Shared Agreement Research Articles

Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies.

The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment. Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used. Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies. A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.

The Craniofacial Collaboration UK: Developmental Outcomes in 7- and 10-Year-Old Children With Sagittal Synostosis

The Craniofacial Collaboration UK (CC-UK) protocol is a shared agreement across the 4 UK Highly Specialist Craniofacial Centres (HSCCs) to conduct robust neurodevelopmental and psychosocial clinical screening for children with craniosynostosis. This agreement allows for the analysis of outcomes of a homogenous sample of children with single suture craniosynostosis (SSC), a frequent limitation of the existing research. The current study is the latest analysis of CC-UK data on behavioral, cognitive, and psychosocial outcomes. The focus of this analysis is 7- and 10-year-olds with nonsyndromic sagittal synostosis (SS) who have undergone primary corrective surgery and completed routine clinical screening at 1 of the 4 HSCCs since the introduction of the CC-UK protocol. Due to changes in clinical pathways, only data from 3 HSCCs is included to preserve homogeneity. Results show that the majority of children with SS fall within the average range across behavioral and neurodevelopmental domains. A notable exception was a task involving perceptual reasoning and visuomotor skills (Block Design). Although this difference was small and the mean score remained within the average range, it suggests some increased risk of subtle difficulty with such skills for children with SS. Across other measures, there was no consistent evidence of any significantly increased risk of poorer outcomes, in line with findings of previous CC-UK papers. Understanding the psychological phenotype of SS is a key research priority for parents and clinicians, and the current study is another step toward achieving this goal.

Single IRB Review and Local Context Considerations: A Scoping Review

ABSTRACTA leading concern about single IRB (sIRB) review for multisite studies, as is now required by federal policies, is whether and how sIRBs consider local context in their review. While several types of local context considerations have been proposed, there is no shared agreement among those charged with the ethics oversight of human subjects research as to the goals and content of local context review, nor the types of research studies for which sIRB review might be inappropriate. Through a scoping review of published scholarship, public comments, and federal guidance documents, we identified five assumed goals for local context review: protecting the rights and welfare of local participants; ensuring compliance with applicable laws and policies; assessing feasibility; promoting the quality of research; and promoting procedural justice. While a variety of content was proposed to be relevant, it was largely grouped into four domains: population/participant‐level characteristics; investigator and research team characteristics; institution‐level characteristics; and state and local laws. Proposed characteristics for exclusion from sIRB requirements reflected both protection‐ and efficiency‐based concerns. These findings can inform ongoing efforts to assess the implications of policies mandating sIRB review, and when exceptions to those policies might be appropriate.

Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)

Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)

A Podcast on Pre- or Perioperative Chemoimmunotherapy for Stage III Non-Small Cell Lung Cancer: Shared Agreement from the Thoracic Surgeon and Oncologist Perspectives.

Management of stage II-III non-small cell lung cancer (NSCLC) has been dramatically revolutionized by studies testing the addition of immunotherapy (IO) to chemotherapy in the pre- or perioperative setting. That is because the integration of chemoimmunotherapy (chemo-IO) with surgery has consistently shown a significant improvement in pathological complete response (path CR) rate, event-free survival, and, more recently, overall survival, versus preoperative chemotherapy alone. Particularly, resectable stage III NSCLCs represent a disease entity with a high risk of distant recurrence after radical surgery, for whom pre- or perioperative chemo-IO should be considered as the preferential treatment option. However, owing to the heterogeneity of stage III NSCLC, a standard definition of resectability is not established yet, being often subjective according to the expertise and clinical background of the thoracic surgeon. In addition, careful patient selection on the basis of tumor biomarkers, meticulous staging of the disease, and accurate monitoring of treatment-related adverse events are critical factors that could prevent the ineligibility for surgery of patients treated with pre- or perioperative chemo-IO. Finally, the impact of downstaging for initially borderline resectable tumors, as well as the exact number of preoperative chemo-IO cycles needed and the indications for adjuvant IO, still need to be fully elucidated. In this podcast, we will touch upon the above-mentioned topics from the perspectives of the thoracic surgeon and the oncologist, and suggest a shared agreement between two of the main actors involved in the treatment of resectable stage III NSCLCs.Podcast audio available for this publication.

