Staff Groups Research Articles

Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study.

Feeding via a misplaced nasogastric tube (NGT) is a common but preventable cause of patient harm. The aim of this study was to determine the accuracy of diagnostic radiographers' assessment of NGT position on chest radiographs (CXRs) and safe-to-feed decisions. A multi-case, multi-reader study was conducted using an online image interpretation platform. A test bank consisting of 15 CXRs with an NGT in-situ was created. Diagnostic radiographers without formal qualifications in CXR interpretation were recruited via two international conferences. Participants placed an electronic marker on each CXR to identify the location of the tip of the NGT and indicated whether or not they believed that the tube was safely positioned. 68 participants were recruited. Each participant reviewed 15 CXRs, providing 1020 unique image assessments. 76% (n=778/1020) image assessments were completely correct (both the position of the tip of the NGT was accurately located and an appropriate safe-to-use decision made). In 5% (n=56/1020) of cases the NGT was safely positioned and the location of the tip was correctly identified by the participant but the tube was erroneously determined to be unsafe for feeding. In a further 6% (n=59/1020) of cases the participant correctly located the tip of an NGT in an unsafe position but indicated that the tube was safe to use. Participants failed to correctly identify the tip of the NGT in the remaining 12% (n=127/1020) of cases. Consistent with previous studies involving other staff groups, diagnostic radiographers without formal qualification in CXR interpretation can assess NGT positioning on radiographs with moderate accuracy but require further training, including strategies for the identification of poorly-visualised tube tips, to achieve the 100% accuracy necessary for this safety-critical task. A bespoke training programme which includes teaching on image quality, tube tip identification and assessment of tube positioning using the National Patient Safety Agency (NPSA) four criteria, should be delivered prior to implementation of a radiographer-led NGT CXR evaluation service.

Service evaluation of the research outputs for 23/24 at a large London teaching hospital

Abstract Introduction The recent report of a UK survey of pharmacy professionals’ involvement in research1 found only small numbers of the pharmacy workforce are currently undertaking research. A number of reasons for this are identified and the report contains a list of recommendations to support the embedding of research into pharmacy careers.1 Within the pharmacy department at King’s College Hospital NHS Foundation Trust (KCH) all research proposals are presented at the pharmacy research and audit group and a log is kept of department research outputs by the clinical academic research lead. The analysis of this data will provide a benchmark. For the purposes of this study, research encompasses audit, service evaluation and research studies as defined by the Health Research Authority defining research table.2 Aim To identify, over the financial year 23/24, the frequency of different types of research outputs from the pharmacy department at KCH broken down by output type, specialty and role. Methods Regular emails were sent April 23 – March 24 to remind staff to identify and share research outputs with the clinical academic research lead. Outputs received were circulated by newsletter to encourage and motivate others. The clinical academic research lead engaged with individual pharmacy teams throughout the year to encourage and support research outputs. Research output data was collected, April 23 – March 24, on an Excel spreadsheet including staff name, role, specialty, type of research output and date the output was completed. Research outputs were categorised into published articles, published abstracts, attendance at conference, abstracts presented at conference and presentations at conference or national webinar. Ethics was not required as the study is defined as a service evaluation. Results There were a total of 89 research outputs by the pharmacy department across the year. These were broken down into published articles (20), published abstracts (16), attendance at conference (24), abstracts presented at conference (26) and presentations at conference or national webinar (3). The two specialty teams who produced or took part in the most research outputs over the year were critical care (15) and liver (11). Consultants pharmacists were involved in the most research activity (32) followed closely by principal pharmacists (26), specialist pharmacists (25) and the deputy chief pharmacists (19). Pharmacy technicians, pharmacists taking part in the STEP programme and non-registered pharmacy staff scored the least in terms of research activity relative to size of staff group. Consultant pharmacists and principle pharmacists were the groups that published the most articles (8 each). Discussion and conclusion The trust implemented a new electronic patient record system during the year which may have impacted the number of research outputs. A limitation to this study is that there are likely to be unrecorded research outputs. The data broken down by specialty and role will allow the pharmacy management group and clinical academic research lead to support, engage and motivate in those areas to allow staff to have the time, skills and guidance to carry out research activities. The results can be used by other healthcare organisations to benchmark against.

