Northern Ireland Research Articles

Pharmacy and Genomic Medicine: A UK-wide survey of pharmacy staff assessing their prior education, confidence and educational needs

Abstract Introduction Pharmacy teams are key in helping patients to get the most from genomic medicine.1,2 However, genomics has only recently been included in undergraduate curricula, and it has been suggested that all healthcare professionals could benefit from education in pharmacogenomics2. We surveyed pharmacy staff to gather information on previous education, current practice and future educational needs in genomics and pharmacogenomics. Aim This survey aimed to establish existing levels of education and confidence in genomics and pharmacogenomics in pharmacy staff working in any role, in any sector, across the UK, and to investigate respondents’ preferences in delivery of genomic education. Methods The survey was based on a 2021 survey of genomic knowledge among medical staff by Health Education England (HEE)3, and amended to reflect pharmacy roles and practice following discussion with pharmacy leads from the 7 NHS Genomic Medicine Service Alliances in England, and from Scotland, Wales and Northern Ireland. SmartSurvey software was used to host the survey, with data held securely. The survey was open between 1st March and 16th May 2022, and was publicised via pharmacy groups including the Royal Pharmaceutical Society, National Pharmacy Association, Local Pharmaceutical Committees, chief pharmacists networks in primary and secondary care, and social media. This work was assessed using the NHS Health Research Authority Research screening tool and judged as ‘not research’; therefore ethical approval was not required. Results 1,552 responses were received from pharmacists, pharmacy technicians, dispensers and other pharmacy staff across the UK; 68% of responses were from England, 13% from Scotland, 10% from Northern Ireland and 9% from Wales. The majority of responses (69%) were from Pharmacists, with 24% from Pharmacy Technicians and 4% from Pharmacy support workers. Only 13% of respondents had received any formal training in genomics. Most respondents felt unprepared to use genomic testing in their practice; just 8% of pharmacists (including trainees), and 1% of pharmacy technicians (including trainees) felt prepared. However, 65% of respondents thought that genomics would change their practice within the next 5 years, and over 70% of pharmacists, and 56% of pharmacy technicians, could envisage ordering, advising on, or counselling patients on genomic testing in the future after appropriate training. 29% of respondents (mainly pharmacy managers) did not currently see patients and therefore might not train personally in genomics. Discussion/Conclusion This work suggests that pharmacy teams are likely to require educational support to embrace the opportunities of genomic medicine. High survey engagement suggested that respondents were keen to make their voices heard. Pharmacists appeared more confident in their ability to advise patients on genomics than Technicians, however both groups seemed keen to receive training. One limitation is that respondents were likely interested in genomics; those with no interest may not have completed the survey. Additionally, pharmacy managers who do not see patients might not train personally in genomics, but may influence strategy for pharmacy genomics service development and delivery. National bodies should capitalise on enthusiasm across the sector to help drive pharmacy genomics services forward through education and training.

Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland

Abstract Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy & Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement.

An inventory of UK mineral resources suitable for enhanced rock weathering

Enhanced Rock Weathering (ERW), a technology based on amending soils with crushed calcium- and magnesium-rich silicate minerals has substantial CO2 removal potential. Evaluation of the available resources of these minerals and current production capacity is crucial for early-stage deployment of this approach. A robust understanding of the potential limitations in exploiting these resources is also required to ensure the scalability of ERW. This paper provides a spatial inventory of basic silicate rock resources in the UK along with current production capacity and permitted reserves. We also integrate spatial data to assess the potential environmental and social impacts of current rock extraction. 68 active and 100 inactive quarries were identified within outcrops of basic silicate rocks which are mainly distributed in Northern Ireland and in the central belt of Scotland. 14.8 Mt yr−1 of basic silicate rock are estimated to be extracted from which up to 3.7 Mt yr−1 of basic silicate waste fines is estimated to be produced which may be available for ERW in the UK. 490 Mt of permitted reserves is associated with active and inactive queries. Spatial distribution of artificial alkaline minerals including Construction and Demolition Wastes (CDW) and legacy slags in the UK have also been included in the inventory. Transport distances are calculated between all resources and the UK's croplands where these materials may be applied for ERW. The relative appropriateness of the UK's croplands for CDR are also calculated based on their proximity to mineral resources and climate parameters controlling the rate of EW.