Systemic failures in nursing home care-A scoping study.

MEDLINE, EMBASE, PSYCHINFO, CINAHLand SCOPUS were searched using the terms: (nursing home care OR residential aged care OR nursing home) AND (organisational failure OR institutional failure OR systemic failure), limited to English language articles, including all years up to the end of February 2021. In addition, we used snowballing of article references and Google searches of the grey literature. System-focused articles were defined as those that explored how an issue at one system level impacted other system levels, or how an issue impacted at least two different agents at the same system level. Thirty-eightarticles addressed systemic issues as defined in four different contexts: United States (14), Canada (2), Australia (11) and European countries (11). Only four studies reported whole-of-system findings, whereas the remaining 34 more narrowly addressed systemic features of specific nursing home issues. The thematic analysis identified 29 key systemic issues across five system layers which consistently appear across every country/health system context. The negative outcomes of these systemic failings include: high rates of regulatory reprimands for unacceptable or unsafe practices; dissatisfaction in care experiences on the part of residents, families, and care staff-including a fear of being sent to a nursing home; and the perception amongst staff that nursing homes are not preferred places to work. The key issues affecting nursing home residents, and the care home sector more generally, are systemic in nature arising from two key issues: first, the lack of shared agreement on the care home system's purpose; and second, the lack of clear governance and accountability frameworks for system regulation and performance at a national level. Addressing these two key issues must be the starting point for any 'real' nursing home system redesign that can achieve a seamlessly integrated system that delivers the outcomes nursing home residents and their families expect. 'Systems thinking' is required to simultaneously improve care quality and outcomes for residents, strengthen regulation and accountability, and enable financial viability.

Integrated Shared Random Key Agreement Protocol for Wireless Sensor Network

The secured data transmission in Wireless Sensor Network (WSN) relies on effective key generation and secured sharing. The generated key must be random to enhance data confidentiality. The processes associated with the security in WSN must be designed at reduced computing time and communication cost. Our research work aims to design a novel lightweight key-sharing protocol that is needed for ensuring data confidentiality. The protocol must meet the constraints of WSN by being lightweight and consuming less energy. Security breaches in WSNs occur due to insecure keys. This can be overcome by generating shared keys which are generated once using the dynamic features of Sensor Nodes (SNs) when the Cluster Heads (CHs) are selected. In this research work, we have generated the Master Shared Key (MSK) at the transmitter node by forming a Galois Ring (GR) using WSN parameters and derived the Shared Random Key (SRK) using matched positions of exchanged Random Sequences (RSs). It is protected using a Physically Unclonable Function (PUF). The novelty lies in the SRK generation from MSK which is chosen at random from the polynomials generated during the formation of GR. The MSK is securely shared with the receiver node by encrypting using a Preloaded Key (PK). After this exchange, the key for encryption and decryption is derived by the transmitter and the receiver by exchanging RSs. The SRK is then encrypted using a key which is a unique fingerprint of the SN generated using PUF and stored in the SNs and the CHs to prevent node capture attack that occurs in WSN. Our proposed Shared Random Key Agreement Protocol (SRKAP) is comparable to the Localized Encryption and Authentication Protocol (LEAP) and performs better compared to the Elliptic Curve Diffie Hellman (ECDH) algorithm

Adherence to rifaximin initiation and prescribing within King’s College Hospital and transfer of prescribing to primary care