Early years pharmacist retention – a listening exercise

Abstract Introduction Pressures on pharmacy workforces are increasing, with 88% of hospital pharmacists reporting high risk of burnout and 62% considering leaving their role due to the impact of work on wellbeing.1 Early years pharmacist (EYP) recruitment is increasingly challenging. Traditional pharmacist career pathways are in competition with increasingly preferred portfolio-based careers. Many trusts are introducing band 6 to 7 progressive schemes to improve retention, including at University Hospital Southampton (UHS). However, anecdotal departmental feedback suggests that EYPs feel this scheme is being applied unequally across different sections and there is discontent with differing workload and development opportunities. Aim To develop an understanding of concerns and expectations of Early Years Pharmacists at UHS. Methods All pharmacists in Agenda for Change band 7, and 6 to 7 progression posts, were invited to participate in an in-person forum. Attendance was voluntary but supported by the senior pharmacy management team. The group facilitator, a senior pharmacist known to participants, introduced the session topics, explained the rationale, then asked participants to provide written comments anonymously on a range of topics. Comments were gathered at the end of the session and thematically analysed with review from an experienced qualitative researcher. Whilst deemed a service evaluation, not requiring ethics approval, data was recorded and managed in accordance with best ethical practices. Results Twenty-Eight EYP attendees provided 102 separate comments. Themes identified related to departmental progressive post variations in; on-call expectations, mentoring, opportunities for formal credentialling, and feedback from line managers. The variations were perceived to be unjust. Commonly, points raised related to professional development. Issues included protected study time both for those undertaking post-graduate courses and those not, workload demands meaning that time for development was limited, and inequalities of access. Discussion/Conclusion As anticipated, there was discontent within the group particularly regarding perceived variations in workload, role opportunities and progression across the department. Additionally, there was some antipathy regarding whether things could be improved. However, the forum feedback suggested the opportunity to participate was well received, having provided participants an opportunity to raise their concerns in a confidential, collaborative, manner. Following initial headline feedback of EYP feeling unappreciated, all senior leaders were reminded of the importance of positive feedback and anecdotally the Trust systems for this have been used more frequently since this reminder. There are limitations with this evaluation, the group was too large to truly be considered a focus group and as such the facilitator was unable to interact with all members and probe for further information which may have been helpful. Furthermore, the facilitator was line manager for a small number of the participants, and they may have felt less able to make negative comments despite the anonymous comment collection. Several of the points raised have led to further questions and we now intend to conduct a formal qualitive study using semi-structured interviews with volunteers across the department to obtain more detailed insight into the challenges of this staff group. Meanwhile work will continue to make the EYP process and experience more equitable. Reference 1. Royal Pharmaceutical Society (2023). ‘Workforce and Wellbeing Survey 2023’. Available online. [Accessed 7th May 2024].

Communities of Practice Support Implementation of Power to Kids in Residential Care: The EMBED Model

ABSTRACTChildren and young people in residential care continue to experience significant harmful sexual behaviour, dating violence and child sexual exploitation. Power to Kids is a programme developed in Australia to prevent and respond to these forms of abuse for this cohort. The aim of the study was to explore how a Communities of Practice initiative could further support the implementation of the Power to Kids programme in the residential care practice of a community service organisation. Qualitative data were collected through feedback loops (n = 12) with residential carers and senior staff and focus groups (n = 4). Quantitative data were collected through two surveys (n = 89) and (n = 46). The data revealed inductively the EMBED model: Executive commitment to Communities of Practice, Members of Communities of Practice engage with content, Becoming part of everyday practice, Enhanced knowledge of sexual health and safety and Decline in going missing and better relationships. Findings suggest that a Community of Practice approach to implementing Power to Kids is promising in embedding the sexual health and safety programme.

