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The aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.
Collected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.
Reassessed and fedback to the trainees throughout.
Our baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.
We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.
From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.
• Trainees must be central to the work in improving their training
• Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan
• Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses
• Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes
• Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central role
We hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.
The COVID pandemic has had both a massive impact on clinical service delivery and the way that training and education is provided. CNWL is a large NHS provider and has approximately 7000 staff working across 150 locations, providing mental health and community health services. In response to the need to share learning across the organisation, a trustwide “Safety Conversation Day” took place to spotlight the work being done to promote safety and to act as a platform to share ideas and learning across the trust. This was the first ever virtual conference organised by the trust.
The one-day conference included virtual posters and an all-day open access virtual conversation delivered via zoom. The day was divided into 6 safety themes: Safety tools; Safer Environments; Supporting and Involving Staff; Safer use of Medicines; See Think Act and Relational Security; and Prevention is Better than Cure. Frontline staff delivered 5-6 short presentations each hour highlighting new ways of working, quality improvement, local research etc.
Staff were also encouraged to submit posters for the event, with webinars held on how to write a poster held prior to the safety conversation to promote engagement. Prizes were awarded for best posters in the different categories.
A mentimeter survey was running throughout the day to get feedback from participants.
This was the largest event of this kind held by the trust. 430 unique viewers logged in during the day to watch the presentations.
Feedback was very positive on the mentimeter survey. 3 questions were asked on a likert scale of: Strongly Disagree – Strongly Agree (rated out of 5):
– ‘I found the posters really useful': 4.5/5
– ‘I found the presentations very useful': 4.6/5
– ‘I will share what I've learnt about safety': 4.6/5
Open space questions and word cloud responses also highlighted qualitative feedback with most frequent responses including ‘inspiring', ‘interesting and ‘stimulating’.
174 posters were presented with good representation from all services and staff groups across the trust (18 on safer use of medicines, 15 on co-production, 52 on quality improvement, 50 on COVID and non-COVID safety, 16 on use of technology, 23 on supporting and involving staff). These posters have since been downloaded 4062 times.
The first CNWL safety conference proved an excellent opportunity to celebrate achievements in patient safety in a very difficult year. It was very well-received and well-attended by staff, promoting maximal learning across the organisation.
Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population.
The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials.
The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner.
Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients.
Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI.
We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence.
A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%.
The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.
This chapter provides a summary about of what is and is not known about interpersonal emotion dynamics. It draws heavily from the other chapters in the book, focusing on integrating themes and gaps in the literature that emerge when considering the other chapters. Open theoretical questions are highlighted, anomalies and contradictions in the empirical results are noted, and methodological limitations and potential solutions are pointed out.
Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women.
The Information–Motivation–Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial.
Pietermaritzburg, South Africa, at two comparable rural public health service clinics.
Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum.
While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm.
Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour.
Created in London c. 1340, the Auchinleck manuscript (Edinburgh, National Library of Scotland Advocates MS 19.2.1) is of crucial importance as the first book designed to convey in the English language an ambitious range of secular romance and chronicle. Evidently made in London by professional scribes for a secular patron, this tantalizing volume embodies a massive amount of material evidence as to London commercial book production and the demand for vernacular texts in the early fourteenth century. But its origins are mysterious: who were its makers? its users? how was it made? what end did it serve? The essays in this collection define the parameters of present-day Auchinleck studies. They scrutinize the manuscript's rich and varied contents; reopen theories and controversies regarding the book's making; trace the operations and interworkings of the scribes, compiler, and illuminators; tease out matters of patron and audience; interpret the contested signs of linguisticand national identity; and assess Auchinleck's implied literary values beside those of Chaucer. Geography, politics, international relations and multilingualism become pressing subjects, too, alongside critical analyses of literary substance.
Susanna Fein is Professor of English at Kent State University (Kent, Ohio) and editor of The Chaucer Review.
Contributors: Venetia Bridges, Patrick Butler, Siobhain Bly Calkin, A. S. G. Edwards, Ralph Hanna, Ann Higgins, Cathy Hume, Marisa Libbon, Derek Pearsall, Helen Phillips, Emily Runde, Timothy A. Shonk, M-l F. Vaughan.