Prescribing and deprescribing in older people with life-limiting illnesses receiving hospice care at the end of life: A longitudinal, retrospective cohort study

Background: Although prescribing and deprescribing practices in older people have been the subject of much research generally, there are limited data in older people at the end of life. This highlights the need for research to determine prescribing and deprescribing patterns, as a first step to facilitate guideline development for medicines optimisation in this vulnerable population. Aims: To examine prescribing and deprescribing patterns in older people at the end of life and to determine the prevalence of potentially inappropriate medication use. Design: A longitudinal, retrospective cohort study where medical records of eligible participants were reviewed, and data extracted. Medication appropriateness was assessed using two sets of consensus-based criteria; the STOPPFrail criteria and criteria developed by Morin et al. Setting/participants: Decedents aged 65 years and older admitted continuously for at least 14 days before death to three inpatient hospice units across Northern Ireland, who died between 1st January and 31st December 2018, and who had a known diagnosis, known cause of death and prescription data. Unexpected/sudden deaths were excluded. Results: Polypharmacy was reported to be continued until death in 96.2% of 106 decedents (mean age of 75.6 years). Most patients received at least one potentially inappropriate medication at the end of life according to the STOPPFrail and the criteria developed by Morin et al. (57.5 and 69.8% respectively). Limited prevalence of proactive deprescribing interventions was observed. Conclusions: In the absence of systematic rationalisation of drug treatments, a substantial proportion of older patients continued to receive potentially inappropriate medication until death.

Contemporary Themes in Education Policy

Since the conclusion of the Belfast Agreement in 1998, whilst Northern Ireland is part of the UK, it has had the right to set its education policy independently of its county of origin (O'Connor et al., 2020). As a result, Northern Ireland has a separate Statutory Curriculum for Key Stage 3: Principles and Details. The aim of this paper is to critically analyse the educational ideology embodied in KS3 and the globalisation trends of the period corresponding to the policy context. The policy is systematically analysed using theoretical concepts such as Human capital and Social Efficiency to shed further light on the historical and economic context in which KS3 has emerged.

A Retrospective Study of Degenerative Cervical Myelopathy and the Surgical Management Within Northern Ireland.

Degenerative cervical myelopathy (DCM) is a condition of growing concern due to its increasing incidence among the ageing population. It involves age-associated pathological changes of the cervical spine that can result in spinal cord compression. This can lead to deficits in motor and sensory function of the upper and lower limbs, issues with balance and dexterity, as well as bladder and bowel disturbance. Patients can be categorised as having mild, moderate, or severe degenerative cervical myelopathy depending on their modified Japanese Orthopaedic Association (mJOA) score. This condition is generally managed surgically; however, patients with mild degenerative cervical myelopathy may be offered or opt for non-surgical treatment initially. The main aim of this study is to evaluate the surgical management of patients with DCM and to ascertain the degree of mJOA improvement from pre-surgery and one-year post-surgery follow-up. The second aim of the study is to explore the demographics within Northern Ireland who are diagnosed with DCM and who undergo surgery. This information could allow for better planning of services in the future for this patient cohort. This is a retrospective review of the surgical management of degenerative cervical myelopathy within the Regional Spinal Orthopaedic Unit in Northern Ireland over three years with one-year follow-up. The data was retrospectively collected from the Fracture Outcome Research Database. A total of 102 patients (10:7, male:female) with DCM were retrospectively evaluated. Exclusion criteria included all patients diagnosed with spinal tumour, fracture, central cord syndrome, and dislocation. Two patients were removed due to incorrect coding of DCM diagnosis and were not included. Key variables assessed were gender, age, symptoms, type of surgery, complications, and MRC score and mJOA score pre-surgery, 48 hours, six months, and one year post surgery. The choice of surgery was guided by the maximal angle of compression, the number of vertebral levels involved, patient comorbidities, and anesthetic risk. The sample consisted of 60 men (58.82%) and 42 women (41.17%) with an average age of 57.17 ± 12.13 years ranging from 27 to 83 years old. Statistical analysis was conducted to explore the effect of time before and after surgery up to one year on the mJOA score. There was a significant difference in mJOA score pre-surgery and at six months and one year post surgery (R = 0.579053, p <0.001). Of the patients,61.8% with a length of stay greater than three days and 71.4% of patients with a length of stay greater than seven days had a posterior approach surgery. A multiple linear regression analysis revealed that the mJOA score pre-surgery and the presence of complications significantly predicted the length of stay post-surgery (β -1.044, p = .011 and β -5.791, p = .028). The first key finding of this study is that the mJOA score tends to improve after surgery for the majority of patients, particularly at six months, which is consistent with the literature. The second key finding is that anterior approach surgery is associated with a lower rate of complications and shorter post-surgery length of stay in hospital compared to posterior approach surgery. The third key finding is that the pre-surgery mJOA score and the presence of complications post surgery significantly predict the post-surgery length of stay.