Building Engagement-Capable Environments for Health System Transformation: Development and Early Implementation of a Capability Framework for Patient, Family and Caregiver Engagement in Ontario Health Teams.

Despite widespread calls to involve patients, families and caregivers (PFCs) as partners at all levels of health system planning and design, there is unevenness in how engagement efforts are supported across these settings. The concept of 'engagement-capable environments' offers a way forward to uncover the key requirements for sustainable, high-quality engagement, but more work is needed to identify the specific competencies required to create these environments. We addressed this gap by developing a capability framework for Ontario Health Teams (OHTs), a newly established structure for planning, designing, organizing and delivering care in Ontario, Canada. The framework was co-developed by a Working Group of OHT staff and leaders, PFC partners, researchers and government personnel. Project activities occurred over four phases: (1) planning, (2) evidence review and surveying of intended users to identify key competencies, (3) framework design and (4) implementation. An evidence review identified more than 90 potential competencies for this work. These results were contextualized and expanded through a survey of OHT stakeholders to brainstorm potential competencies, supports and enablers for engagement. Surveys were completed by 69 individuals; 689 knowledge and skill competency statements, 462 attitude and behaviour competency statements and 250 supports and enablers were brainstormed. The statements were analysed and organized into initial competency categories, which were reviewed, discussed and iteratively refined by Working Group members and through broader consultations with the OHT community. The final framework includes six competency domains and four support and enabler domains, each with sub-domain elements, mapped across a three-stage maturity model. The framework has been disseminated across OHTs, and its adoption and implementation are now requirements within OHT agreements. The framework combines a strong conceptual foundation with actionable elements informed by the literature and consultations with the intended users of the framework. Although developed for OHTs, the framework should be broadly applicable to other health system organizations seeking similar health system transformation goals. Patient, family and caregiver partners were involved at all stages and in all aspects of the work. As end users of the framework, their perspectives, knowledge and opinions were critical.

Analisis Kinerja Underwriter Dalam Menentukan Calon Peserta pada Produk Dana Pensiun: Studi Kasus Ajb Bumiputera 1912 Wilayah Medan

Insurance is a series of processes related to the supply of services needed by the community in quality. The magnitude of the influence of insurance on the sustainability of a company also makes the insurance process a good risk control. Without good handling, the impact on performance will be very large. This study uses qualitative research. Qualitative research is research that emphasizes the aspect of in-depth understanding of a problem rather than looking at the problem for generalization research. Underwriter performance assessment is carried out by the company leadership by considering the results of meetings of superiors, staff groups, committee decisions, field reviews and subordinates or colleagues. : a. Quality of work b. Work quantity c. Reliable d. Cooperative work Keywords: AJB Bumiputera 1912, Pension Fund and Underwriter

The Association between Social Engagement, Social Network, Social Embeddedness and Quality of Life among University Students

Quality of life (QoL) among university students is a critical concern that impacts not only their academic success but also their overall well-being and prospects. Social relationships are critical for university students' quality of life. Positive social interactions and a supportive network can enhance students' sense of belonging and emotional well-being. However, many students struggle with loneliness and social isolation on campus. This study aims to investigate the association between civic engagement (social engagement, social network, and social embeddedness) and the QoL among university students. We conducted this cross-sectional study among 179 university students on the UiTM Puncak Alam campus via an online survey. We adapted the questionnaire from previous studies and used SPSS version 29 to analyze the data. The Pearson correlation test revealed a link between all the independent variables and the dependent variable, demonstrating both convergent and concurrent validity. The regression analysis showed that social embeddedness was the best predictor of QoL, followed by attitude and behavior. A secure social environment can help one adapt more effectively and provide emotional support, which lowers the risk of depressive symptoms and improves the QoL. In addition, active involvement in social activities helps to increase the sense of belonging to the university community. Identifying oneself as a member of a group of peers, faculty, and staff contributes to the student’s self-concept and higher self-esteem, which is vital in terms of psychological health and QoL.