Abstract Introduction Hepatic encephalopathy (HE) is described as ‘the most debilitating manifestation of liver disease, severely affecting the lives of patients and their caregivers’ due to cognitive manifestations1. In March 2015 NICE Technical Appraisals approved the use of rifaximin in hepatic encephalopathy2. Rifaximin must be initiated in secondary care under a consultant gastroenterologist or hepatologist. Once considered stable after an initial period of six months (or three months within South East London), prescribing and supply should move to primary care with appropriate Shared Care Agreement documentation. Aim An audit to establish the appropriate initiation and follow up of rifaximin in patients with HE at King College Hospital (KCH) in line with area prescribing was completed in 20173. The purpose of this re-audit is to compare results following implementation of the electronic initiation form, recruitment of a specialist pharmacy technician, and Shared Care Agreement adaptations. Methods Data was collected retrospectively between 1st January 2022 to 31st October 2022, from electronic patient records and dispensing records. Data was compiled and analysed using Microsoft Excel. An ethics approval was not deemed necessary as we were looking retrospectively at standard practice. Results 52 adult patients were identified and the results against the audit standards were as follows: All patients should have a documented diagnosis of HE– 90% was found; All patients should have been initiated directly or been advised by a consultant gastroenterologist or Hepatologist – 94% was found; 90% of patients should have documented evidence of improvement – 62% was found; All patients should receive the first 3-6 months of rifaximin from KCH – 81% was found; All patients should have a hepatology clinic appointment booked – 96%; was found; All stable patients should have shared care agreement in place – 77% was found; All patients should have the initiation form completed on EPR at the time of prescribing – 62% was found. Discussion/Conclusion Although no standards were met there were improvements in most objectives when the data was compared to the 2017 audit. Only 23% of stable patients compared to 50% in 2017 received more than a 6 month supply of rifaximin or did not have a shared care agreement in place. Recruitment of a specialist pharmacy technician could be attributed to this improvement, as they facilitated the whole pathway. Of the 38% of patients who did not have an initiation form completed, 4 were started as inpatients, but the remaining 16 patients were initiated in outpatient clinics. This highlights a need for outpatient clinicians to be reminded of the rifaximin initiation process. Limitations included different documentation styles per clinician reviewing patients and therefore reduction in HE symptoms caused by rifaximin may not have been documented resulting a lower outcome for standard 3. Following this re-audit a pathway to refer patients newly started on rifaximin to a pharmacist led general hepatology clinic will be established. This is to ensure effectiveness of rifaximin is consistently assessed, documented and referred to the pharmacy technician, who should be encouraged to lead on medicines management across sectors of care.

The factorial survey as an approach to investigate clinical decision-making: examining influences on a clinician's decision to initiate life-sustaining clinical technology for a child with spinal muscular atrophy type 1

BackgroundSpinal Muscular Atrophy (SMA) type 1 is a debilitating condition with a poor prognosis, though therapeutic advances are promising. Long-term ventilation is a common management strategy as respiratory function deteriorates. Without consensus on best practice respiratory management, the decision to initiate invasive LTV (I-LTV) for this group of young children involves many ethical considerations. Understanding the main influencing factors on a clinician's likelihood to initiative I-LTV for a child with chronic critical illness is important to maintain transparency and trust with the family during this challenging time.MethodsA factorial survey was used to identify the factors that influence a clinician to support initiation of I-LTV for children with SMA type 1. Factorial survey content was based on literature and evidence-based practice and the content was subject to extensive pretesting and pilot testing. An anonymous survey was disseminated (Oct 2021–Jan 2022), via eight international professional organisations, to clinicians with experience caring for children at the time of initiation of I-LTV.Results251 participants answered 514 vignettes on SMA type 1. The greatest influencing factor on clinician's likelihood to initiate I-LTV was parental agreement with the need to initiate I-LTV. Additional qualitative comments from participants support this finding. Clinicians also highlighted the important role of innovative therapies as well as the availability of supports for families when considering initiation however these findings were context based.ConclusionsThe factorial survey approach provides a valuable way of identifying influencers on decision-making in sensitive situations. The findings demonstrate the acceptance of the centrality of parental influence in decisions on care delivery. Effective communication with the child's family is key to ensuring shared understanding and agreement of goals of care. More international research is needed on the long-term effects of novel treatments, as well as impact on quality of life and influence of geographical location, to inform decision-making.