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis.

The United Kingdom (UK) has a sustainable healthcare system. Nonetheless, the burden of acute coronary syndrome (ACS) is still a significant challenge. A scarcity of literature primarily focuses on the continuum of care for ACS patients in the UK. Moreover, limited research studies highlight the clinical trajectories of ACS patients across the UK. Therefore, the current study was designed to explore clinical trajectories and the continuum of care for patients with ACS in the UK. Secondary data was obtained from the Myocardial Ischaemia National Audit Project (MINAP) database. The latest data available in the MINAP database was used. As our objective was to explore clinical trajectories and the continuum of care for patients, we retrieved data regarding the care received by ACS patients admitted to hospitals across the UK. The data of 85574 ACS patients was retrieved. A large number (n=47035) of patients were estimated to be eligible for the angiogram; however, an angiogram was performed for 87.15% (n=40995) of eligible patients. Angioplasty within 72 hours of admission was required for most (n=26313) ACS patients. Nonetheless, angioplasty within 72 hours of admission was performed for 59.7% (n=15703) of the eligible patients. There was a significant difference (P<0.05) between different regions of the UK and the percentage of patients for whom angioplasty was performed within 72 hours of admission. Primary percutaneous coronary intervention (PCI) was performed for 23923 ACS patients, of which the door-to-balloon interval for 17590 (73.5%) patients was ≤60 minutes while the door-to-balloon interval for 3086 (12.9%) patients was ≤90 minutes. Out of the total 85574 ACS patients, 65959 (77.08%) patients were discharged on appropriate medications, while 19615 (22.92%) were transferred to another hospital or died there. A total of 75361 were eligible to be referred to cardiac rehabilitation settings. Nonetheless, 64518 (85.61%) were referred to cardiac rehabilitation. About 85000 patients were reported in the UK (England, Northern Ireland, Wales). Optimal care was provided to most patients in the UK. However, some patients received sub-optimal care, highlighting the disparity in the healthcare system. There is a need to explore further the factors that might be responsible for the sub-optimal care to the patients.

Alley greening: a tool for enhancing community resilience?

ABSTRACT In many cities across the world alleys are transitioning from residual spaces to hybrid places providing the foundation for new functions, uses, and identities to take root and coincide through a process of “alley greening”. Such manifestations are transforming the relationship between people (local residents) and place (alleyway – local area), most notably during the COVID-19 pandemic when a new urgency for the provision, or repurposing, of safe, social spaces emerged. Yet, the potential of alley greening to affect people-place relationships and engender community resilience has been relatively unexplored. Adopting a mixed-methods approach, including questionnaires, interviews, and case study analyses, this paper critically investigates the experience and perspectives of green alleys from various place-based actors in Belfast, Northern Ireland. The findings reveal that, even in the absence of institutional and policy support, green alley projects have the potential to stimulate positive people-place relationships in various ways and enhance wider community resilience to shocks and stresses. However, barriers prevail, curtailing the reach and purpose of such projects both in Belfast and elsewhere. The paper considers how governance arrangements might best overcome such hurdles and strengthen pro-environmental and pro-social behaviours that are fundamental to community resilience. Key policy highlights Despite their integral form and function in the city, alleyways, nor their potential, are rarely recognised in the policy. The COVID-19 pandemic exposed a policy-implementation gap in the provision of locally accessible greenspace. Policy inertia exacerbated this gap preventing the fulfilment of changing community needs. Alley greening emerged as a tactical urban response. A lack of place-based approaches within policy has polarised institutions from communities. People-place relationships, essential to resilience-building and green alley longevity, are subsequently inadequately engaged with and fostered. An opportunity exists for alley greening to be a place-based policy instrument to stimulate pro-social and pro-environmental behaviours for building community resilience.