What do we mean by “agency”? A framework and tools for supporting visitors' agency in museums and science centers

AbstractAgency is a central value within museums and science centers, but it has not been defined and operationalized in ways that can guide museum practice or support inclusion for new audiences. In this project, an interdepartmental group of science center staff co‐created a conceptual framework for noticing and supporting visitors' agency. The framework includes four interconnected aspects of agency: physical environment, social engagement, choice and autonomy, and relevance and empowerment. Conceptualizing agency as multifaceted led to more expansive approaches for supporting it, allowing staff to move beyond open‐endedness to consider a wider range of supports and structures that can make museum experiences more inviting and inclusive. The framework informed the development of practical tools for use by exhibit/program developers and facilitators. Tools are freely available and guide museum staff in questioning current practices and integrating the four facets of agency into planning, prototyping, and observation of interactive experiences.

Design by Transitional Committee: learning from the Green Climate Fund

ABSTRACT In 2022 at the UN climate conference in Sharm el-Sheikh (COP27), countries agreed to establish a new fund for loss and damage. This decision was one of the most significant outcomes of the COP, and something Small Island Developing States had spent the previous three decades calling for. The approach taken to realize this new funding arrangement includes many similarities to that taken to create a similarly significant new fund twelve years earlier – the Green Climate Fund (GCF) – including its design by a Transitional Committee. The aim of this article is to assess the extent to which the ambitions for the GCF have been realized, with a view to informing the ongoing design and early implementation of the new fund. To do this, the article compares the GCF’s present-day outcomes to its original intentions as described by the COP16 decision text. This paper finds that the GCF’s operation today only partially reflects the ambitions expressed at COP16. While the ambition for a Board with equal representation by developing and developed countries has been achieved, ambitions to expand the sources of finance and increase funding for adaptation have been mixed. The influence of the World Bank was a key point of tension over the GCF’s Transitional Committee period, and the Bank continues in the Trustee role today. The role of the Committee’s Technical Support Unit – the group of staff seconded from various international development banks and agencies to provide technical and administrative support to the GCF’s Transitional Committee – had an outsized influence on the shape of the GCF, such that these organizations continue to receive the bulk of GCF funding today. These findings suggest a greater plurality of voices providing such technical inputs would enhance the design of new funding bodies. The creation of new international finance institutions is relatively rare, so understanding the history of the GCF’s design is important for contextualising discussions about other climate finance options.

Positive behaviour support in Irish residential services: Perspectives of frontline staff, management and clinicians on implementation challenges

ABSTRACT Background The current study explored the perspectives of staff working with adults with intellectual disabilities and behaviours that challenge. We sought insight into their understanding of procedural fidelity and challenges faced when implementing behaviour support. Method We interviewed 15 staff members supporting adults with intellectual disabilities in residential settings. Participants included five front-line staff, five residential managers, and five clinicians. Interviews were transcribed and thematic analysis conducted. Results Issues identified by the participants related to four main themes: (1) Organisational and environmental constraints; (2) Understanding and monitoring of procedural fidelity; (3) Theory versus practice; (4) There's nothing positive about behaviour support. Conclusion Across staff groups, lack of understanding of fidelity emerged, as well as minimal accountability regarding behaviour support. Front-line staff felt isolated and under pressure. Greater emphasis on partnership, practice leadership, and positive feedback may give front-line staff the support needed to use behavioural interventions with high fidelity.

The impact of perceived leadership quality, moral stress and participation on turnover intentions in ECEC sector

The aim of this study was to investigate how perceived leadership quality, moral stress and participation are related to turnover intentions in early childhood education and care (ECEC). The theoretical framework was based on mentalizing leadership, participation, and moral stress. The data were collected via a survey (N = 332). The results showed that the ECEC staff were on average quite content with the quality of leadership and participation. Their turnover intentions and moral stress were moderate on average. However, the staff groups differed statistically significantly, with the ECEC nurses scoring lower on leadership satisfaction and participation, and higher on moral stress and turnover intentions than the teachers and leaders. This suggests that we need to develop a way of recognizing stressors at earlier stages, as well as handling them in time before they grow too large. For this, a functioning leadership that promotes reflection and participation is crucial.