The Fire Adapted Communities Pathways Tool: Facilitating Social Learning and a Science of Practice

Abstract Wildfire science, policy, and practice lack systematic means for “tailoring” fire adaptation practices to socially diverse human populations and in ways that aggregate existing lessons. This article outlines the development and initial operationalization of the Fire Adapted Communities Pathways Tool, an inductive set of processes that help facilitate dialogue about needs and priorities for wildfire adaptation strategies across ownership boundaries or partners. We outline the stages and considerations organized by the tool, including how its components build from decades of social science and practitioner experience facilitating fire adaptation choices among communities spanning the United States. We then outline examples for how the pathways tool provides opportunities to reflect and respond to the needs of diverse human populations implementing fire adaptation in distinct places. Finally, we discuss how the tool can help advance a “science of practice” for wildfire adaptation by promoting social learning or gathering monitoring information at multiple scales. Study Implications: The pathways tool provides a series of empirically informed processes, choices, and engagement tactics designed to foster shared agreement about the best practices for wildfire adaptation across site-specific local conditions. We outline how the tool can advance adaptation processes for a variety of users, including (1) a community oriented planning process that will help reinforce or catalyze collective action about fire management, (2) a systematic approach for monitoring differential progress toward development of fire-adapted communities, and (3) a potential feedback mechanism that informs programmatic foci or allocation of future resources across potential actions designed for diverse social conditions.

Beyond image defined risk factors (IDRFs): a delphi survey highlighting definition of the surgical complexity index (SCI) in neuroblastoma

Preoperative evaluation of Image Defined Risk Factors (IDRFs) in neuroblastoma (NB) is crucial for determining suitability for upfront resection or tumor biopsy. IDRFs do not all carry the same weighting in predicting tumor complexity and surgical risk. In this study we aimed to assess and categorize a surgical complexity (Surgical Complexity Index, SCI) in NB resection. A panel of 15 surgeons was involved in an electronic Delphi consensus survey to identify and score a set of shared items predictive and/or indicative of surgical complexity, including the number of preoperative IDRFs. A shared agreement included the achievement of at least 75% consensus focused on a single or two close risk categories. After 3 Delphi rounds, agreement was established on 25/27 items (92.6%).A severity score was established for each item ranging from 0 to 3 with an overall SCI range varying from a minimum score of zero to a maximum score of 29 points for any given patient. A consensus on a SCI to stratify the risks related to neuroblastoma tumor resection was established by the panel experts. This index will now be deployed to critically assign a better severity score to IDRFs involved in NB surgery.

P008 Hydroxychloroquine-related adverse events, attrition and reasons for cessation over 5 years at a district general hospital: estimating future ophthalmology screening service use

Abstract Background/Aims Hydroxychloroquine (HCQ) is used widely in the management of rheumatic diseases and is considered to be generally well tolerated. HCQ ocular toxicity is a dose- and time-related reaction. The Royal College of Ophthalmologists (RCOphth) noted a low rate of drug discontinuation as a result of baseline testing (< 4%) and that prevalence data for HCQ ocular toxicity was based on treatment duration >5 years. The RCOphth updated their ocular toxicity screening guideline in 2020. A major change was removal of requirement for baseline screening, with screening commenced at 5 years of treatment unless risk factors are present. Though the number of patients starting HCQ treatment and the UK prescribing data could be estimated, the proportion of patients remaining on treatment for >5 years was stated to be unknown. We reviewed departmental HCQ prescribing, adverse event and attrition data over 5 years from Bolton NHS Foundation Trust, a district general hospital which serves a population of nearly 300,000. Methods Patients were identified as newly commencing HCQ if they had a shared care agreement in the calendar year 2016. Adverse events, attrition rates and reasons for cessation were obtained through review of hospital records over 5 years. Results In the 2016 calendar year, 100 patients commenced HCQ. The mean age was 58, and 70% patients were female. The most common indication was rheumatoid arthritis (75%). At 1 year, 30% of patients had stopped taking HCQ. At 5 years 57% of patients had stopped taking HCQ. The most common reason for cessation at 1 year was gastrointestinal symptoms (30%), and remained the most common reason at 5 years (19%). Eye symptoms were documented as reason for cessation in 7% of patients at 1 year, and 5% of patients at 5 years. On review of records, none of these were thought to be attributable to HCQ, though it was not recommenced. There were no patient deaths directly attributable to HCQ use. Conclusion A significant proportion of patients (57%) stopped taking HCQ after 5 years. The rate of attrition was highest within 12 months, which then almost doubled by 5 years. Centres wishing to estimate the workload related to HCQ retinopathy screening can capture their prescribing for patients newly starting HCQ and/or their catchment population numbers to estimate the Ophthalmology activity related to this 5 years' hence. This may help to fund and staff adequately to successfully carry out this drug safety activity. Disclosure D. Barahman: None. C. Saleh: None. A. Paul: None.