Heritage trails and the framing of place authenticity in Belfast’s Titanic memoryscape

ABSTRACT Titanic heritage tourism has recently become a major objective in Belfast, Northern Ireland, as civic leaders look to leverage the infamous liner’s local origins to advance the city’s post-industrial, post-conflict economic development. Much of this activity has centred on the Titanic Quarter, a new residential, commercial, and cultural district emerging in the historic docklands of East Belfast. This district is home to Titanic Belfast, an ostentatious, new-build visitor attraction created to tell a celebratory, Belfast-focused Titanic origin story. Titanic Belfast is surrounded by numerous heritage elements once associated with the Harland and Wolff shipyards where Titanic was built, which have been incorporated into two heritage trails traversing the Titanic Quarter. This article draws on literature related to authenticity, heritage trails, and memoryscapes to interrogate how these trails underscore the place authenticity of the heritage assets dispersed throughout the Titanic Quarter. It also examines how these trails position Titanic Belfast as the focal point of a vast and coherent maritime heritage memoryscape, revealing a symbiotic relationship whereby Titanic Belfast draws people and capital to the area while the authentic heritage elements nearby furnish the ‘credibility armour’ needed to justify this grandiose new signature attraction and the celebratory narrative it offers visitors.

A chronology of the history and development of social work education in Northern Ireland

ABSTRACT This article presents a detailed history of the development of social work education in Northern Ireland from 1962 to 2020 as a chronology spanning 58 years. Policy mapping was used as a model to build the chronology. A brief examination of the social, political and geographical context of Northern Ireland outlining the distinctive nature of social work in a post-conflict context are discussed. The chronology is presented as a table detailing the development of social work education in Northern Ireland over the last five decades. This culminates in a discussion which highlights some key shifts in policy and practice developments as they relate to social work education in Northern Ireland at pre and post qualifying levels.

“Don’t tell me how to tell my story”: Exploring young people’s perceptions around what it means to ‘feel (mis)understood’ by adults in supporting roles

The subjective and emotional experience of feeling (mis)understood by another person is distinct from being literally (mis)understood. While there is literature exploring young people’s experiences of feeling (mis)understood in therapeutic or clinical settings by adults and the impacts thereof, there is limited exploration of young people’s conceptualisations and perspectives of feeling (mis)understood within a range of young person-supporting adult relationships. This paper reports on the first stage of a project that was co-designed and co-produced by young people, exploring how young people experience and conceptualise ‘feeling (mis)understood’ in the context of receiving support from adults in their lives. This initial stage of the project captures young people’s views on what feeling (mis)understood feels like, its impact on their mental health, and how adults can help young people to feel understood. Conceptualisation, design, fieldwork, analysis and writing were all co-produced with peer-researchers. Data for this project was generated through four workshops each held in England, Scotland, Wales and Northern Ireland. A total of 26 participants aged between 16 and 24 years of age took part in these workshops, and each workshop was facilitated by two peer-researchers and a member of university staff. Data was analysed through collaborative thematic analysis. The study found that feeling understood by supporting adults has a very positive impact on young people’s wellbeing, mental health and help-seeking behaviour. Feeling misunderstood was found to have the converse effect, and in addition was found to make young people less likely to seek further support. Young people also identified a number of key actions adults can take to help the young people they support feel better understood. The findings of this research suggest that practitioners in the health and social care sector working with young people should consider the ways in which they can help young people feel better understood.

Perceived friendships protect against the development of anger following childhood adversities in UK military veteran men residing in Northern Ireland

ABSTRACT Background: Experience of childhood adversity is associated with greater anger as an adult, particularly in men. Soldiers and veterans report higher incidence of adverse childhood experiences, many of whom also experience elevated rates of PTSD and anger. However, little is known about factors which may protect against the development of anger after experiencing childhood adversity. Objective: This study aims to assess the potential protective aspects of perceived social support in military veterans. Methods: Data from the Northern Ireland Veterans’ Health and Wellbeing Study (N = 590, Mage = 56) was utilised in regression models to examine perceived social support (family, friend, partner; MSPSS) as a moderator of the association between adverse childhood experiences (ACEQ-10) and anger (DAR-7). This sample comprised men who were UK Armed Forces veterans residing in Northern Ireland. Results: Significant interaction effects, visualised using interaction plots, were found between perceived friend support and both child abuse and household challenge. When men perceived high friend support, there was no association between child abuse or household challenge and anger. For veteran men who perceived the maximum amount of partner support, there was no association between child abuse and anger. Family support did not change the positive association between child abuse, child neglect or household challenge and future anger. Conclusions: This study indicates that it is especially important to foster supportive and empathetic friendships for men that have experienced adversity as a child, perhaps through programmes such as Men’s Sheds, as these friendships may alleviate the negative influences of child abuse and household challenge on anger.

