The transition between Core Psychiatry Training (CPT) and Psychiatry HTs is often anxiously anticipated by trainee psychiatrists, in view of the heightened responsibility and increased demand faced by trainees. The author wrote and delivered a one-day simulation induction course for newly appointed CAMHS HTs across London. The aim of this course was to improve participant's confidence, skills and knowledge in managing a range of conditions and challenging scenarios in children and young people (CYP) presenting to CAMHS. The course was also designed to improve HT's confidence in supporting junior colleagues and in managing conflict resolution. There was also an overarching aim of increasing human factor skills by focusing on these within the scenarios and debriefs.

The simulation training was delivered online and consisted of five scenarios commonly faced by CAMHS SPRs based in a variety of settings. Themes within the scenarios included eating disorders and deliberate self-harm, as well as managing risk, multiple demands, and the psychosocial factors contributing to mental illness. Professional actors, plants and virtual backgrounds were used to enhance fidelity of the scenarios. Platform orientation and an introduction to simulation were initially provided followed by “ice breaker” activities, which were used to promote psychological safety amongst participants. Each scenario lasted approximately 10 minutes. Following each scenario, participants were supported to engage in a debrief using the Maudsley Debrief model. Pre- and post-course evaluation questionnaires were given to participants to complete and comparative analysis was conducted.

Seven participants completed both the pre- and post- course evaluation questionnaires. The mean sum score for course specific questions was 51.86 (SD = 9.56) pre course, and 68.00 (SD = 10.08) post course, showing a 31.12% increase in knowledge, skills, and confidence across the course specific domains.

The mean sum score for the Human Factors Skills for Healthcare Instrument (HFSHI) was 76.67 (SD = 17.26) pre course, and 86.50 (SD = 16.54) post course, showing a 12.82% increase in human factors skills.

This simulation course demonstrated it is an effective and innovative way to help with induction for HT, resulting in an increase in knowledge, skills and confidence in trainees transitioning from CPT to HT, both in terms of factors specific to managing CYP's care and in relation to broader human factor skills.

Experiential learning, such as simulation-based training, is widely used in health education. Dramatic self-expression adds another layer through enacted perspective taking, and embodied self-exploration of interaction with others, to foster situated learning. We describe the evaluation of an innovative drama-based experiential learning project involving collaboration between multidisciplinary mental healthcare staff and people with lived experience of mental illness. The programme was facilitated at East London NHS Foundation Trust by a theatre company experienced in delivering workshops with service users. A weekly group programme took place online over 8 weeks during the COVID-19 pandemic and included activities of improvisation, embodied enactments and debriefing. The programme led to co-production of a drama piece that was filmed and distributed online. It was hypothesised that the experiential learning might result in individual benefits for all participants, such as improved well-being and increased mutual understanding of each other's experience of mental health care. The project aimed to improve relationships between healthcare disciplines, and between staff and service users. Additionally, aims were to empower service users, and support staff to practice core interpersonal skills. Objectives of the evaluation were to study the impact of the experiential learning, understand participants’ experience, and explore challenges and benefits.

A mixed methods approach was taken to evaluate the programme. Following completion of the project, participants were invited to complete a questionnaire utilising a Likert scale rating of overall satisfaction with the project, perceived benefit and impact on specific domains such as working with others. One-to-one semi-structured interviews were conducted according to a topic-guide, and qualitative data were analysed using open & axial coding for thematic analysis.

11 participants, including Psychiatrists, Occupational Therapists and current service users, completed the experiential learning and filming. Questionnaire data suggested participants were highly satisfied with the learning and felt it would be valuable to others. Themes include the positive experience of creativity, dismantling of hierarchy, improved empathy, confidence and connection. Potential challenges were digital inequality and lack of dedicated time for professional development.

A drama-based experiential learning group programme for healthcare staff and service users is a highly beneficial learning experience. Participants describe changes on a personal level as well as improved understanding of others’ perspectives. This form of experiential learning features collaborative working that aligns with principles of co-production and supports the development of interpersonal skills; the findings suggest that drama-based experiential learning is a useful method in health education to complement knowledge acquisition.

Effective incident management is essential for coordinating efforts of multiple disciplines and stakeholders when responding to emergencies, including public health disasters such as the ongoing coronavirus disease 2019 (COVID-19) pandemic.

