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This Quality Improvement Project (QIP) was undertaken within a Liaison Psychiatry (LP) department at a district general hospital in North West London. The current service model has LP nurses and junior doctors providing first contact with patients, and subsequently discussing assessments with the team psychiatrists. A need for effective communication when presenting clinical cases has emerged given high rates of staff turnover. The aims of this QIP were; (1) To assess the quality of presentations within the multidisciplinary team (2) to deliver a targeted teaching session focused on frameworks for assessment presentation and (3) to evaluate the effectiveness of the intervention.
The ‘SBAR: Situation, Background, Assessment, Recommendation’ communication tool already used widely within healthcare was adapted for LP by an MDT including doctors, senior nurses and pharmacist.
A survey was designed with MDT input to collect data about the content of presentations using adapted Likert scales, a quantitative global score and qualitative data highlighting areas for improvement. Over two weeks, senior team members completed surveys for every patient discussion.
A targeted teaching session was delivered on the adapted LP SBAR including: presenting complaint, current medical issues, referral question, psychiatric background, mental state examination, delirium/cognitive screening, risk assessment, impression and management plan. The session included breakout groups with clinical vignettes to practice presenting. All team members filled in a pre- and post-intervention surveys rating their confidence in presenting assessments and received copies of teaching materials.
Data were collected over a 2-week period post-intervention using the same methodology as pre-intervention. Post-intervention data were presented to the MDT and feedback was sought for improvement in the next cycle.
Pre-intervention data (n=30) indicated a risk assessment, impression and plan were often missed from presentations.
Following targeted teaching, team members felt more confident presenting assessments, formulating impressions, and management plans. Post-intervention data (n=22) showed an improvement in inclusion of all key information covered in the LP SBAR except management plans. The percentage of presentations with a global score ≥7 increased from 41% to 57%.
This ‘Plan, Do, Study, Act’ cycle has modestly improved the quality of assessment presentations within LP and has identified a critical need for communication tools within LP. We will perform another cycle in February 2023 given the high turnover of staff and continue to seek feedback from the MDT on the effectiveness of this targeted teaching session to continue to improve the presentation of assessments in LP.
This issue contains assessments of battery performance involving complex, interrelated physical and chemical processes between electrode materials and electrolytes. Transformational changes in battery technologies are critically needed to enable the effective use of renewable energy sources such as solar and wind to allow for the expansion of hybrid electric vehicles (HEVs) to plug-in HEVs and pure-electric vehicles. For these applications, batteries must store more energy per unit volume and weight, and they must be capable of undergoing many thousands of charge-discharge cycles. The articles in this theme issue present details of several growing interest areas, including high-energy cathode and anode materials for rechargeable Li-ion batteries and challenges of Li metal as an anode material for Li batteries. They also address the recent progress in systems beyond Li ion, including Li-S and Li-air batteries, which represent possible next-generation batteries for electrical vehicles. One article reviews the recent understanding and new strategies and materials for rechargeable Mg batteries. The knowledge presented in these articles is anticipated to catalyze the design of new multifunctional materials that can be tailored to provide the optimal performance required for future electrical energy storage applications.
High-energy cathode materials with high working potential and/or high specific capacity are desired for future electrification of vehicles. In this article, we provide a general overview of advanced high-energy cathode materials using different approaches such as core-shell, concentration-gradient materials, and the effects of nanocoatings at the particle level to improve both electrochemical performance and safety. We also summarize the methods used to prepare these materials. Special attention is placed on the co-precipitation process for making dense, spherical particles for the purpose of improving the powder packing density and increasing the electrode energy density.
Li4+xTi4O12 and Li1-yMn2O4 materials have been respectively prepared by a chemical lithiation of Li4Ti4O12 in the presence of an excess of butylithium (LiC4H9) in hexane solution and chemical delithiation of LiMn2O4 spinel using NO2BF4 oxidizer in an acetonitrile medium. The thermal gravimetric results show that Li1-yMn2O4 releases oxygen starting from 200°C with an overall oxygen loss of 6 wt% at 500 °C, whereas Li4+xTi4O12 gains oxygen starting from 200 °C with an overall oxygen gain of 4 wt % at 500 °C. The reactivity of the Li4+xTi4O12 and Li1-yMn2O4 powders in the presence of electrolytes was investigated by a differential scanning calorimetry (DSC) between room temperature and 375°C, and compared to a lithiated graphite in the case of the Li4+xTi4O12 negative electrode material.
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