Association between friendship quality and subjective wellbeing in adolescents: a cross-sectional observational study

BackgroundFriendships play a vital role in the social lives of teenagers, and friendship quality can substantially impact the adolescents’ overall health and wellbeing. This study aimed to investigate the association between friendship quality and subjective wellbeing in Northern Irish adolescents. MethodsIn this cross-sectional observational study, we used data from the second wave of the Wellbeing in Schools Survey, conducted in Northern Ireland from April 2 to May 31, 2018. This survey used a clustering sampling method and included students aged 15–19 years. The survey was approved by the School of Social Sciences, Education and Social Work's Research Ethics Committee, with pupil opt-in and parental opt-out consents. Participants from the survey's initial wave in 2016 were considered eligible. Data on friendship quality and classroom friendships were gathered. Subjective wellbeing was assessed using the 7-item Short Warwick-Edinburgh Mental Wellbeing Scale. Metrics for psychological wellbeing (6 items), mood (7 items), and friendship quality (6 items) were taken from the KIDSCREEN-52 questionnaire. All items were rated on a 1–5 point Likert scale. We examined the association between friendship network quality and subjective wellbeing outcomes through social network analysis and network autocorrelation modelling. FindingsOf 1542 students invited, 1189 (77%) from 83 schools responded to the friendship network queries. Slightly more than half of these participants were female (609 [51%] girls and 580 [49%] boys), and the median age was 16 years (range 14–19, IQR 16–16). The median overall friendship score stood at 20 (IQR 18–26, with possible scores ranging from 6 to 30). Adjusted network autocorrelation models indicated that higher friendship quality scores were significantly associated with improved psychological wellbeing (β=0·3448, p<0·0001), subjective wellbeing (β=0·3075, p<0·0001), and a reduction in negative mood (β=–0·1934, p<0·0001). InterpretationThe study found that friendship quality had a significant association with mood, psychological wellbeing, and subjective wellbeing in adolescents. The results emphasise the value of fostering positive social relationships among adolescents, with a particular focus on the quality of their friendships. Next stages of this research include longitudinal analysis to test these associations more robustly. FundingTaibah University.

“Backlash of the ‘betrayed’ squaddies”: the framing of veteran anti-investigation activism on British news websites

ABSTRACT This article examines how particular frames of military violence emerge, solidify, and fracture around popular media representations of veteran-led protest in response to the Northern Ireland legacy investigations. Curious about how popular ‘pro-militarist’ media navigate unsettling incidents of extreme and unlawful military violence that anti-activism draws attention to, this article uses a discourse analysis of the news coverage of the activism to interrogate how boundaries, distinct to those of formal legal and truth-seeking mechanisms, between ‘legitimate’ and ‘illegitimate’ violences, are drawn. Based on an analysis of 372 photographs and their attendant texts from 72 online news articles, I argue that the coverage is organized around an understanding of military violence as natural and necessary, (re)producing a largely untroubled fantasy of a homogenous national community betrayed by the investigation of its ‘squaddies’. In allowing only partial ruptures in an otherwise smooth narrative of military heroism and betrayal by the state, these stories of military transgression inhibit the disruptive potential of state-led investigations by obscuring the violence they supposedly seek to address.

The Shape of Medical Devices Regulation in the United Kingdom? Brexit and Beyond

The United Kingdom’s Medicines and Medical Devices Act (MMD Act) 2021 received royal assent on 11 February 2021. In its passage through parliament, as well as in the accompanying Explanatory Notes, the Act was framed by the government as a necessary post-Brexit bill. Yet prior to this, it was widely presumed that existing statutory instruments, enacted in 2019 to address medical devices regulation in anticipation of a ‘No Deal Brexit’, would provide the United Kingdom (UK) with the necessary legal framework through the transition period and beyond. The European Union (EU) exit legislation included provisions aimed at aligning domestic law with the new EU Medical Devices Regulation (EU MDR) and In Vitro Devices Regulation (EU IVDR) (which were initially due to be implemented during the EU exit transition period). However, just over a year later, at the end of 2020, while the 2021 Act was in the final stages of its parliamentary journey, legislation was introduced that reversed the provisions of the domestic medical device regulations concerning alignment for Great Britain (GB: England, Wales, and Scotland). The result is that the UK now has a dual system of regulation, with Northern Ireland (NI) being governed by the new EU MDR and EU IVDR and GB by older pre-Brexit (yet still EU-derived) law. This article is an attempt to analyse the complex situation now in existence regarding the regulation of medical devices in the UK. To this end, we focus on three main issues. First, we examine the difficulties and challenges presented by the dual system of regulation between NI and GB, highlighting the potentially far-reaching consequences of regulatory divergence between different UK jurisdictions. Second, we ask whether, in the rush to new legislation in 2021, opportunities to properly reform the approach to medical devices were missed. Finally, we look to the future, focusing on the recent Medicine and Healthcare products Regulatory Agency Consultation on the future of medical devices regulation in the UK and the challenges and opportunities that remain.

