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Article ; Online: The impact of remote care approaches on continuity in primary care: a mixed-studies systematic review.

Ladds, Emma / Khan, Maaedah / Moore, Lucy / Kalin, Asli / Greenhalgh, Trish

The British journal of general practice : the journal of the Royal College of General Practitioners

2023 Volume 73, Issue 730, Page(s) e374–e383

Abstract: Background: The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity.: Aim: To explore ... ...

Abstract	Background: The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity. Aim: To explore the impact of the expansion of remote and digital care models on continuity in primary care. Design and setting: A systematic review of continuity in primary care. Method: A keyword search of Embase, MEDLINE, and CINAHL databases was used along with snowball sampling to identify relevant English-language qualitative and quantitative studies from any country between 2000 and 2022, which explored remote or digital approaches in primary care and continuity. Relevant data were extracted, analysed using GRADE-CERQual, and narratively synthesised. Results: Fifteen studies were included in the review. The specific impact of remote approaches on continuity was rarely overtly addressed. Some patients expressed a preference for relational continuity depending on circumstance, problem, and context; others prioritised access. Clinicians valued continuity, with some viewing remote consultations more suitable where there was high episodic or relational continuity. With lower continuity, patients and clinicians considered remote consultations harder, higher risk, and poorer quality. Some evidence suggested that remote approaches and/or their implementation risked worsening inequalities and causing harm by reducing continuity where it was valuable. However, if deployed strategically and flexibly, remote approaches could improve continuity. Conclusion: While the value of continuity in primary care has previously been well demonstrated, the dearth of evidence around continuity in a remote and digital context is troubling. Further research is, therefore, needed to explore the links between the shift to remote care, continuity and equity, using real-world evaluation frameworks to ascertain when and for whom continuity adds most value, and how this can be enabled or maintained.
MeSH term(s)	Humans ; Remote Consultation ; Research ; Primary Health Care
Language	English
Publishing date	2023-04-27
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2022.0398
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Article ; Online: Double-domed arch sign on chest X-ray secondary to a hydatid cyst.

Ulas, Ali Bilal / Aydin, Yener / Eroglu, Atilla / Kalin, Asli

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2021 Volume 59, Issue 5, Page(s) 1135

MeSH term(s)	Echinococcosis, Pulmonary/diagnostic imaging ; Humans ; Radiography ; X-Rays
Language	English
Publishing date	2021-02-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezaa458
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Article ; Online: A contemporary ontology of continuity in general practice: Capturing its multiple essences in a digital age.

Ladds, Emma / Greenhalgh, Trisha / Byng, Richard / Rybczynska-Bunt, Sarah / Kalin, Asli / Shaw, Sara

Social science & medicine (1982)

2023 Volume 332, Page(s) 116112

Abstract: Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically ... ...

Abstract	Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and telephone triage) and clinical encounters (e.g. telephone, video and electronic consultations). Re-evaluation of continuity's relational, organisational, socio-technical and professional characteristics is therefore timely. We developed theory in parallel with collecting and analysing data from case studies of 11 UK general practices followed from 2021 to 2023 as they introduced (or chose not to introduce) remote and digital services. We used strategic, immersive ethnography, interviews, and material analysis of technologies (e.g. digital walk-throughs). Continuity was almost universally valued but differently defined across practices. It was invariably situated and effortful, influenced by the locality, organisation, technical infrastructure, wider system and the values and ways of working of participating actors, and often requiring articulation and 'tinkering' by staff. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving-to a greater or lesser extent-continuity of digital records and shared understandings of a patient and illness episode across the clinical team. Delivering continuity for the most vulnerable patients was sometimes labour-intensive and required one-off adaptations. Building on earlier work by Haggerty et al. we propose a novel ontology of four analytically distinct but empirically overlapping kinds of continuity-of the therapeutic relationship (based on psychodynamic and narrative paradigms), of the illness episode (biomedical-interpretive paradigm), of distributed work (sociotechnical paradigm), and of the practice's commitment to a community (political economy and ethics of care paradigm). This ontology allowed us to theorise and critique successes (continuity achieved) and failures (breaches of continuity and fragmentation of care) in our dataset.
MeSH term(s)	Humans ; Physician-Patient Relations ; General Practice ; Anthropology, Cultural ; Referral and Consultation ; Technology
Language	English
Publishing date	2023-07-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2023.116112
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Article ; Online: Direct and indirect evidence of efficacy and safety of rapid exercise tests for exertional desaturation in Covid-19: a rapid systematic review.

