Hospital Trust Research Articles

Workforce wellbeing centres and their positive role for wellbeing and presenteeism in healthcare workers during the COVID-19 pandemic: secondary analysis of COVID-Well data

BackgroundSupported wellbeing centres established during the COVID-19 pandemic provided high quality rest spaces and access to peer-to-peer psychological first aid for healthcare workers (HCWs). The centres were well accessed and valued by HCWs, but their relationship with wellbeing and job-related factors is not well established. The aim of this study was to explore the relationship between wellbeing centre use, HCWs wellbeing and job-related factors (job stressfulness, job satisfaction, presenteeism, turnover intentions).MethodsSecondary analysis of data from 819 HCWs from an acute hospital trust who completed an online survey in April-July 2020, as part of the COVID-Well study. Measures included the Warwick Edinburgh Mental Wellbeing Scale, and four single-item global measures of job stressfulness, job satisfaction, presenteeism and turnover intentions. ANCOVA models and regression analyses were conducted on these data.ResultsHCWs who had not accessed the wellbeing centres had lower wellbeing (β = 0.12, p < .001), higher job stressfulness (β = − 0.22, p < .001), lower job satisfaction (β = 0.39, p < .001), higher presenteeism (β = − 0.22, p < .001) and were of younger age (β = 0.09, p = .002). Centre use was associated with wellbeing irrespective of job stressfulness. Those reporting presenteeism and who accessed the centre (M = 3.30, SE = 0.04) had higher wellbeing than those who accessed the centre but did not report presenteeism (M = 3.06, SE = 0.04) (F(1, 791) = 18.65, p < .001, ηp2 = 0.02). Centre use was not significantly associated with turnover intentions (B = − 0.30, p = .13; Wald = 2.26; odds = 0.74), while job stress and job satisfaction showed significant effects.ConclusionsAccessing wellbeing centres was associated with higher wellbeing of HCWs, particularly for those reporting presenteeism. Therefore, the centres may have provided greatest respite and restoration for those present at work but not in optimal health. Younger workers were disproportionately affected in terms of wellbeing, and targeted support for this population is needed. Strategies to decrease presenteeism and maximise job satisfaction are urgently required. Healthcare organisations should provide rest spaces and psychological support to HCWs for the long-term, as part of a systems-wide approach to improving workforce health and wellbeing.

Want doctors to use VR simulation? Make it mandatory, accessible, educationally valuable, and enjoyable!

Background Virtual reality (VR) simulation training is mandatory for postgraduate year 1-2 doctors at the author’s hospital trust. Despite this, a preceding quantitative study demonstrated uptake below required levels. While the educational value of VR simulation has been highlighted, little attention has been paid to participant utilisation in postgraduate curricula. With the increasing development and incorporation of VR-based clinical education, it is essential to understand the factors influencing how frequently postgraduate doctors utilise it so that its potential can be maximised. Methods A qualitative study design was employed. All 108 postgraduate year 1-2 doctors from the 2020-21 training year were invited for a semi-structured interview. Interviews continued until data saturation was reached in the form of informational redundancy. Reflexive thematic analysis was conducted. Results A total of 17 interviews were conducted. Four main themes that influenced participation in VR simulation were identified: (1) the mandatory nature encouraged participation but led to negative perceptions as a tick-box exercise; (2) there were multiple challenges to accessing the resource; (3) the scenarios were felt to have limited educational value; and (4) there was untapped potential in drawing benefits from VR as an enjoyable leisure activity. Conclusions Recommendations from these findings include: (1) VR simulation should be mandatory but with a degree of learner autonomy; (2) sessions should be integrated into doctors’ rotas as protected time; (3) more challenging scenarios ought to be created aligned with postgraduate courses, examinations, and specialty training, and (4) presented as a difficulty level system akin to gaming experiences.