Rethinking the life of court dwarfs in early modern Florence: the case of Pietro Barbino at the Medici court☆

AbstractCourt dwarfs were a feature of aristocratic entourages across Europe from the Medieval period until the eighteenth century and their presence is recorded in both contemporary artworks and written sources. Traditionally, it has been assumed that these courtly attendants functioned solely as jester‐buffoons who were exploited and humiliated by their patrons, but is this assumption accurate? By recovering the forgotten histories of this significant group of court staff, new perspectives emerge on the lives of court dwarfs and the various roles they undertook, beyond their conventional role as jesters. This article examines the case of Pietro Barbino, a dwarf attendant at the Medici court in sixteenth‐century Florence, who was the subject of a portrait by the court sculptor Valerio Cioli. Information from archival sources about Barbino's life, both inside and outside the court, corresponds with Giorgio Vasari's description of him as ‘a gifted dwarf, well‐lettered, a very gentle spirit and a favourite of our Duke’ (Lives of the Artists, 1568). Barbino's story suggests that, at least in some instances, dwarf attendants were involved with more erudite aspects of courtly entertainment and were able to achieve a measure of personal autonomy within the complex hierarchy of the court system.

Patient and care team experiences with an EHR-integrated symptom management program (eSyM) in routine oncology practice.

324 Background: Clinical trials have shown that collecting electronic patient-reported outcomes (ePROs) improves quality of life and survival in cancer patients. To bolster integration of ePROs into routine care, the SIMPRO Research Consortium developed an electronic symptom management (eSyM) program, deployed it at six cancer centers, and conducted a hybrid effectiveness-implementation study. eSyM, an ePRO toolkit integrated into the Epic EHR, enables patients to report and care teams to triage symptoms in real-time. To assess eSyM, we conducted structured qualitative interviews with patients and clinic staff, including doctors, nurses, advanced practice providers, and administrative staff. We sought to understand eSyM from the patient and staff perspectives. Methods: Using an iterative process, we developed semi-structured interview guides to query the experiences and perceptions of patients and staff exposed to eSyM. Questions were informed by the Consolidated Framework for Implementation Research. One year after eSyM was launched, sites identified and referred participants for interviews or focus groups. Participants must have either used eSyM to submit symptoms (patients) or had access to eSyM at their institution (staff). Patients provided written consent; a consent waiver was obtained for staff. Interviews were recorded and transcribed, and a common analytic codebook was developed. Transcripts were dual or triple-coded and underwent thematic analysis to identify key contexts and concepts within and across patient and staff groups. Results: From 9/28/20 to 4/14/23, 50 staff participated in individual interviews and 29 participated in focus groups (79 total). From 9/14/23 to 3/14/24, 14 patient interviews were conducted. Transcripts revealed that staff and patients held similar beliefs regarding eSyM compatibility, communication, and prioritization. 93% (13/14) of patients and 72% (57/79) of staff believed eSyM was easy to use and improved communication. Both cohorts (66% staff, 36% patients) noted that competing demands often needed to be prioritized over responding to symptom concerns. Discordance emerged in the domains of receptivity and technology; patients were more receptive and capable of using eSyM than staff perceived. Both groups believed eSyM was helpful but perceived that deeper engagement from patients and staff was necessary for sustainability. Conclusions: Most interviewees reported that eSyM added value and was easy to navigate. Competing clinical demands, however, frequently deprioritized use of eSyM. Staff tended to underestimate patients’ receptivity to use eSyM and were more likely to cite competing demands as a barrier to their own use of eSyM. Sites looking to adopt eSyM, or similar ePRO programs, will benefit from understanding the facilitators that need to be incorporated and the barriers that need to be surmounted to optimize success. Clinical trial information: NCT03850912 .

