Manchester Clinical Research Articles

Satisfaction with supervision of healthcare workers in relation to job satisfaction and selected characteristics of supervision

Aim: The aim of the study was to find out whether there was a correlation between satisfaction with supervision and job satisfaction among healthcare workers, and, in addition, whether there is a correlation between satisfaction with supervision and selected demographic data. Design: Cross-sectional study. Methods: The research sample consisted of staff in healthcare facilities who took care of patients / clients, and underwent supervision (n = 234). The McCloskey / Mueller Satisfaction Scale and Manchester Clinical Supervision Scale questionnaires were used. Results: In the case of job satisfaction, a statistically significant correlation was demonstrated between the effectiveness of the provided supervision and level of job satisfaction. When comparing selected demographic characteristics, a significant difference was demonstrated between satisfaction with supervision of psychiatric staff and hospice care staff. No statistically significant difference between the groups of respondents was demonstrated in satisfaction with supervision according to level of education. Conclusion: Our research demonstrated a correlation between satisfaction with supervision and job satisfaction. Satisfaction with supervision, in turn, depends on the workplace of the respondents. It is important to further educate staff in this area and promote the benefits of supervision in nursing practice.

MANCHESTER CLINICAL PLACEMENT INDEX (MCPI) AS CLINICAL LEARNING ENVIRONMENT ASSESSMENT TOOL: ADAPTATION INTO INDONESIAN LANGUAGE

Background: Clinical Learning Environment (CLE) involves many active dynamics, perceptions construction, learners' experiences, and behavior while learning. It includes every human resource working and learning together, a health system, and communities. Standard assessment of CLE is essential to evaluate CLE. The Manchester Clinical Placement Index (MCPI) assesses the CLE based on Community of Practice Theory, emphasizing learning according to experience-based learning. Translation of the MCPI into the Indonesian language will be valuable to assess the CLE. This research intends to translate and adapt MCPI into the Indonesian language. Therefore, MCPI can be used to assess the CLE in Indonesian medical schools.Methods: An expert panel translated the MCPI into the Indonesian language (I-MCPI), and a language learning center validated the translation. Participants who were final year students (N: 155) filled up the online I-MCPI after the informed consent. To assess the I-MCPI validity, we performed exploratory factor analysis (EFA) and item discrimination. To seek reliability, we utilized internal consistency reliability showing as the Cronbach's alpha coefficient.Results: The factor analysis and item discrimination showed the I-MCPI's validity. We found two subscales similar to the original MCPI. Leadership, reception, people, facilities, and organization have similar correlation strength to Subscale Learning Environment (0.60-0.71). Instruction and observation have similar correlation strength to Subscale Training (0.86-0.89). Subscale feedback correlates less than 0.60 for both subscales; thus, we concluded that feedback went to the subscale Training as the original MCPI. Reliability of the I-MCPI showed an excellent internal consistency with Cronbach's alpha of 0.87.Conclusion: I-MCPI is a valid and reliable tool to assess the CLE. Further research with broader cohorts of medical schools will be valuable for advancing medical education in Indonesia.

The expression and activity of Toll-like receptors in the preimplantation human embryo suggest a new role for innate immunity.