A quality improvement project on operative records

Introduction: In 2013 the Royal College of Surgeons of England (RCSEng) published a Standard of Good Practice for surgeons to adhere to in the UK. The guideline included the importance of legible documentation and what should be included in the operative notes. We conducted an audit and quality improvement project in our regional vascular unit in Northern Ireland which showed multiple elements of our operative records that could be improved, such as the documentation of deep vein thrombosis prophylaxis, antibiotic prophylaxis and the use of electronic operative records. Methods: We organised an audit between 3rd and 16th October 2022 where operative notes were collected consecutively and analysed. Multifaceted interventions such as discussion with colleagues, reminder emails and the placement of guidelines around the vascular theatres were done. The second loop of audit was completed between 7th and 20th November 2022. After the audit, we underwent four cycles of Plan-Do-Study-Act (PDSA) where we designed and developed an electronic operative note template and linked it to our electronic records system within the Trust.Results: A total of 24 and 28 operative records were collected, respectively, in the first and second loop of the audit. The majority of the domain showed improvement after the multifaceted interventions: for instance, the documentation of incision (from 46% to 89%), operative diagnosis (from 58% to 93%) and details of closure technique (from 92% to 100%). Through our PDSA cycles, an electronic operative note template was created and improved via feedback from the vascular surgeons. Logistic and IT issues were addressed and we are currently in the process of increasing the number of computers and printers around the vascular theatres. The Vascular Surgical Unit is currently slowly adapting to the use of electronic operative records. Conclusion: Our work has improved the compliance of operative records with the RCSEng guideline and increased the use of electronic operative notes, which are more accessible and legible for our multidisciplinary team.

The Role of Cybersecurity in Medical Devices Regulation: Future Considerations and Solutions

The cybersecurity of medical devices is paramount in a world where everything is increasingly digitised. Attention to how this important defence against malicious actors is regulated must, therefore, also increase. This paper uncovers how the cybersecurity of medical devices is currently regulated and how it can be improved going forward. First, the paper compares the regulation of medical device cybersecurity in the European Union, the United States and the United Kingdom (UK)—differentiating between Great Britain and Northern Ireland as per the current state of the law in the UK. Second, the paper develops a model of how cybersecurity shapes three key areas in the ecosystem of medical devices. These areas are the medical device itself; the structure between the surrounding institutional systems (such as manufacturers and healthcare providers); and the security of the data, the surrounding institutional system and the medical device. Third, based on a comparative analysis and a view of the system from above, the paper puts forward four recommendations on what future regulation should contain to properly regulate the cybersecurity of medical devices: technology specificity, circumvention protection, genuine privacy and security by design. The paper recommends that these four principles be followed. Technology specificity because it guarantees legislation that understands the necessary technical aspects to promote security and safety. Circumvention protection because preventing manufacturers and others from circumventing these requirements decreases risks to the health and wellbeing of patients. Finally, genuine privacy and security by design should be followed to align cybersecurity and privacy with current and future technical capacities.