P428 Pharmacist led clinic in Inflammatory Bowel Disease

Abstract Background Only 13% of IBD teams across the UK have a specialist pharmacist within the MDT (1). Pharmacists have a crucial role in safe and effective medication prescribing and monitoring (2). Studies have shown that pharmacist led clinics are acceptable to clinicians and patients (2). At our trust we set up a pharmacist led biologic switch clinic where a specialist pharmacist counselled regarding biologic therapy switch from intravenous (IV) to subcutaneous (SC) medication and assessed disease burden at baseline and follow up. We set up thiopurine clinic where the specialist pharmacist arranges monitoring and facilitates pre-emptive switch of stable patients to shared care prescribing with the GP, in line with the national commitment of providing convenient and easy access to services. We analysed patient feedback, biologic and shared care prescribing data to assess the impact of our pharmacist-led clinics. Methods Patients who had been scheduled in thiopurine and biologic switch clinic were sent with questionnaires either by post or email. Both paper and electronic data were collected and analysed using Microsoft ExCel. Biologic therapy and thiopurine prescribing and monitoring databases were setup and data were captured and analysed retrospectively. Results 112 patients were switched from IV biologic therapy to SC therapy of which 8 patients needed to be switched back to IV due to either an adverse reaction or uncontrolled IBD. By reducing drug cost and increasing hospital CIU capacity, the biologic switch clinic has generated significant financial savings to the organisation (estimated £333,666 per annum). In thiopurine clinic, 80 patients were identified as suitable candidates for shared care agreement with primary care. 88% patients have been successfully transferred to primary care and the remaining 12% remained under secondary care because the GP opted-out. 88% of patients who had been scheduled in pharmacist led clinic were happy with the service and the remainder had a neutral opinion regarding the service (see chart). Some patients fed-back that the telephone consultation did not happen at scheduled time or they preferred face to face clinic. Conclusion Pharmacist led clinic led to significant cost savings, increased accessibility to thiopurines and was acceptable to patients. In response to patient feedback we amended our appointment letters to clarify appointment time frames and give pharmacist contact details for further patient queries. We have also set up face to face clinics for patients preferring this option.

Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction

BackgroundSelected patients with adhesion-related chronic abdominal pain can be treated effectively by adhesiolysis with the application of adhesion barriers. These patients might also have an increased risk to develop adhesive small bowel obstruction (ASBO). It is unknown how frequently these patients develop ASBO, and how elective adhesiolysis for pain impacts the risk of ASBO.MethodsPatients with adhesion-related chronic pain were included in this cohort study with long-term follow-up. The diagnosis of adhesions was confirmed using CineMRI. The decision for operative treatment of adhesions was made by shared agreement based on the correlation of complaints with CineMRI findings. The primary outcome was the 5-years incidence of readmission for ASBO. Incidence was compared between patients with elective adhesiolysis and those treated non-operatively and between patients with and without previous ASBO. Univariable and multivariable Cox regression analysis was performed to identify predictive factors for ASBO. Secondary outcomes included reoperation for ASBO and self-reported pain and other abdominal symptoms.ResultsA total of 122 patients were included, 69 patients underwent elective adhesiolysis. Thirty patients in both groups had previous episodes of ASBO in history. During 5-year follow-up, the readmission rate for ASBO was 6.5% after elective adhesiolysis compared to 26.9% after non-operative treatment (p = 0.012). These percentages were 13.3% compared to 40% in the subgroup of patients with previous episodes of ASBO (p = 0.039). In multivariable analysis, elective adhesiolysis was associated with a decreased risk of readmission for ASBO with an odds ratio of 0.21 (95% CI 0.07–0.65), the risk was increased in patients with previous episodes with a odds ratio of 19.2 (95% CI 2.5–144.4). There was no difference between the groups in the prevalence of self-reported abdominal pain. However, in surgically treated patients the impact of pain on daily activities was lower, and the incidence of other symptoms was lower.ConclusionMore than one in four patients with chronic adhesion-related pain develop episodes of ASBO when treated non-operatively. Elective adhesiolysis reduces the incidence of ASBO in patients with chronic adhesion-related symptoms, both in patients with and without previous episodes of ASBO in history.Trial registration The study was registered at Clinicaltrials.gov under NCT01236625.

Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study.

Improving medication safety during transition of care is an international healthcare priority. While existing research reveals that medication-related incidents and associated harms may be common following hospital discharge, there is limited information about their nature and contributory factors at a national level which is crucial to inform improvement strategy. To characterise the nature and contributory factors of medication-related incidents during transition of care from secondary to primary care. A retrospective analysis of medication incidents reported to the National Reporting and Learning System (NRLS) in England and Wales between 2015 and 2019. Descriptive analysis identified the frequency and nature of incidents and content analysis of free text data, coded using the Patient Safety Research Group (PISA) classification, examined the contributory factors and outcome of incidents. A total of 1121 medication-related incident reports underwent analysis. Most incidents involved patients over 65 years old (55%, n = 626/1121). More than one in 10 (12.6%, n = 142/1121) incidents were associated with patient harm. The drug monitoring (17%) and administration stages (15%) were associated with a higher proportion of harmful incidents than any other drug use stages. Common medication classes associated with incidents were the cardiovascular (n = 734) and central nervous (n = 273) systems. Among 408 incidents reporting 467 contributory factors, the most common contributory factors were organisation factors (82%, n = 383/467) (mostly related to continuity of care which is the delivery of a seamless service through integration, co-ordination, and the sharing of information between different providers), followed by staff factors (16%, n = 75/467). Medication incidents after hospital discharge are associated with patient harm. Several targets were identified for future research that could support the development of remedial interventions, including commonly observed medication classes, older adults, increase patient engagement, and improve shared care agreement for medication monitoring post hospital discharge. Study using reports about unsafe or substandard care mainly written by healthcare professionals to better understand the type and causes of medication safety problems following hospital discharge Why was the study done? The safe use of medicines after hospital discharge has been highlighted by the World Health Organization as an important target for improvement in patient care. Yet, the type of medication problems which occur, and their causes are poorly understood across England and Wales, which may hamper our efforts to create ways to improve care as they may not be based on what we know causes the problem in the first place.What did the researchers do? The research team studied medication safety incident reports collected across England and Wales over a 5-year period to better understand what kind of medication safety problems occur after hospital discharge and why they happen, so we can find ways to prevent them from happening in future.What did the researchers find? The total number of incident reports studied was 1121, and the majority (n = 626) involved older people. More than one in ten of these incidents caused harm to patients. The most common medications involved in the medication safety incidents were for cardiovascular diseases such as high blood pressure, conditions such as mental illness, pain and neurological conditions (e.g., epilepsy) and other illnesses such as diabetes. The most common causes of these incidents were because of the organisation rules, such as information sharing, followed by staff issues, such as not following protocols, individual mistakes and not having the right skills for the task.What do the findings mean? This study has identified some important targets that can be a focus of future efforts to improve the safe use of medicines after hospital discharge. These include concentrating attention on medication for the cardiovascular and central nervous systems (e.g., via incorporating them in prescribing safety indicators and pharmaceutical prioritisation tools), staff skill mix (e.g., embedding clinical pharmacist roles at key parts of the care pathway where greatest risk is suspected), and implementation of electronic interventions to improve timely communication of medication and other information between healthcare providers.

Přechod smluvních závazků při převodu závodu

This paper aims to research the mandatory transfer of contractual obligations under the institute of the transfer of enterprise (or its part) under the Czech law. The transfer of business enterprises was reintroduced in the Czech law in more than 30 years ago, however to this day, the case law has not been united regarding the transfer of contractual rights and obligations. The author tries to conduct research by solving two case studies relating to the statutory guarantee of the transferor for the transferred debts. The first case study relates to the question, whether the transferor guarantees fulfilment of debts under specified framework agreements, provided the creditor has not consented to the transfer of the enterprise. In case of first study, the author succeeded to find solution under the current case law of the Czech Supreme Court. The aim of the second case study is to answer the question of “shared agreements” in case of the transfer of part of business enterprise, in particular whether there are any principles of determination which rights and obligations under shared agreement are subject of the transfer. According to the Czech Civil Code, the same principles as in case of the transfer of a whole enterprise should also be applied to the transfer of part of an enterprise, however there is no statutory nor doctrinal support on how to proceed in case of shared agreements. Although the current doctrine and case law provide no specific principles regarding which rights and obligations are transferred along with the part enterprise, the author provides an approach based on logical and teleological interpretation of the principles of enterprise transfer. The most preferred variant is to split the respective contractual rights and obligations, and if not possible, the rights and obligations should follow the legal fate of the part of enterprise to which they relate more closely.

