RSS 1.0Trustwide Services
Browse by
Recent Submissions
-
Switching from inhaled to intravenous general anaesthesiaInhalational and intravenous medications can be used to induce and maintain general anaesthesia. In recent years, the use of total intravenous anaesthesia (TIVA) has increased.1 Although both techniques are safe, TIVA has some clinical and environmental benefits when compared with inhalational anaesthesia.
-
Proactivity in VTE prevention: a concept analysisVenous thromboembolism (VTE) prevention is an international patient safety issue. The author has observed gaps in prescription and provision of VTE prophylaxis, and that the attitude to VTE is often reactive rather than proactive. This concept analysis aims to explore proactivity and apply it to VTE prevention to address this. Ten databases were searched (1992-2012) using the keywords proactive, proactivity, nurse, nursing, VTE/venous thromboembolism, prevent/prevention/preventing, behaviour, DVT/PE (deep vein thrombosis, pulmonary embolism). The Walker and Avant (2010) method of concept analysis identified the defining attributes as personal initiative, taking charge and feedback-seeking behaviour. Antecedents and consequences have been identified, and empirical referents are demonstrated. Defining proactivity in VTE prevention has the potential to increase prescription and, crucially, provision of prophylaxis, thereby improving patient care, reducing avoidable harm and improving the patient experience.
-
Population health management of fuel poverty.Fuel poverty is a wider determinant of health1,2 and of legitimate interest of Integrated Care Systems (ICSs). A total of 60 573 deaths have been attributed to cold between 2000–2019 in England and Wales.3 The National Institute for Health and Care Excellence4 recommends a single point of contact should be commissioned to support patents vulnerable to cold including those over 65 years, under 5 years, with mental health conditions, chronic cardiovascular disease, or chronic respiratory disease. Nottinghamshire County Council has co-commissioned the Nottingham Energy Partnership (NEP). NEP supports clients to access support according to their financial and housing circumstances. Opportunistic referral of appropriate patients by healthcare clinicians is challenging. Referrals have been below the service’s capacity. A Population Health Management (PHM) project has been developed by Nottingham and Nottinghamshire Integrated Care Board. Data are used to generate lists of at-risk patients likely to be eligible for support. Iterations have generated referrals matched to specific grant criteria and availability such as a specific number of households not yet connected to gas. Practices from five Primary Care Networks took part in one iteration. Patient-level health data were linked via residential address with Energy Performance Certificate (EPC) where available, and Index of Multiple Deprivation (IMD). Patients at risk of cold-related harm, living in areas associated with IMD deciles 1–2, and resident in homes with EPC ratings E, F, or G were triangulated. Primary care medical centre staff sent SMSs to patients offering NEP referral if they opted in. A total of 154 patients were referred between December 2022 and March 2023. Seventy-nine (51%) were contactable. All 79 received a measure of support. In total, 157 wide-ranging interventions were instigated including two cavity wall insulations, 15 loft insulations, 12 solar power systems, and one heat pump. The initial capital cost of these improvements combined with their 1-year projected savings reaches £144 740. Other interventions included 55 Priority Services Registrations, 8 mobility aids (Homes for Living), 26 water-saving discounts, 15 vouchers, boiler optimisation, hardship funding, and financial advice. This PHM approach is deployed periodically in Nottingham and Nottinghamshire to alleviate health inequality, tackle fuel poverty, and is potentially generalisable. © British Journal of General Practice 2024
-
The links between the amount of antipsychotic medication prescribed at GP practice level, local demographic factors and medication selection.Background: Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. Methods: The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Results: We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. Conclusions: The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.
-
Modelling the economic constraints and consequences of Anaesthesia Associate expansion in the UK National Health Service. Response by the Association of Anaesthetists SAS Committee to Br J Anaesth 2024.We welcome publication of the article on the economic constraints and consequences of anaesthesia associate expansion in the UK by Hanmer and colleagues. 1 This article provides valuable economic context to the current discussion surrounding where anaesthesia associates (AAs) might fit into the current and future delivery of anaesthetic services in the UK.
-
Sedation from analgesics: patient preference surveyBackground The propensity for certain analgesics to cause sedation is well documented, yet physician–patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect. Objectives To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making. Methods Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion. Results Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis. Conclusions Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.
-
Recognition, prevention and management of 'digital harm'.The digital world continues to evolve and is apparent in all aspects of daily life. For children and young people, their online life is as real to them as their in-person life. Health professionals urgently need to update their knowledge and awareness of the positive and negative impacts of the myriad of online content and how this is viewed and used by children and young people. Digital harm can contribute to multiple clinical presentations and paediatricians must ask about online life in consultations and be able to provide holistic digital safety advice, while recognising serious digital harm requiring safeguarding input.This article will introduce the main areas of harm and how to include assessment in routine clinical practice. It will equip paediatricians to offer advice and safeguard children and young people and offer resources and links to further learning.