The Clinical Teaching Fellow role: exploring expectations and experiences

BackgroundMany UK junior doctors are now taking a year out of the traditional training pathway, usually before specialty training, and some choose to work as a clinical teaching fellow (CTF). CTFs primarily have responsibility for delivering hospital-based teaching to undergraduate medical students. Only a very small amount of literature is available regarding CTF posts, none of which has explored why doctors choose to undertake the role and their expectations of the job. This study aimed to explore the expectations and experiences of CTFs employed at NHS hospital Trusts in the West Midlands.MethodsCTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 took part in a survey and a focus group.ResultsTwenty-eight CTFs participated in the survey and ten participated in the focus group. In the survey, participants reported choosing a CTF role due to an interest in teaching, wanting time out of training, and being unsure of which specialty to choose. Expectations for the year in post were directly related to reasons for choosing the role with participants expecting to develop teaching skills, and have a break from usual clinical work and rotations. The focus group identified five main themes relating to experiences starting their job, time pressures and challenges faced in post, how CTF jobs differed between Trusts, and future career plans. Broadly, participants reported enjoying their year in a post at a mid-year point but identified particular challenges such as difficulties in starting the role and facing time pressures in their day-to-day work.ConclusionThis study has provided a valuable insight into the CTF role and why doctors choose a CTF post and some of the challenges experienced, adding to the sparse amount of literature. Understanding post holders’ experiences may contribute to optimisation of the role. Those employing CTFs should consider ensuring a formal handover process is in place between outgoing and incoming CTFs, having a lead person at their Trust responsible for evaluating changes suggested by CTFs, and the balance of contractual duties and personal development time.

Association of Urinary Incontinency with COPD Severity: An Analytical Cross-sectional Study

Large number of patients suffers from urinary incontinence (UI) with COPD leading to urine leakage and affecting their quality of life. Objective: To determine the prevalence and association of UI among with the severity of COPD patients. Methods: The cross sectional study was conducted from February 2023 to June 2023 in Ghurki Teaching Trust Hospital, Shalimar Hospital and Gangaram Hospital. 230 male patients of age 45-65 years suffering with COPD were selected by using convenient sampling technique. The demographic data and International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) were used collected. SPSS version 26.0 along with Chi-square was used for analysis with p-value &lt;0.05. Results: The results showed that 36 (15.7%) suffering with mild COPD, 142 (61.7%) had moderate COPD and 52 (22.6%) had severe COPD in which 33 (14.3%) experience have no urine incontinency, 25 (10.9%) had urge Incontinence, 154 (67%) had stress Incontinence and 18 (7.8%) had mixed Incontinence. Additionally; moderate COPD had shown significant association with stress incontinency with Chi-square value of 188.58 and p-value =0.00 and with the leakage of urine on coughing/ sneezing, during any physical activity/ exercise and all the time with value of 143.37, p-value = 0.00. Conclusions: The study concluded that UI is highly prevalent in COPD patients as stress and urge incontinency is highly prevalent among moderate and severe patients respectively, associated with coughing/ sneezing and physical activity/ exercises.

A Survey Exploring Inflammatory Back Pain in Patients With Inflammatory Bowel Disease.

Background Diagnostic delay of axial spondyloarthritis (axSpA) is a widely recognized issue worldwide, providing a great burden for patients with this disease. AxSpA is present in a significant proportion of patients with inflammatory bowel disease (IBD). This UK study primarily aims to identify the presence of inflammatory back pain (IBP) in patients attending IBD clinic.Further aims of this study include investigating if participants had received further referrals and diagnoses for their IBPand considering factors contributing to diagnostic delay. Methods Patients were recruited from a Royal Free London NHS Trust hospital's IBD clinic. Each participant completed a 23-question survey. The Berlin criteria were applied to the questions to investigate the presence of IBP. Further questions were asked about their IBD diagnosis and treatment, the healthcare professionals they had seen for their back pain, and other extra-articular features associated with axSpA. Results Seventy-five patients completed the online survey sent out via email. Forty percent (n = 30) of participants were female and 60% (n = 45) were male.Sixty-one percent (n = 36) of participants from the colitis clinic reported they had back pain, and 41% of the participants reported back pain for over three months. Of these, 39% (12) of participants fulfilled the Berlin criteria for IBP. Of patients experiencing back pain for over three months, we found that 10% (3) fulfilled the Berlin criteria but had not received a diagnosis for their IBP.All patients who had fulfilled the Berlin criteriabut had not received a diagnosis for their IBPhadseen their general practitioner(GP) and an allied healthcare professional, but not a rheumatologist. Conclusions This study highlights the presence of possibly undiagnosed axSpA in patients with IBD.The reasons for the diagnostic delay of axSpA are multifactorial. We consider specific patient characteristics, lack of awareness and education of the condition, and issues in the referral process. There is a need to improve education and awareness of axSpA, reconsider referral processes, and consider new initiatives such as joint specialty clinics to identify and treat axSpA on time.