Patient Experience Survey as a Tool to Support Quality Improvement of a Geriatric Service in the Emergency Department (ED)

Abstract Background The aim of this survey was to valuate patient’s satisfaction with a Frailty Intervention Therapy Team (FITT) and gain insight into their thoughts about the service. Patients’ feedback is a vital component in monitoring and improving the quality of care. The data collected will help develop the service ensuring it’s patient centred and tailored to their needs. Methods A qualitative approach was taken in the form of a patient satisfaction survey. To limit bias responses, non-patient facing clerical facilitated the completion of the questionnaire with the patient. Results 27 surveys were administered over a 5-week period with an 81% response rate (n=22). 91% of patients surveyed felt the purpose of the FITT service was clearly explained to them, the team member had clearly introduced themselves and the team used both written and verbal information well –indicating an effective and efficient style of communication. 100% of patients reported that FITT treated them with dignity and respect. 18% of patients reported they were not involved in decision making relating to the care they received. The ED environment was rated as poor by 14% of patients, long wait time to be seen was also a concern. While some areas of patient concerns cannot be directly targeted by the team alone, we have a duty of care to highlight these concerns to the wider ED staff and hospital group. Conclusion A ‘what matters to you’ question has been incorporated into the assessment paperwork, to ensure patients’ wishes are being formally captured and placed centrally within care management planning. Communication to the patient was supported by providing a FITT information leaflet. Additional seating was procured by FITT to promote improvements in comfort and facilitate safe transfers of older patients in the ED. Patient feedback was presented to the ED governance group, including major themes of patient concern.

A Tool to Visualise and Interact with Probability Density Functions - Development and Case Study

This article is an overview of the design, implementation and testing of a tool to visualise and interact with probability density functions. The tool is a desktop application implemented entirely in Python using the tkinter library for the graphical user interface. The project was undertaken as part of a collaboration between Mathematics and Computer Science. The goal of the application is to provide a simple user interface for teaching staff and students to visualise and interact with probability density functions. The application should help improve students’ understanding of the concepts involved and its simple design should reduce the complexity barrier that often faces users when using technology in the classroom. Following initial testing, a variety of teaching staff were involved with trialling the tool, together with student volunteers from a first-year and second-year statistics module at Swansea University. Feedback was obtained and evaluated from all participants. For the teaching staff group, we found that all four participants strongly agreed that the application is easy to use and that the user interface was not distracting. Furthermore, all teaching staff stated that they would consider using the application in their own teaching and all would recommend using the application to a colleague/friend. For the student volunteer group, all twelve participants either agreed or strongly agreed with the statements that the application is easy to use, useful and not distracting. Similar to the teaching staff group, all the student participants stated that they would consider using the application in their own learning and all would recommend the application to a friend. A full analysis of the survey results is provided in the Feedback section.

Health literacy, including related vaccination, of the working Russian population: data from a survey on the Atria platform