Attitudes About Extremely Preterm Birth Among Obstetric and Neonatal Health Care Professionals in England

Variation in attitudes between health care professionals involved in the counseling of parents facing extremely preterm birth (<24 wk gestational age) may lead to parental confusion and professional misalignment. To explore the attitudes of health care professionals involved in the counseling of parents facing preterm birth on the treatment of extremely preterm infants. This qualitative study used Q methods to explore the attitudes of neonatal nurses, neonatologists, midwives, and obstetricians involved in the care of extremely preterm infants in 4 UK National Health Service perinatal centers between February 10, 2020, and April 30, 2021. Each participating center had a tertiary level neonatal unit and maternity center. Individuals volunteered participation through choosing to complete the study following a presentation by researchers at each center. A link to the online Q study was emailed to all potential participants by local principal investigators. Participants ranked 53 statements about the treatment of extremely preterm infants in an online quasi-normal distribution grid from strongly agree (6) to strongly disagree (-6). Distinguishing factors per professional group (representing different attitudes) identified through by-person factor analysis of Q sort-data were the primary outcome. Areas of shared agreement (consensus) between professional groups were also explored. Q sorts achieving a factor loading of greater than 0.46 (P < .01) on a given factor were included. In total, 155 health care professionals volunteered participation (128 [82.6%] women; mean [SD] age, 41.6 [10.2] years, mean [SD] experience, 14.1 [9.6] years). Four distinguishing factors were identified between neonatal nurses, 3 for midwives, 5 for neonatologists, and 4 for obstetricians. Analysis of factors within and between professional groups highlighted significant variation in attitudes of professionals toward parental engagement in decision-making, the perceived importance of potential disability in decision-making, and the use of medical technology. Areas of consensus highlighted that most professionals disagreed with statements suggesting disability equates to reduced quality of life. The statement suggesting the parents' decision was considered the most important when considering neonatal resuscitation was placed in the neutral (middistribution) position by all professionals. The findings of this qualitative study suggest that parental counseling at extremely low gestations is a complex scenario further complicated by the differences in attitudes within and between professional disciplines toward treatment approaches. The development of multidisciplinary training encompassing all professional groups may facilitate a more consistent and individualized approach toward parental engagement in decision-making.

O99 - Together at the Top: How teamwork allows a New Graduate to thrive in a Midwifery Continuity of Care position

To inspire further opportunities for New Graduate Midwives to move into Continuity of Care positions. As midwifery students we gain experience with continuity of care by completing ‘follow through’ experiences with women-where we join them for their pregnancy, birth and postpartum care. However, as registered midwives, positions in continuity of care often require 2-3 years experience, making it difficult for New Graduate’s to become involved. 2022 is the first year a NewGrad position has become available within a Midwifery Group Practice model at John Hunter Hospital. The Hunter MGP provides COC to low-risk women throughout their pregnancy, birth and postpartum period. Mostly completing Antenatal and Postnatal visits at home and utilising the Birth Centre at JHH for birth. As a NewGrad in this role, I was assigned 2 mentors who volunteered to assist my learning. We developed a shared agreement based on my confidence and skill development over the initial 12 weeks of supernumerary practice. My manager produced a plan which was available as a guide, but largely we used individual, agreed-upon time frames. Initially I was provided with a reduced caseload whilst I consolidated skills, working the same rostered days-on as my mentors, for 6 weeks each. This ensured the availability for assistance as I began to practice more independently, knowing I could access my mentor for support if needed. I believe necessary requirements for this position include a visionary manager to implement the program, teamwork, flexibility, and a NewGrad who is motivated to learn and NOT afraid to ask for help. To promote learning within a woman-centred model of care, where the NewGrad can consolidate their understanding of ‘normal’. Ultimately this transition has provided me with the time to focus on building relationships with women, their families and other midwives on the team, allowing me to develop my midwifery skills in a supportive environment. Assisting New Graduate Midwives to transition into COC positions encourages growth and sustainability of the midwifery workforce. This occurs through the gained confidence and sensations of accomplishment that occur when NewGrads can utilise their full scope of practice. Allowing growth in skills and retention of knowledge, which is vital as a new practitioner. I feel such a rich sense of fulfillment when I have the opportunity to support known women through the trials of labour and birth. I have observed empowered women accessing gold-standard care, and I know I have contributed to their experience, which is absolutely priceless.