STUDY QUESTIONIs the innate immunity system active in early human embryo development?SUMMARY ANSWERThe pattern recognition receptors and innate immunity Toll-like receptor (TLR) genes are widely expressed in preimplantation human embryos and the pathway appears to be active in response to TLR ligands.WHAT IS KNOWN ALREADYEarly human embryos are highly sensitive to their local environment, however relatively little is known about how embryos detect and respond to specific environmental cues. While the maternal immune response is known to be key to the establishment of pregnancy at implantation, the ability of human embryos to detect and signal the presence of pathogens is unknown.STUDY DESIGN, SIZE, DURATIONExpression of TLR family and related genes in human embryos was assessed by analysis of published transcriptome data (n = 40). Day 5 (D-5) human embryos (n = 25) were cultured in the presence of known TLR ligands and gene expression and cytokine production measured compared to controls.PARTICIPANTS/MATERIALS, SETTING, METHODSHuman embryos surplus to treatment requirements were donated with informed consent from several ART centres. Embryos were cultured to Day 6 (D-6) in the presence of the TLR3 and TLR5 ligands Poly (I: C) and flagellin, with gene expression measured by quantitative PCR and cytokine release into medium measured using cytometric bead arrays.MAIN RESULTS AND THE ROLE OF CHANCETLR and related genes, including downstream signalling molecules, were expressed variably at all human embryo developmental stages. Results showed the strongest expression in the blastocyst for TLRs 9 and 5, and throughout development for TLRs 9, 5, 2, 6 and 7. Stimulation of Day 5 blastocysts with TLR3 and TLR5 ligands Poly (I: C) and flagellin produced changes in mRNA expression levels of TLR genes, including the hyaluronan-mediated motility receptor (HMMR), TLR5, TLR7, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and monocyte chemoattractant Protein-1 (MCP-1) (P < 0.05, P < 0.001 compared to unstimulated controls), and release into culture medium of cytokines and chemokines, notably IL8 (P = 0.00005 and 0.01277 for flagellin and Poly (I: C), respectively).LIMITATIONS, REASONS FOR CAUTIONThis was a descriptive and experimental study which suggests that the TLR system is active in human embryos and capable of function, but does not confirm any particular role. Although we identified embryonic transcripts for a range of TLR genes, the expression patterns were not always consistent across published studies and expression levels of some genes were low, leaving open the possibility that these were expressed from the maternal rather than embryonic genome.WIDER IMPLICATIONS OF THE FINDINGSThis is the first report of the expression and activity of a number of components of the innate immunity TLR system in human embryos. Understanding the role of TLRs during preimplantation human development may be important to reveal immunological mechanisms and potential clinical markers of embryo quality and pregnancy initiation during natural conception and in ART.STUDY FUNDING/COMPETING INTEREST(S)This work was funded by the Ministry of Higher Education, The State of Libya, the UK Medical Research Council, and the NIHR Local Comprehensive Research Network and NIHR Manchester Clinical Research Facility and the European Union’s Horizon 2020 Research and Innovation Programmes under the Marie Skłodowska-Curie Grant Agreement No. 812660 (DohART-NET). In accordance with H2020 rules, no new human embryos were sacrificed for research activities performed from the EU funding, which concerned only in silico analyses of recorded time-lapse and transcriptomics datasets. None of the authors has any conflict of interest to declare.TRIAL REGISTRATION NUMBERn/a.

Integrated miRNA/Cytokine/Chemokine Profiling Reveals Severity-Associated Step Changes and Principal Correlates of Fatality in COVID-19

Inflammatory cytokines and chemokines (CC) drive COVID-19 pathology. Yet, patients with similar circulating CC levels present with different disease severity. Here, we determined 171 microRNAomes from 58 hospitalised COVID-19 patients (Cohort 1) and levels of 25 cytokines and chemokines (CC) in the same samples. Combining microRNA (miRNA) and CC measurements allowed for discrimination of severe cases with greater accuracy than using miRNA or CC levels alone. Severity group-specific associations between miRNAs and COVID-19-associated CC (e.g. IL6, CCL20) or clinical hallmarks of COVID-19 (e.g. neutrophilia, hypoalbuminemia) separated patients with similar CC levels but different disease severity. Critically, analysis of an independent cohort of 108 patients from a different centre (Cohort 2) demonstrated feasibility of CC/miRNA profiling in leftover blood samples with similar severe disease CC and miRNA profiles, and revealed CCL20, IL6, IL10, and miR-451a as key correlates of fatal COVID-19. These findings highlight that systemic miRNA/CC networks underpin severe COVID-19.Funding: The study was funded by the UKRI MRC/NIHR award to the UK Coronavirus Immunology Consortium (UK-CIC, MR/V028448/1). Sample collection at Manchester NHS Trusts was supported by the NIHR Manchester Biomedical Research Centre (TH and AS) and 3M Global Giving award (JRG and TH). Sample collection at York and Scarborough NHS Trust was supported by the Wellcome Trust (ISSF grant WT204829 through the Centre for Future Health at the University of York) and the Hull York Medical School. JRG is supported by a senior fellowship by The Kennedy Trust for Rheumatology Research. This report contains independent research supported by the North West Lung Centre Charity and the NIHR Manchester Clinical Research Facility at Wythenshawe Hospital.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: For the cohort 1, ethics approval was obtained from the North West-Haydock Research Ethics Committee for ManARTS (reference 15/NW/0409) and from the Wales Research Ethics Committee 4 for NCARC (reference 18/WA/0368). For the cohort 2, ethics approval was obtained from Yorkshire & The Humber - Leeds West Research Ethics Committee (REC reference 19/YH/0394 with approved 26 SA002 amendment of IRAS project 269597).