Kalin, Asli / Javid, Babak / Knight, Matthew / Inada-Kim, Matt / Greenhalgh, Trisha

Systematic reviews

2021 Volume 10, Issue 1, Page(s) 77

Abstract: Background: Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence ... ...

Abstract	Background: Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. Main research questions: 1. What exercise tests have been used to assess exertional hypoxia at home or in an ambulatory setting in the context of Covid-19 and to what extent have they been validated? 2. What exercise tests have been used to assess exertional hypoxia in other lung conditions, to what extent have they been validated and what is the applicability of these studies to acute Covid-19? Method: AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases were searched to September 2020. Studies where participants had Covid-19 or another lung disease and underwent any form of exercise test which was compared to a reference standard were eligible. Risk of bias was assessed using QUADAS 2. A protocol for the review was published on the Medrxiv database. Results: Of 47 relevant papers, 15 were empirical studies, of which 11 described an attempt to validate one or more exercise desaturation tests in lung diseases other than Covid-19. In all but one of these, methodological quality was poor or impossible to fully assess. None had been designed as a formal validation study (most used simple tests of correlation). Only one validation study (comparing a 1-min sit-to-stand test [1MSTST] with reference to the 6-min walk test [6MWT] in 107 patients with interstitial lung disease) contained sufficient raw data for us to calculate the sensitivity (88%), specificity (81%) and positive and negative predictive value (79% and 89% respectively) of the 1MSTST. The other 4 empirical studies included two predictive studies on patients with Covid-19, and two on HIV-positive patients with suspected pneumocystis pneumonia. We found no studies on the 40-step walk test (a less demanding test that is widely used in clinical practice to assess Covid-19 patients). Heterogeneity of study design precluded meta-analysis. Discussion: Exertional desaturation tests have not yet been validated in patients with (or suspected of having) Covid-19. A stronger evidence base exists for the diagnostic accuracy of the 1MSTST in chronic long-term pulmonary disease; the relative intensity of this test may raise safety concerns in remote consultations or unstable patients. The less strenuous 40-step walk test should be urgently evaluated.
MeSH term(s)	COVID-19/blood ; COVID-19/pathology ; COVID-19/virology ; Dyspnea ; Exercise ; Exercise Test/adverse effects ; Humans ; Hypoxia ; Lung Diseases/blood ; Lung Diseases/diagnosis ; Lung Diseases/pathology ; Lung Diseases/virology ; Oxygen/blood ; Physical Exertion ; Predictive Value of Tests ; SARS-CoV-2 ; Sensitivity and Specificity
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-03-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2662257-9
ISSN	2046-4053 ; 2046-4053
ISSN (online)	2046-4053
ISSN	2046-4053
DOI	10.1186/s13643-021-01620-w
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Bilious pleuritis following transpulmonary radiofrequency ablation of liver metastases.

Kalin, Asli / Hassan, Maged / Anderson, Mark / Rahman, Najib

Thorax

2017 Volume 73, Issue 5, Page(s) 493–494

MeSH term(s)	Bile ; Biliary Tract Diseases/diagnostic imaging ; Biliary Tract Diseases/etiology ; Fistula/diagnostic imaging ; Fistula/etiology ; Humans ; Liver Neoplasms/secondary ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Pancreatic Neoplasms/secondary ; Pleurisy/diagnostic imaging ; Pleurisy/etiology ; Radiofrequency Ablation/adverse effects
Language	English
Publishing date	2017-10-05
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thoraxjnl-2017-210508
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Article ; Online: A Patient with Severe Cervicofacial Subcutaneous Emphysema Associated with Munchausen's Syndrome: A Case Report.

Şahin Önder, Serap / Şahin Yılmaz, Ayşe Aslı / Şahin, Ceyhan / İlçe, Zekeriya / Kalın, Sevinç

Turkish archives of otorhinolaryngology

2021 Volume 59, Issue 3, Page(s) 230–233

Abstract: Subcutaneous cervicofacial emphysema is a rare and life-threatening condition that results from various causes. In this report, we documented a case of a patient with severe subcutaneous cervicofacial emphysema a condition that falls under the umbrella ... ...