-
Hypothermic episodes during hospital admission and the correlation with clinical condition and mortality in different age groups.Studies demonstrate that older patients are more likely to have a lower body temperature,1 yet we currently use the same National Early Warning Score (NEWS) parameters for all adults.2 Recent studies indicate that low temperature is associated with increased mortality in younger patients;3 however, no such correlation was found in older patients. We wondered whether episodes of hypothermia are normal in older patients, even when medically safe for discharge (MSFD), or do they correlate with clinical deterioration and poor mortality outcomes?
-
Understanding organizational learning in a healthcare organization during sudden and disruptive change.Purpose Complex and sudden change that healthcare organizations often have to respond to, such as during the recent pandemic, can create major disruptions and a prolonged state of alert. Although the impact of such crises can be predominantly negative, rapid adjustments during this time can also yield positive change that can support organizational response to crisis, if managed well. Using insights from organizational learning and organizational change theory, the aim of this study was to understand organizational learning during sudden change. Specifically, the authors aimed to understand the experiences and types of gains and losses in the processes of complex and disruptive change in one large healthcare organization in the UK. Design/methodology/approach Focus group data were used from 23 focus group discussions with 575 participants representing all functions and departments in one Healthcare Trust. Findings The participants revealed the rich gains, losses, and lessons experienced in response to sudden change that can promote organizational learning. Perceived losses are more likely to drive a desire to refreeze “back to normal” and perceived gains more likely to lead to an emphasis on embedding gains and changing to better. Therefore, on balance, the substantial, in number and variety, gains and learnings point to a learning organization. This is an essential attribute for responding to disruptive change successfully and facilitating organizational recovery in a post-pandemic world. Practical implications The findings highlight the importance of timely harnessing of the organizational learning emerging from crises and how this can inform a more resilient organization, as well as supporting sustainable organizational cross-learning. Originality/value By extending these insights on workers’ adaptation to sudden change, the findings can help to advance the science and practice of organizational learning and support organizational recovery, especially as they describe the new status in UK healthcare organizations.
-
Mental health professionals and telehealth in a rural setting: a cross sectional survey.Background: Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery. Methods: An online cross-sectional survey that explored mental health professional's experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery. Results: Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client's access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth. Conclusions: This study addresses three major gaps in knowledge: the experience of delivering local telehealth solutions to address rural mental health needs, the provision of strong rural-specific telehealth recommendations, and the dearth of rural research emanating from the United Kingdom. As the world settles into a living with COVID-19 era, the uniqueness of the rural telehealth context may be forgotten as urban myopia continues to dominate telehealth policy and uptake. It is critical that rural resourcing and digital connectivity are addressed.
-
Cerebrospinal fluid xanthochromia in acute bacterial meningitis as a red herring for subarachnoid haemorrhage: A case report.This article presents a case that highlights the importance of excluding underlying intracranial pathology in a patient presenting with severe headache and positive xanthochromia. This case report demonstrated that false-positive xanthochromia without subarachnoid haemorrhage (SAH) is possible in acute bacterial meningitis when there is a combination of traumatic lumbar puncture and either hyperbilirubinaemia or raised cerebrospinal fluids (CSF) protein.
-
Civility in the care setting and the impact of incivility.Denise Guzdz discusses the importance of healthcare staff being civil towards each other in the workplace and how incivility can affect both staff and patients.
-
Reduction of needlestick injuries among nurses and healthcare assistants through an intervention: national hospital sri lanka (NHSL)Introduction Cutaneous injuries, resulting from needle sticks, injection devices and sharps are a major issue for all health care workers and cause a considerable threat of spreading blood-related infections like HIV. Aim To reduce NSI among nurses (NO) and health care assistants (HCA) in the NHSL, by assessing the current gaps in the Knowledge, attitude and practice and designing intervention to mitigate the harm and reduce the injuries. Method An Interventional study was conducted in three components, pre-interventional, interventional and post interventional. Random sampling technique was applied to select the appropriate number of nurses and health care assistants. Pre-interventional component: To identify the gaps in the present managerial practices on NSI, a pre-tested structured questionnaire on knowledge, attitude and practices was administered. Interventional component: Two separate in-service programmes were conducted for both categories. WHO recommended injection safety tool kit was also introduced. Post-interventional component: Outcome of the interventions were assessed by measuring the pre- and post-test knowledge, attitude, and practice of the same participants. The same tool was administered. Results Both Groups (NO and HCA) showed a highly significance different after interventions, on Reporting system for NSI: p value (0.05, 0.001). Awareness on Post Exposure prophylaxis (0.003, 0.049). Non–significance difference among nursing officers on Knowledge attitude and practice. All the p values observed 0.05 < and z evident with negative findings. Only Knowledge component among the HCA indicates a significant difference. Conclusion and recommendation It was recommended to conduct more awareness programs and training modules on post exposure management of NSI because it has shown positive Results in both categories. WHO injection safety tool kit has also shown positive Results.