Improvement in the Short-Term Effectiveness of the Clinical Supervision of Physiotherapists Who Have Taken Part in a Clinical Supervision Training Programme.

Purpose: The purpose of this study was to evaluate change in the effectiveness of clinical supervision of physiotherapists who took part in a clinical supervision training programme. Method: Our pre-post study design used both quantitative and qualitative methods. The programme consisted of three interactive sessions held with physiotherapists from a metropolitan public health network in Melbourne, Victoria, Australia. The effectiveness of clinical supervision of supervisees was measured using the Manchester Clinical Supervision Scale (MCSS-26). The effectiveness of clinical supervision from the supervisors' perspective was measured using a clinical supervisor questionnaire. The physiotherapists' experience of participating in the training programme was then explored in focus groups. Results: A total of 36 physiotherapists participated in the training programme. Twelve weeks later, the physiotherapists (35) reported a moderate improvement in the effectiveness of clinical supervision, with a mean improvement of 5.4 units (95% CI: 2.0, 8.9; p=0.003) on the MCSS-26 (score range 0-104). After training, a higher proportion of physiotherapists reported receiving effective clinical supervision (97% after vs. 53% before; p=0.001). In the focus groups, the physiotherapists reported greater flexibility in their approach to clinical supervision and a more effective supervisory relationship. However, difficulty finding time for supervision remained a barrier. Conclusions: Physiotherapists reported an improvement in the effectiveness of clinical supervision after a clinical supervision training programme.

Clinical supervision in a high secure hospital: a service evaluation

Few environments demand a higher level of emotional competences than forensic care settings, and the importance of clinical supervision to mitigate against the risks of such an environment cannot be underestimated. This paper explores the efficacy of clinical supervision provided to nursing staff within a high secure hospital using the Manchester Clinical Supervision Scale. Results indicated that the nursing workforce were overall very satisfied with their clinical supervision, specifically clinical team leaders are most likely to be very satisfied. Results also showed the significance of time: clinical supervision is more effective when it lasts between 30–60 minutes, but correspondingly, time is one of the key barriers to accessing clinical supervision.

Long-Lasting Alterations in T and B Cell Function in Convalescent COVID-19 Patients