Abstract	Subcutaneous cervicofacial emphysema is a rare and life-threatening condition that results from various causes. In this report, we documented a case of a patient with severe subcutaneous cervicofacial emphysema a condition that falls under the umbrella of Munchausen's syndrome and discussed the workup of this patient. Thorough diagnostic investigations seeking the etiology of the condition proved unsuccessful. When faced with cases of recurring subcutaneous cervicofacial emphysema, where the root cause remains ambiguous a diagnosis of Munchausen's Syndrome should be considered.
Language	English
Publishing date	2021-10-15
Publishing country	Turkey
Document type	Case Reports
ISSN	2667-7474
ISSN (online)	2667-7474
DOI	10.4274/tao.2021.2021-3-16
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Book ; Online: Is it Safe for Patients With COVID-19 to Fast in Ramadan?

Kalin, Asli / Mahmood, Ammad / Waqar, Salman / Yusuf, Asim / Ghouri, Nazim / Sattar, Naveed / Chowdhury, Tahseen

Pandemic Response and Religion in the USA: Ethics

2020

Abstract: ...

Abstract	*
Keywords	Fasting ; International ; Islam ; Ramadan ; Risk ; Safety ; American Studies ; Ethics in Religion ; Virus Diseases ; covid19
Publishing date	2020-04-22T07:00:00Z
Publisher	ScholarWorks at WMU
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Training needs for staff providing remote services in general practice: a mixed-methods study.

The British journal of general practice : the journal of the Royal College of General Practitioners

2023 Volume 74, Issue 738, Page(s) e17–e26

Abstract: Background: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but ... ...

Abstract	Background: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice. Aim: To identify training needs, core competencies, and learning methods for staff providing remote encounters. Design and setting: Mixed-methods study in UK general practice. Method: Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning. Results: Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings. Conclusion: The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.
MeSH term(s)	Humans ; General Practice ; Family Practice ; Clinical Competence ; Anthropology, Cultural ; Surveys and Questionnaires
Language	English
Publishing date	2023-12-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2023.0251
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Article ; Online: Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis.

BMJ quality & safety

2023

Abstract: Background: Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.: Setting and sample: UK primary care. 95 safety incidents (complaints, settled ... ...

Abstract	Background: Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them. Setting and sample: UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021-2023. Methods: Multimethod qualitative study. We explored causes of real safety incidents retrospectively ('Safety I' analysis). In a prospective longitudinal study, we used interviews and ethnographic observation to produce individual, organisational and system-level explanations for why safety and near-miss incidents (rarely) occurred and why they did not occur more often ('Safety II' analysis). Data were analysed thematically. An interpretive synthesis of why safety incidents occur, and why they do not occur more often, was refined following member checking with safety experts and lived experience experts. Results: Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances. These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating seemed especially vulnerable. General practices were facing resource constraints, understaffing and high demand. Triage and care pathways were complex, hard to navigate and involved multiple staff. In this context, patient safety often depended on individual staff taking initiative, speaking up or personalising solutions. Conclusion: While safety incidents are extremely rare in remote primary care, deaths and serious harms have resulted. We offer suggestions for patient, staff and system-level mitigations.
Language	English
Publishing date	2023-11-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2023-016674
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Article ; Online: What is the efficacy and safety of rapid exercise tests for exertional desaturation in Covid-19: A rapid review protocol

kalin, Asli / Greenhalgh, Trish / Javid, Babak / Knight, Matthew / Inada-Kim, Matthew

medRxiv

Abstract: Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation. Research question ... ...

Abstract	Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation. Research question What tests have been formally evaluated for the rapid assessment of exertional hypoxia? What is the evidence for their accuracy, practicability and safety in the context of suspected acute Covid-19? To what extent will these tests help identify patients with evidence of either silent or hidden hypoxia leading to earlier recognition of those at risk of severe outcomes? Method We aim to review three independent searches of AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases until 24th September 2020. Screening, data abstraction, and quality appraisal of full-text papers will be completed independently by two reviewers including a topic expert and a review expert. Studies will be tabulated and assessed for risk of bias using QUADAS 2 tool.
Keywords	covid19
Language	English
Publishing date	2020-11-04
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.10.31.20223453
Database	COVID19

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