-
War Psychiatry: Identifying and Managing the Neuropsychiatric Consequences of Armed Conflicts.War refugees and veterans have been known to frequently develop neuropsychiatric conditions including depression, post-traumatic stress disorder (PTSD), and anxiety disorders that tend to leave a long-lasting scar and impact their emotional response system. The shear stress, trauma, and mental breakdown from overnight displacement, family separation, and killing of friends and families cannot be described enough. Victims often require years of mental health support as they struggle with sleep difficulties, recurring memories, anxiety, grief, and anger. Everyone develops their coping mechanism which can involve dependence and long-term addiction to alcohol, drugs, violence, or gambling. The high prevalence of mental health disorders during and after the war indicates an undeniable necessity for screening those in need of treatment. For medical health professionals, it is crucial to identify such vulnerable groups who are prone to developing neuropsychiatric morbidities and associated risk factors. It is pivotal to develop and deploy effective and affordable multi-sectoral collaborative care models and therapy, which primarily depends upon family and primary care physicians in the conflict zones. Herein, we provide a brief overview regarding the identification and management of vulnerable populations, alongside discussing the challenges and possible solutions to the same.
-
Using peer-to-peer induction to improve the confidence of incoming surgical fy1s during changeoverAim The benefits of peer-led teaching are well evidenced, as are the benefits of interactive over passive learning in a clinical setting. This project aimed to create an FY1-led induction model that could be reproduced across departments, cost-effectively boosting junior trainee confidence, and improving continuity of care during quarterly changeover periods with minimal pressure on senior clinicians. Method Areas for focus were identified by consultants and departing FY1s to produce an FY1-led, presentation-based induction for December and April changeovers. Incoming FY1 confidence was assessed using pre-induction and post-induction surveys to identify areas for improvement in future. An interactive e-learning induction replaced the presentation for the new FY1s in August, again using surveys assessing trainee’s confidence versus previous cycles. Results The first two inductions both showed a complete reduction in trainees rating themselves overall ‘not so confident' or below. Four of the six targeted areas showed increased improvement in confidence in April versus December. The August e-learning induction showed a 71% increase in newly qualified FY1s rating themselves as overall ‘confident’ or ‘very confident’, an improvement on previous inductions. ‘Confident’ and ‘very confident’ ratings for focused areas increased by 62% on average, versus 37% and 27% previously. Conclusions This induction greatly increased FY1s’ confidence, with feedback citing peer-gained insights as the main positive addition to the consultant-led induction. Combining the evidence-based methods of peer-led teaching and interactive e-learning resulted in a replicable, cost-effective, and time-efficient template for improving confidence and continuity of care in the changeover period. This could be implemented in any department nationwide.
-
Feasibility of using QR code for registration & evaluation of training and its ability to increase response rate - The learners' perception.Taking learners' attendance and obtaining an evaluation of teaching is a routine activity performed by teachers. The traditional method of taking attendance using pen and paper posed a huge challenge during the COVID-19 pandemic. This has been time-consuming as compared to pre-COVID as well as frustrating for learners waiting in a queue for their turn to sign the register. Quick Response (QR) Codes were used to complete registration to buy back the time consumed using traditional methods of registration. Learners' evaluations are used as an instrument to evaluate teaching quality. At the researcher's workplace, a traditional paper-based evaluation method has been used for decades. However, over time a significant decrease in the response rate of evaluations was noticed. The pandemic provided an opportunity of using QR Codes to obtain learners' evaluation of teaching quality. This study assessed the learners' perception of using QR Codes for registration and evaluation, and the likelihood of learners completing the evaluation surveys, thus increasing the response rate. Participants of the study were asked to complete an electronic survey to help assess their perception of using QR Codes and a comparison was made between the responses gathered using paper-based evaluations over 5 months and QR Code evaluations over the same 5 months in the following year. The results of this study demonstrate that using QR Codes for registration and evaluation is easy and straightforward, thus increasing the likelihood of learners completing the evaluation. The comparison between paper-based and QR Code evaluations confirms that a substantial increase in response rate can be achieved by using QR Code evaluations.