Emerging studies indicate that some COVID-19 patients suffer from persistent symptoms including breathlessness and chronic fatigue; however the long-term immune response in these patients presently remains ill-defined. Here we describe the phenotypic and functional characteristics of B and T cells in healthy individuals and individuals with acute or convalescent COVID-19. We report that the alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients. In contrast, T cells from convalescent patients displayed long-term alterations with persistence of a cytotoxic programme evident in CD8+ T cells as well as elevated production of type-1 cytokines and IL-17. Interestingly, B cells from patients with acute COVID-19 displayed an IL-6/ IL-10 cytokine imbalance in response to toll-like receptor activation, skewed towards a pro-inflammatory phenotype. Whereas the frequency of IL-10+ B cells was restored in a subset of convalescent patients, IL-6 production remained elevated. Our data are the first to define long-term alterations in the lymphocyte compartment of previously hospitalized COVID-19 patients, at up to 19 weeks of convalescence, and identify 3 subgroups of convalescent patients based on distinct lymphocyte phenotypes. We propose that alterations in B and T cell function following hospitalisation with COVID-19 could impact long-term immunity and contribute to some persistent symptoms observed in convalescent COVID-19 patients.Funding: This study was funded by the BBSRC (BB/M025977/1 to JEK, BB/S01103X/1 to TNS), by the Lister Institute (Prize Fellowship to JEK), by PTDF (SHS/1327/18 to HAS), The Wellcome Trust (202865/Z/16/Z to TH), The Kennedy Trust for Rheumatology Research (Rapid Response Award to JRG) and Versus Arthritis (FAM and JEK studentship). This report is independent research supported by the North West Lung Centre Charity and the NIHR Manchester Clinical Research Facility at Wythenshawe Hospital. We acknowledge the Manchester Allergy, Respiratory and Thoracic Surgery Biobank for supporting this project and thank the study participants for their contribution. Ethical Approval: Ethical approval obtained from the National Research Ethics Service (REC reference 15/NW/0409 for ManARTS and 18/WA/0368 for NCARC). Informed consent was obtained from each patient, clinical information was extracted from written/electronic medical records including demographic data, presenting symptoms, comorbidities, radiographic findings, vital signs, and laboratory data.Declaration of Interest: None to declare.

Mammographic density change in a cohort of premenopausal women receiving tamoxifen for breast cancer prevention over 5 years

BackgroundA decrease in breast density due to tamoxifen preventive therapy might indicate greater benefit from the drug. It is not known whether mammographic density continues to decline after 1 year of therapy, or whether measures of breast density change are sufficiently stable for personalised recommendations.MethodsMammographic density was measured annually over up to 5 years in premenopausal women with no previous diagnosis of breast cancer but at increased risk of breast cancer attending a family-history clinic in Manchester, UK (baseline 2010-2013). Tamoxifen (20 mg/day) for prevention was prescribed for up to 5 years in one group; the other group did not receive tamoxifen and were matched by age. Fully automatic methods were used on mammograms over the 5-year follow-up: three area-based measures (NN-VAS, Stratus, Densitas) and one volumetric (Volpara). Additionally, percentage breast density at baseline and first follow-up mammograms was measured visually. The size of density declines at the first follow-up mammogram and thereafter was estimated using a linear mixed model adjusted for age and body mass index. The stability of density change at 1 year was assessed by evaluating mean squared error loss from predictions based on individual or mean density change at 1 year.ResultsAnalysis used mammograms from 126 healthy premenopausal women before and as they received tamoxifen for prevention (median age 42 years) and 172 matched controls (median age 41 years), with median 3 years follow-up. There was a strong correlation between percentage density measures used on the same mammogram in both the tamoxifen and no tamoxifen groups (all correlation coeficients > 0.8). Tamoxifen reduced mean breast density in year 1 by approximately 17–25% of the inter-quartile range of four automated percentage density measures at baseline, and from year 2, it decreased further by approximately 2–7% per year. Predicting change at 2 years using individual change at 1 year was approximately 60–300% worse than using mean change at 1year.ConclusionsAll measures showed a consistent and large average tamoxifen-induced change in density over the first year, and a continued decline thereafter. However, these measures of density change at 1 year were not stable on an individual basis.

Physiotherapists Prefer Clinical Supervision to Focus on Professional Skill Development: A Qualitative Study.

Purpose: We explored physiotherapists' perceptions of clinical supervision. Method: Individual semi-structured interviews were conducted with a purposive sample of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS-26) was administered to evaluate the participants' perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.

The effects of hyaluronate-containing medium on human embryo attachment to endometrial epithelial cells in vitro.

