uniquie vs overlap entity - Is there subclinical GCA in PMR? - Is PMR for PCPs?

second medical opinion: a grey area Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions. https://lnkd.in/d2m29wtw https://lnkd.in/dSPm_GJm

Happy World Music Day! 🎶 Increasing evidence shows that music can help with health at any age. Music therapists work in hospitals, clinics, nursing homes, senior centers, rehab centers, and schools to use music for healing. 🌟 Share the power of music with us! Comment your favorite "happy place" song below. Let's celebrate the healing power of music together! 💙 #WorldMusicDay Article: Music and Health: What You Need To Know | NCCIH (nih.gov)