Health literacy (HL), including related vaccination, is an important health determinant. For the working population, it helps to maintain and improve their ability to work. Despite the clear benefits of vaccination, vaccine confidence has recently declined worldwide, which may lead to decreased vaccination coverage and a renewal of infectious diseases. Based on this, increasing the level of public health, including vaccination issues, is one of the preventive medicine tasks. Staff groups seem to be an effective place for implementing measures to improve the health and vaccination prevention of the working population.Aim. To assess the level of public health, including vaccination issues, among the working Russian population using digital technologies.Material and methods. The study was conducted online and included employees filling out a questionnaire on their own. The results were posted on the Atria digital platform, which is a tool for assessing and implementing corporate programs to improve employee health. HL was assessed using the updated 2019 Health Literacy Survey Questionnaire (HLS19-Q) adapted into Russian and validated. The study lasted 18 months (from December 2022 to May 2024).Results. A total of 58357 employees took part in the study on the Atria digital platform to assess the public health level, of which 47044 (80,6%) were women. In general, workers had a predominantly excellent HL (n=39637, 67,9%), while in women it was 69,4% (n=32644). The insufficient HL varied slightly among workers of different age groups. The fewest workers with an excellent HL were recorded in the age group of 40-49 years (65,4%, n=11857), and the most among workers >60 years old (74,2%, n=3573). The study found that 43,3% of men and 56,2% of women are vaccinated against influenza annually. Among those workers who are vaccinated against influenza annually, the highest HL rate was recorded among workers >60 years of age (63,4%, n=4188), and the lowest among workers <30 years of age (48,2%, n=4992). Workers with an excellent HL are predominantly vaccinated against influenza annually (77,8%, n=21306).Conclusion. For the first time in the Russian Federation, a study was conducted to assess the HL level, including vaccination issues, among workers using digital technologies. The results obtained indicate that further measures are needed to increase the HL level of workers, including in terms of vaccination. Based on research data, methodological documents and corporate programs aimed at improving the current situation should be developed and implemented.

Wellbeing and retainment of healthcare workers in Wales from 2020 to 2023

ObjectivesThe COVID-19 pandemic greatly impacted the wellbeing of healthcare workers (HCWs) due to stress, longer hours, and risks of infection during an uncertain time. Post-pandemic, we need to understand the extent of the lasting impacts on wellbeing and staff retainment. ApproachUsing linked administrative health and workforce records within the SAIL Databank, we conducted a cohort study of HCWs employed directly by the National Health Service in Wales between 2020 and 2023. We investigated trends in HCW turnover by fiscal quarter and staff group and the prevalence of occupational health issues per primary care records, including authorised sick leave. We analysed time until leaving the profession using Cox regression incorporating workforce, demographic and health characteristics. ResultsFrom January 2020 to December 2023, HCW employment grew from 101,600 to 121,970 (+20.0%). During this period, 34,760 people left the profession, averaging a turnover of 4.4% per fiscal quarter. Equally, an average of 1.9% of HCWs were diagnosed with a mental health issue, and 17.9% received a related prescription per fiscal quarter. We present further results highlighting how staff turnover has increased over time and differed across staff groups. We also show the extent to which leaving the profession is associated with workforce, demographic and health characteristics. ConclusionThe rate of mental health issues and increases in turnover from the profession highlight the need for additional support. Healthcare systems need to prioritise the welfare of their workforce to ensure sustained resilience and quality of care.

Resisting to Exist and the Subtle Invisible Protest: Six Solution Focused Tactics about Challenging Behaviour

According to Young Minds, ‘everyone gets angry sometimes’. Their website offers a number of de-escalating strategies, including staying calm, managing responses, and setting limits to help young people who most deem resistive. Yet, Young Minds are not alone because such logical advice is ubiquitous in the literature about challenging behaviour despite the fact that in our experience when faced with high states of arousal, most young people tend to act first and deal with the consequences later. It is not that they are stupid or non-caring, but they are human, capable of great feats as well as stupidity. The same is true for any claims that solution focused (SF) conversations can put right the several decades of psychological theory suggesting resistance requires logic and better cognition. By giving the correct thinking skills, young people will walk away from risk, avoid physical confrontation, handle challenging situations like logical thinkers, and generally discount that the process of growing up is part of the challenge. It is with this in mind that over recent years in our current SF practice (with staff group supervision), we have examined the concept of ‘resistance’ and how it can be put to use as a process of collaboration. To do this, we have revisited SF theory that preoccupied many of its pioneers during the 1980s and 1990s and attempted to make it useful for the early 2020s for professionals having conversations with young people, who, in traditional models, are labelled challenging. We want to introduce key differences of solution focused practice and how our research started to formulate a 6D-SF model (details, dynamics, dimensions, dispositions, dislocations, descriptions) for contemplating how groups of professionals relate to each other and are triggered by challenging behaviour. We do not claim to have proof, logic, or exactness on our side, but we are happy to suggest how our resistance mirrors what many of the staff teams feel and describe when working through their work.