STUDY QUESTIONDoes embryo transfer medium containing hyaluronate (HA) promote the attachment phase of human embryo implantation?SUMMARY ANSWERHA-containing medium does not promote human blastocyst attachment to endometrial epithelial cells in vitro.WHAT IS KNOWN ALREADYEmbryo transfer media containing high concentrations of HA are being used to increase implantation and live birth rates in IVF treatment, although the mechanism of action is unknown.STUDY DESIGN, SIZE, DURATIONExpression of HA-interacting genes in frozen-thawed oocytes/embryos was assessed by microarray analysis (n = 21). Fresh and frozen human blastocysts (n = 98) were co-cultured with human endometrial epithelial Ishikawa cell layers. Blastocyst attachment and the effects of a widely used HA-containing medium were measured.PARTICIPANTS/MATERIALS, SETTING, METHODSHuman embryos surplus to treatment requirements were donated with informed consent from several ART centres. Blastocyst-stage embryos were transferred at day 6 to confluent Ishikawa cell layers; some blastocysts were artificially hatched. Blastocyst attachment was monitored from 1 to 48 h, and the effects of blastocyst pre-treatment for 10 min with HA-containing medium were determined.MAIN RESULTS AND THE ROLE OF CHANCEHuman embryos expressed the HA receptor genes CD44 and HMMR, hyaluronan synthase genes HAS1–3, and hyaluronidase genes HYAL1–3, at all stages of preimplantation development. Attachment of partially hatched blastocysts to Ishikawa cells at 24 and 48 h was related to trophectoderm grade (P = 0.0004 and 0.007, respectively, n = 34). Blastocysts of varying clinical grades that had been artificially hatched were all attached within 48 h (n = 21). Treatment of artificially hatched blastocysts with HA-containing medium did not significantly affect attachment at early (1–6 h) or late (24 and 48 h) time points, compared with control blastocysts (n = 43).LIMITATIONS, REASONS FOR CAUTIONUsing an adenocarcinoma-derived cell line to model embryo-endometrium attachment may not fully recapitulate in vivo interactions. The high levels of blastocyst attachment seen with this in vitro model may limit the sensitivity with which the effects of HA can be observed.WIDER IMPLICATIONS OF THE FINDINGSMorphological trophectoderm grade can be correlated with blastocyst attachment in vitro. HA-containing medium may increase pregnancy rates by mechanisms other than promoting blastocyst attachment to endometrium.STUDY FUNDING/COMPETING INTEREST(S)This work was funded by a grant from the Wellbeing of Women, the NIHR Local Comprehensive Research Network and NIHR Manchester Clinical Research Facility, the Department of Health Scientist Practitioner Training Scheme, and the Ministry of Higher Education, The State of Libya. None of the authors has any conflict of interest to declare.

Effective clinical supervision of allied health professionals: a mixed methods study

BackgroundClinical supervision is recommended for allied health professionals for the purpose of supporting them in their professional role, continued professional development and ensuring patient safety and high quality care. The aim of this mixed methods study was to explore allied health professionals’ perceptions about the aspects of clinical supervision that can facilitate effective clinical supervision.MethodsIndividual semi-structured interviews were conducted on a purposive sample of 38 allied health professionals working in a metropolitan public hospital. Qualitative analysis was completed using an interpretive description approach. To enable triangulation of qualitative data, a quantitative descriptive survey of clinical supervision effectiveness was also conducted using the Manchester Clinical Supervision Scale (MCSS-26).ResultsThree main themes emerged from qualitative analysis: Allied health professionals reported that clinical supervision was most effective when their professional development was the focus of clinical supervision; the supervisor possessed the skills and attributes required to facilitate a constructive supervisory relationship; and the organisation provided an environment that facilitated this relationship together with their own professional development. Three subthemes also emerged within each of the main themes: the importance of the supervisory relationship; prioritisation of clinical supervision relative to other professional duties; and flexibility of supervision models, processes and approaches to clinical supervision. The mean MCSS-26 score was 79.2 (95%CI 73.7 to 84.3) with scores ranging from 44 to 100. MCSS-26 results converged with the qualitative findings with participants reporting an overall positive experience with clinical supervision.ConclusionsThe factors identified by allied health professionals that influenced the effectiveness of their clinical supervision were mostly consistent among the professions. However, allied health professionals reported using models of clinical supervision that best suited their profession’s role and learning style. This highlighted the need for flexible approaches to allied health clinical supervision that should be reflected in clinical supervision policies and guidelines. Many of the identified factors that influence the effectiveness of clinical supervision of allied health professionals can be influenced by health organisations.