O4-7 An alternative framework for HEPA projects: Developing recommendations for the use of the Capability Approach

BackgroundUsing Amartya Sen's capability approach (CA) to conceptualize physical activity (PA) promotion projects has been suggested as a promising alternative to conventional theories, as it focuses on the real opportunities people have to engage in PA rather than on PA behavior alone. The Capital4Health research consortium used the CA to conceptualize and implement PA projects in four different settings across the life-course. The aim of the study was to evaluate the implementation of the CA in these projects and to develop recommendations for the use of the concept in future PA promotion projects.MethodsBased on an overarching analytical framework, we investigated the utilization of the CA in the individual projects using document analysis, workshops, and group interviews with project teams. Results were used to develop a set of draft principles and recommendations for effectively employing the CA in future projects and as a bridging framework for larger consortia. A participatory process combining elements of action research and Delphi surveys is currently conducted with all members of the Capital4Health consortium to arrive at final set of agreed-upon principles.ResultsPreliminary results show that the use of the CA varied substantially between projects and settings, but that a number of common conclusions can be drawn. A future framework for using capabilities for PA promotion may focus on three areas: (a) Project conceptualization should address both the target group and relevant multipliers. It should also consider both individual PA competences and structural factors, (b) Evaluation should cover both capabilities for PA as well as actual changes in PA levels to assess health impact on multiple levels, (c) The CA may be very useful to research consortia for developing shared goals and evaluation frameworks. This, however, requires a shared knowledge base and agreement about central theoretical concepts.ConclusionsThe CA constitutes a potentially useful theoretical basis for both individual PA promotion projects and multi-setting research consortia. However, the application of the concept is complex and may vary significantly between settings. The proposed guiding principles may therefore provide a useful aid to future projects wishing to apply this innovative approach.

Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study

BackgroundShared care agreements between clinical pharmacists and physicians can improve suboptimal lithium monitoring in in- and outpatient settings. However, it is unknown whether incorporating community pharmacists in such agreements can also improve lithium monitoring in an outpatient setting.AimTo assess the necessity for a shared care agreement for lithium monitoring in our region by investigating: intervention rates by community pharmacists and whether those are sufficient; lithium monitoring by physicians in ambulatory patients; the extent of laboratory parameter exchange to community pharmacists.Method Patient files of lithium users were surveyed in a retrospective cohort study among 21 community pharmacies in the Northern Netherlands. Outcome was the intervention rate by community pharmacists and whether those were deemed sufficient by an expert panel. Additionally, we investigated both the percentages of patients monitored according to current guidelines and of laboratory parameters exchanged to community pharmacists.Results129 patients were included. Interventions were performed in 64.4% (n = 29), 20.8% (n = 5), and 25.0% (n = 1) of initiations, discontinuations, and dosage alterations of drugs interacting with lithium, respectively. The expert panel deemed 40.0% (n = 14) of these interventions as “insufficient”. Physicians monitored 40.3% (n = 52) of the patients according to current guidelines for lithium serum levels and kidney functions combined. Approximately half of the requested laboratory parameters were available to the community pharmacist.ConclusionIntervention rates by community pharmacists and lithium monitoring by physicians can be improved. Therefore, a shared care agreement between community pharmacists, clinical pharmacists, and physicians is needed to improve lithium monitoring in ambulatory patients.