Care coordinator delivered method of levels therapy to improve engagement and other outcomes in early psychosis (CAMEO): protocol for a feasibility cluster-randomised controlled trial

BackgroundRates of disengagement from early intervention in psychosis (EIP) services are high. Care coordinators make up the largest staff group in EIP services and have the most frequent and sustained contact with service users. The quality of relationships between service users and care coordinators plays a central role in determining the effectiveness of EIP services. Care coordinators, however, are not routinely offered training in psychosocial interventions that could enhance the therapeutic impact of their role. Method of levels (MOL) is a flexible, transdiagnostic cognitive therapy with potential advantages over previously evaluated approaches. Training care coordinators in MOL could make their routine contacts with service users more helpful and improve outcomes such as recovery rates and levels of engagement.AimsThis study aims to assess the feasibility of training care coordinators in EIP services to deliver MOL, to understand whether this approach might improve service user engagement and recovery from psychosis compared to treatment as usual, and to assess the feasibility of conducting a cluster-randomised controlled trial (C-RCT) with clustering at the level of teams. Specific feasibility outcomes relate to the recruitment and retention of participants, care coordinators’ level of engagement with the MOL training and supervision programme, implementation of MOL in practice, and the acceptability of the intervention amongst participants.MethodsA feasibility parallel group cluster-randomised controlled trial (C-RCT) designs with two arms: (1) treatment as usual (TAU) or (2) TAU plus support from a care coordinator who has received training in MOL. Randomisation will take place at the level of EIP teams with an allocation ratio of 1:2 in favour of the intervention arm. Our recruitment target is 12 EIP teams, 24 care coordinators working in participating EIP teams, and up to 96 service users working with participating care coordinators. Outcomes will be collected at baseline, 3 months, and 6 months. Qualitative methods will be used to understand participants’ experiences of the study, MOL training programme, and MOL intervention.DiscussionThis is the first study that aims to evaluate the feasibility of training EIP care coordinators to deliver MOL in their routine practice. Training care coordinators in MOL could enhance the quality of relationships between care coordinators and service users and improve outcomes for people experiencing early psychosis. Results will be used to determine the appropriateness of progressing to a larger evaluation trial.Trial registrationThis study was prospectively registered with the ISRCTN Registry (14082421).

Prevalence of Type 2 Diabetes Risk in a Higher Education Community of North-Eastern Portugal: a Prospective Cross-sectional Observational Analysis

Objectives: Type 2 diabetes (T2D) is considered one of the most prevalent diseases worldwide. The aim of this study was to analyse the risk of developing T2D in a higher education community of Bragança, North-Eastern Portugal.Methods: The observational, cross-sectional and prospective sample comprised 3021 individuals, aged between 18 and 64 years old, of whom 1759 were women (mean age 24.16 ± 8.80 years) and 1263 were men (mean age 23.37 ± 8.70 years). The Finnish Diabetes Risk Score (FINDRISC) questionnaire was employed to estimate the risk of developing T2D over the next 10 years.Results: The results indicated that approximately 37 (1%) participants in the sample exhibited a high risk of developing T2D, 117 (4%) participants exhibited a moderate risk, 660 (22%) participants exhibited a slight risk, and 2206 (73%) participants exhibited a low risk. A higher T2D risk was observed in the staff group in comparison with the other groups (p < 0.001). Furthermore, body mass index (BMI) and waist circumference (WC) were the variables that most contributed to the increased risk of developing T2D (X2 = 1034.5; p < 0.001).Conclusions: In conclusion, the study reported a low T2D risk for the higher education community of Bragança in the Portuguese North-Eastern region. However, the risk of T2D was found to be higher in the staff group than in the student group. The FINDRISK questionnaire may be applied for the early diagnosis of T2D risk factors.