How acceptable is a weight maintenance programme for healthy weight young women who are at increased risk of breast cancer?

Objective: To determine if a weight gain prevention intervention is acceptable to young women with a normal Body Mass Index and a moderately increased or high risk of breast cancer. Design: Qualitative semi-structured interview study involving 14 women aged 26–35 years who were registered with a Family History Clinic in Manchester, UK, due to family history of breast cancer. Participants’ views were analysed thematically. Results: Four themes were produced: (1) perceptions of a healthy lifestyle: women’s perceptions included health-related behaviours and subjective wellbeing; (2) construing a healthy weight: women rely on appearance, feelings and others opinions to construe weight instead of quantitative indicators; (3) configuring a useful programme: the idea of a programme that is remotely accessible; provides a point of contact; and promotes general wellbeing was appealing. Women believed information explaining the link between lifestyle and breast cancer would facilitate behaviour change; (4) the importance of will(power): women recognised that commitment to a programme is affected by time, money and readiness to change. Conclusion: A weight gain prevention intervention that focuses on wellbeing and behaviour change appears acceptable to many healthy weight women. Future research should examine whether women’s expressed acceptability translates into actual acceptability of such a programme.

Predictors of Nurse’s Caring Behavior towards Patients with CriticalIllness

Background: Caring for a critical ill patient are challenges for nurses. The nurse is required to deliver comprehensive nursing care including mental, psychological and physical. Caring behavior of nurse is influenced by several factors both internal and external. Objectives: This study aimed was to examine the relationship between nursing supervision, spirituality, caring efficacy, emotional quotation, work stress and working periods with caring behavior while deliver care for a critical patient.&#x0D; Methods: Cross-sectional design was used with the number of participants were 66 nurses. Data were collected in July 2018 in three wards: emergency room, HCU, and ICU in dr. DradjatPrawiranegara Hospital, Banten. Instruments used were the Spiritual Orientation Inventory questionnaires, Manchester Clinical Supervision Scale, Caring Behavior Assessment, and Caring Efficacy Scale which were modified and tested for validity and reliability. Data were analyzed using multivariate linear regressions.&#x0D; Results: The results showed that there were significant relationships between nursing supervision(r=0.511;p&lt;0.01),spirituality(r=0.448;p&lt;0.01),caringefficacy(r=0.433; p&lt;0.01) and emotional intelligence (r = 0.419; p&lt;0.01) with nurse caring behavior in care critical patients (p&lt;0.001). There was no significant relationship between Work Periodandworkstresswithcaringbehavior(p&gt;0.05).&#x0D; Final statistical analysis by using multiple regression showed that nursing supervision Beta=0.434;p&lt;0.01),spirituality (Beta = 0.312; p&lt;0.01) and caring efficacy (Beta = 0.297; p&lt;0.01) were recognized as predictors of nurse’s caring behavior in care critical patient ward.&#x0D; Conclusion: The Increasing of nursing supervision as an external effort and developing activities are expected to improve spirituality and caring efficacy of nurse is needed to improve nurse’s caring behavior in caring for a critical patient.

The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting

Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients’ outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients’ mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.