BS P03 The burden of bariatric tourism on the Health and Social Care System in Northern Ireland: a descriptive analysis

Abstract Background The lack of public bariatric surgical services in Northern Ireland has favoured the growth of bariatric tourism. This retrospective study aimed to analyse the data extracted from the records of bariatric patients who presented with complications to Belfast Health and Social Care Trust following their surgery abroad and investigate the costs associated with managing these complications. It also aimed to explore other factors, such as emotional trauma, that may be associated with bariatric tourism. Methods This was a retrospective study including all patients, who had their bariatric procedure abroad, presenting acutely to our hospital between August 2016 and February 2023. Data were collected from hospital records and included demographic characteristics, type of surgery, nature of complications, and costs associated with managing these complications. Descriptive statistics were used to analyse the data. Results 42 patients included in the study. Majority were female (n=35, 83.3%) with a mean age of 46.6 years. Sleeve gastrectomy was the most common surgery (n=22,52.3%), followed by AGB (n=11,26.1%), Gastric bypass (n=6,14.2%) and Gastric balloon (3,7.1%). Operations were performed in 7 countries, majority were done in Turkey (n= 22). The most common complication was leak (n=14), followed by band erosion (n=7) and nutritional failure (n=7). The total cost was estimated to be (£737,126), which includes hospital-stay costs (£553,179), non-surgical intervention (£55,607), scans (£41,728), and surgical intervention (£75,413). The total cost of dietetic inputs were about £17,390,including 410 hours. Conclusions Most patients experienced emotional trauma related to lack of adequate perioperative care, and difficulties in communication with their overseas surgeons. The results of this study highlight significant costs associated with managing such complications in Northern Ireland. The findings suggest investing in public bariatric surgical services may be more cost-effective than relying on bariatric tourism. Furthermore, Bariatric care is delivered by MDTs which are actively involved in management of these patients throughout their care-pathway. The study highlights lack of perioperative care and follow up needed to minimize complications and associated costs, as well as addressing the emotional trauma of those patients.

College Student Mental Health and Wellbeing Prior to and during the COVID-19 Pandemic

Student mental health was a growing concern globally prior to the onset of the COVID-19 pandemic. The aim of this study was to assess the impact of the pandemic and associated restrictions on the psychological wellbeing of college students. Baseline data were collected pre-pandemic in September 2019 among students attending a university in Northern Ireland and an Institute of Technology in the Republic of Ireland. Surveys were also conducted with this cohort during the pandemic, at the start of the academic years 2020 and 2021 (499 students fully completed all three waves). A follow-up survey was conducted at the end of their third year, in summer 2022 (n = 229). High levels of mental health problems were already present among students commencing college. The subsequent pandemic had a very negative impact on student’s academic experience and other aspects of life. Rates of depression (PHQ-9) increased significantly from the onset of the pandemic and remained high. Anxiety (GAD-7) initially decreased but then escalated at the end of college. The study highlights the importance of early intervention and makes recommendations for addressing the needs of students during times of stress. Additional supports may be required to deal with the long-lasting impact of the pandemic.

HPB P53 Readmission rate after laparoscopic cholecystectomy in a tertiary HPB Unit

Abstract Background Laparoscopic cholecystectomy comprises a large portion of benign biliary surgery, and is increasingly performed safely as a daycase. The aim of our study was to determine the rate of unplanned readmission to hospital or unscheduled contact with medical services following discharge after laparoscopic cholecystectomy, along with the reasons for seeking medical advice. Methods Patients were identified retrospectively from our HPB Unit's operative database. All patients were included (daycases and inpatients) who underwent laparoscopic cholecystectomy in our unit in the calendar year 2019. Patients were excluded if they also had a CBD Exploration, or if their operation was converted to an open procedure. All patients' records were reviewed in detail on the Northern Ireland Electronic Care Record to capture readmissions, A&amp;E attendances and contact with Out of Hours GP service within 30 days of discharge from hospital following operation. Results 273 patients were admitted for planned cholecystectomy under 7 Consultant Surgeons. 257 had their operation completed laparoscopically (5.86% conversion rate). The overall daycase rate was 66%. 39 patients (15%) sought unplanned medical advice within 30 days of discharge. 15 patients (5.8%) contacted Out of Hours. A further 9 patients (3.5%) went to A&amp;E. Most of these had pain or wound problems. There were 15 (5.8%) readmissions to hospital: 3 within 48 hours; with abdominal wall haematoma, constipation and pneumonia. The remainder (day 4-29) had mostly pain, vomiting or umbilical wound infection. Median length of stay was 3 days. Conclusions Our early readmission rate was low and in line with local guidance of &amp;lt;10%. Most patients seeking unplanned advice had pain or wound problems. Further work looking at counselling patients regarding postoperative pain and wound care may reduce the total readmission rate and unscheduled contact after discharge. Readmission was not dependent on the age or size of the patient, or on whether the operation was carried out as a daycase or inpatient.