Existing research frameworks tend to focus on formal structures and doctrine (eg, ICS-NIMS); however, organizational processes that underlie incident management have not been systematically assessed and synthesized into a coherent conceptual framework.

The lack of a framework has hindered the development of measures of performance that could be used to further develop the evidence base and facilitate process improvement. To address this gap, we present a conceptual framework of incident management drawn from expert feedback and a review of literature on incident management and related fields. The framework features 23 measurement constructs grouped into 5 domains: (1) situational awareness and information sharing, (2) incident action and implementation planning, (3) resource management and mobilization, (4) coordination and collaboration, and (5) feedback and continuous quality improvement.

As such, the article provides a first step toward the development of robust measures for assessing the performance and effectiveness of incident management systems.

Arsenic, lead and mercury are common environmental contaminants in low- and middle-income countries. We investigated the association between child toxicant exposure and growth and development and determined if this association was mitigated by selenium concentration.

Toxicant concentrations in fingernail samples, anthropometry, and Bayley’s Scales of Infant Development, 3rd edition (BSID) domains were assessed in 36-month-old children whose mothers had been part of a randomised controlled trial in rural Vietnam. Multivariable regression analyses were performed to estimate the effect of toxicant exposure on clinical outcomes with adjustments for potential confounders and interaction with fingernail selenium concentration.

We analysed 658 children who had data for at least one physical or developmental outcome, and at least one toxicant measurement, and each of the covariates. Fingernail arsenic concentration was negatively associated with language (estimate per 10% increase in arsenic: −0.19, 95% CI: [−0.32, −0.05]). Lead was negatively associated with cognition (estimate per 10% increase in lead: −0.08 [−0.15, −0.02]), language (estimate per 10% increase in lead: −0.18 [−0.28, −0.10]), and motor skills (estimate per 10% increase in lead: −0.12 [−0.24, 0.00]). Mercury was negatively associated with cognition (estimate per 10% increase in mercury: −0.48, [−0.72, −0.23]) and language (estimate per 10% increase in mercury −0.51, [−0.88, −0.13]) when selenium concentration was set at zero in the model. As selenium concentration increased, the negative associations between mercury and both cognition and language scores were attenuated. There was no association between toxicant concentration and growth.

Arsenic, lead and mercury concentrations in fingernails of 3-year-old children were associated with lower child development scores. The negative association between mercury and neurological development was reduced in magnitude with increasing selenium concentration. Selenium status should be considered when assessing heavy metal toxicants in children and their impact on neurodevelopmental outcomes.

Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.

To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.

We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.

The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.

In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.

Many triage algorithms exist for use in mass-casualty incidents (MCIs) involving pediatric patients. Most of these algorithms have not been validated for reliability across users.

Investigators sought to compare inter-rater reliability (IRR) and agreement among five MCI algorithms used in the pediatric population.

A dataset of 253 pediatric (<14 years of age) trauma activations from a Level I trauma center was used to obtain prehospital information and demographics. Three raters were trained on five MCI triage algorithms: Simple Triage and Rapid Treatment (START) and JumpSTART, as appropriate for age (combined as J-START); Sort Assess Life-Saving Intervention Treatment (SALT); Pediatric Triage Tape (PTT); CareFlight (CF); and Sacco Triage Method (STM). Patient outcomes were collected but not available to raters. Each rater triaged the full set of patients into Green, Yellow, Red, or Black categories with each of the five MCI algorithms. The IRR was reported as weighted kappa scores with 95% confidence intervals (CI). Descriptive statistics were used to describe inter-rater and inter-MCI algorithm agreement.

Of the 253 patients, 247 had complete triage assignments among the five algorithms and were included in the study. The IRR was excellent for a majority of the algorithms; however, J-START and CF had the highest reliability with a kappa 0.94 or higher (0.9-1.0, 95% CI for overall weighted kappa). The greatest variability was in SALT among Green and Yellow patients. Overall, J-START and CF had the highest inter-rater and inter-MCI algorithm agreements.

The IRR was excellent for a majority of the algorithms. The SALT algorithm, which contains subjective components, had the lowest IRR when applied to this dataset of pediatric trauma patients. Both J-START and CF demonstrated the best overall reliability and agreement.