Effect of an Educational Program about Clinical Supervision for First Line Nurse Managers on Quality of Their Clinical Supervision An Educational Program about Quality of Clinical Supervision for First Line Nurse Managers

Background: Clinical supervision (CS) is becoming standard practice for health professionals, and has been considered to be an important component of comprehensive clinical governance. Also CS has been promoted as a key clinical governance component to ensure the provision of and accountability for the quality of care provided to patient and to minimize the risk of adverse outcome for patient. Aim: to investigate the effect of an educational program about clinical supervision for first line nurse managers on quality of their clinical supervision. Setting: The study was carried out at Minia University Hospital; Gynecology, Obstetric and Pediatric University Hospitals. Subject: A convience sample of first-line nurse managers' (no.= 50) and staff nurses (no.= 300) were included in the study. Tools: Three tools were used in this study; Clinical supervision knowledge questionnaire, Clinical Supervisor self-assessment questionnaire and Manchester Clinical Supervision Scale (MCSS). Results: The total knowledge score and levels of CS, and its subscales among first line nurse managers were low before the program implementation; after the program implementation they had high scores with statistically significant differences; also the staff nurses perception about first line managers were low before program and became higher after the implementation. Conclusions: statistically significant increase in the knowledge test scores have been found after program implementation and during the different periods of testing. Recommendations: Clinical supervision program should be periodically conducted for all head nurses, integrate the clinical supervision in the philosophy of the hospital, and first line managers should periodically have nursing group meeting to verbalized, vitalize and support peer and social interaction develop supportive working conditions and relationship that encourage trust, empathy and mutual regard; put and identify the work policies and routine in place and allow supervisees to know their limitations.

Clinical supervision and ward orientation predict new graduate nurses’ intention to work in critical care: Findings from a prospective observational study

IntroductionClinical supervision and transitional support programs are important in supporting the successful transition and retention of new graduate nurses and their intention to work in specialty settings. However, little is known about which elements of support programs influence this intention. This study aimed to examine new graduate nurses' perceptions of clinical supervision and the practice environment, and how these influenced their intention to stay in critical and non-critical care areas following their transitional support program. MethodsBetween May 2012 and August 2013, new graduate nurses (n = 87) were surveyed towards the end of their 12-month transitional support program. In addition to demographic and ward details, participants completed the Manchester Clinical Supervision Scale (MCSS) and the Practice Environment Scale Australia (PES-AUS). The ‘Intention to Stay in a Clinical Specialty’ survey was used to measure new graduate nurses’ intention to remain working in their current ward or unit. ResultsPredictors of new graduate nurses' intention to stay in their current ward/unit were not having to practise beyond personal clinical capability (AOR: 4.215, 95% CI: 1.099–16.167) and working in a critical care specialty (AOR: 6.530, 95% CI: 1.911-22.314). Further analysis of those nurses who indicated an intention to remain in critical care revealed that high satisfaction with clinical supervision (AOR: 3.861, 95% CI: 1.320–11.293) and high satisfaction with unit orientation (AOR: 3.629, 95% CI: 1.236–10.659) were significant predictors. ConclusionWhile this study identified that new graduates who worked within their scope of practice were more likely to report their intention to remain in their current ward, new graduates assigned to critical care were six times more likely to indicate their intention to remain than new graduates in other wards/units. Ensuring new graduate nurses assigned to critical care areas receive good unit orientation and clinical supervision increases their intention to remain in this setting.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee's work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.

Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial

BackgroundThe World Health Organisation amongst others recognises the need for the introduction of clinical supervision education in health professional education as a central strategy for improving patient safety and patient care. Online and blended learning methods are growing exponentially in use in higher education and the systematic evaluation of these methods will aid understanding of how best to teach clinical supervision. ObjectiveThe purpose of this study was to test whether undergraduate nursing students who received clinical supervisee skills training via a blended learning approach would score higher in terms of motivation and attitudes towards clinical supervision, knowledge of clinical supervision and satisfaction of learning method, when compared to those students who received an online only teaching approach. DesignA post-test-only randomised controlled trial. MethodsParticipants were a total of 122 pre-registration nurses enrolled at one United Kingdom university, randomly assigned to the online learning control group (n = 60) or the blended learning intervention group (n = 62). The blended learning intervention group participated in a face-to-face tutorial and the online clinical supervisee skills training app. The online learning control group participated in an online discussion forum and the same online clinical supervisee skills training app. The outcome measures were motivation and attitudes using the modified Manchester Clinical Supervision Scale, knowledge using a 10 point Multiple Choice Questionnaire and satisfaction using a university training evaluation tool. Statistical analysis was performed using independent t-tests to compare the differences between the means of the control group and the intervention group. Thematic analysis was used to analyse responses to open-ended questions. ResultsAll three of our study hypotheses were confirmed. Participants who received clinical supervisee skills training via a blended learning approach scored higher in terms of motivation and attitudes – mean (m) = 85.5, standard deviation (sd) = 9.78, number of participants (n) = 62 – compared to the online group (m = 79.5, sd = 9.69, n = 60) (p = .001). The blended learning group also scored higher in terms of knowledge (m = 4.2, sd = 1.43, n = 56) compared to the online group (m = 3.51, sd = 1.51, n = 57) (p = .015); and in terms of satisfaction (m = 30.89, sd = 6.54, n = 57) compared to the online group (m = 26.49, sd = 6.93, n = 55) (p = .001). Qualitative data supported results. ConclusionBlended learning provides added pedagogical value when compared to online learning in terms of teaching undergraduate nurses clinical supervision skills. The evidence is timely given worldwide calls for expanding clinical skills supervision in undergraduate health professional education to improve quality of care and patient safety.

Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial

Evidence for management of asthma comes from closely monitored efficacy trials done in highly selected patient groups. There is a need for randomised trials that are closer to usual clinical practice. We did an open-label, randomised, controlled, two-arm effectiveness trial at 74 general practice clinics in Salford and South Manchester, UK. Patients aged 18 years or older with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy were randomly assigned to initiate treatment with a once-daily inhaled combination of either 100 μg or 200 μg fluticasone furoate with 25 μg vilanterol or optimised usual care and followed up for 12 months. The primary endpoint was the percentage of patients who achieved an asthma control test (ACT) score of 20 or greater or an increase in ACT score from baseline of 3 or greater at 24 weeks (termed responders), in patients with a baseline ACT score less than 20 (the primary effectiveness analysis population). All effectiveness analyses were done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01706198. Between Nov 12, 2012, and Dec 16, 2016, 4725 patients were enrolled and 4233 randomly assigned to initiate treatment with fluticasone furoate and vilanterol (n=2114) or usual care (n=2119). 1207 patients (605 assigned to usual care, 602 to fluticasone furoate and vilanterol) had a baseline ACT score greater than or equal to 20 and were thus excluded from the primary effectiveness analysis population. At week 24, the odds of being a responder were higher for patients who initiated treatment with fluticasone furoate and vilanterol than for those on usual care (977 [71%] of 1373 in the fluticasone furoate and vilanterol group vs 784 [56%] of 1399 in the usual care group; odds ratio [OR] 2·00 [95% CI 1·70-2·34], p<0·0001). At week 24, the adjusted mean ACT score increased by 4·4 points from baseline in patients initiated with fluticasone furoate and vilanterol, compared with 2·8 points in the usual care group (difference 1·6 [95% CI 1·3-2·0], p<0·0001). This result was consistent for the duration of the study. Pneumonia was uncommon, with no differences between groups; there was no difference in other serious adverse events between the groups. In patients with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy, initiation of a once-daily treatment regimen of combined fluticasone furoate and vilanterol improved asthma control without increasing the risk of serious adverse events when compared with optimised usual care. GlaxoSmithKline.

Prevalence of recreational drug use reported by men who have sex with men attending sexual health clinics in Manchester, UK.

Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.