A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes

BackgroundAcute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales. MethodsTwenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data. Completion rates of AKI care standards and regional variations in care were established. Results989 AKI episodes were included in the analyses. In-hospital 30-day mortality was 31-33.1% (AKI 2/3). Standard AKI interventions were completed in >80% of episodes. Significant inter-hospital variation remained in attainment of AKI care standards after adjustment for age and sex. Recording of urinalysis (41.9%) and timely imaging (37.2%) were low. Information on discharge summaries relating to medication changes/re-commencement and follow-up blood tests associated with reduced mortality. No quality indicators relating to clinical management associated with mortality. Better communication on discharge summaries associated with reduced mortality. ConclusionsOutcomes for patients with AKI in hospital remain poor. Regional variation in care exists. Work is needed to assess whether improving and standardising care improves patient outcomes.

Increasing trends in the use of the Precivia® intravitreal injection assist device across the UK.

Intravitreal anti-VEGF injections are the most frequently performed outpatient procedure in the UK, the need for which continues to rise. To meet this demand, injection assist devices such as Precivia® are increasingly adopted to aid in their prompt and safe delivery. We present data on the usage of Precivia® intravitreal injection assist device across two district general hospitals and its distribution across the UK over five years. A retrospective review was undertaken of all Precivia® assisted intravitreal injections delivered at Great Western Hospitals NHS Trust (GWH), and Gloucestershire and Cheltenham Hospitals NHS Trust (GCH) between 2015-2020. Data were also obtained from the Precivia® device UK distributor; Veni Vidi Medical. In GCH, 47,968 intravitreal injections were administered with Precivia®: 5947 in year 1; 7058 in year 2; 9893 in year 3; 11,503 in year 4 and 13,567 injections in year 5, observing a 128.13% increase in the use of Precivia® over the five-year-period. In GWH, 26,923 injections were administered with Precivia®: 4232 in year 1; 5117 in year 2; 5437 in year 3; 5878 in year 4 and 6259 in year 5, observing a 47.89% increase in Precivia® injections over a five-year study period. The number of Precivia® devices distributed across the UK similarly increased including 42,150 devices sold in 2015; 68,125 in 2016; 72,575 in 2017; 88,325 in 2018; 112,850 in 2019 and 115,125 in 2020 observing a 173.31% increase in five years. An increasing trend in the use of the Precivia® intravitreal injection assist device was observed across the UK.

Assessment of thermal index compliance in clinical ultrasound examinations.

The thermal index (TI) is critical for monitoring potential heating risks in ultrasound examinations. This study aims to analyse adherence to TI guidelines in clinical ultrasound exams, focusing on the thermal index for soft tissue (TIS) and thermal index for bone at the focus (TIB). Clinical ultrasound images over a five working day period from a single NHS University Hospital Trust were analysed using a custom MATLAB script. TI values were extracted from DICOM headers, supplemented by optical character recognition for missing values. Time at each TI value (image interval) was measured assuming a constant TI between consecutive images. TI values and corresponding image intervals were compared to TI guidelines provided by the British Medical Ultrasound Society (BMUS). Analysis included 627 obstetric and 1023 non-obstetric examinations, comprising 4643 obstetric and 19,228 non-obstetric image intervals. TIS values across all examinations and image intervals adhered to recommended BMUS limits; however, breaches of the guidelines were observed for TIB. In obstetrics, 44 image intervals across 47 examinations exceeded the TIB limits (1.01% of TIB image intervals and 7.02% of examinations). For non-obstetrics, two image intervals across two examinations exceeded the TIB limits (0.02% of intervals and 0.44% of examinations). The majority of ultrasound examinations considered for this analysis demonstrated compliance with BMUS guidelines for TI, except for a small fraction which showed breaches in the obstetric thermal index for bone at the focus limits. All breaches were associated with the use of pulsed-wave Doppler.

Hepatitis D seroprevalence: An alarming situation and war without weapon.

Objective: To determine the seroprevalence of HDV in HBs Ag positive patients and the burden of true viral hepatitis infection (viremia) as evidenced by detectable either HBV DNA and/or HDV RNA (single or dual infection). Study Design: Cross-sectional Observational Study. Setting: Al-Tibri Medical College Hospital, Karachi, and OPD Saylani Welfare Trust, Karachi. Period: August 2021 to July 2022. Material &amp; Methods: All patients of both genders with HBsAg positivity were included in the study. All included subjects underwent a process of evaluation through history, physical examination, baseline or specific laboratory tests of Anti HDV Ab and PCR for detection of HBV DNA and HDV RNA, if applicable, followed by classification of subjects as follows: group I: Only HBs Ag positive (no active infection), group II: HBs Ag positive along with HBV DNA detected by PCR (HBV infection), group III: HBs Ag and Anti HDV Ab positive but no HBV or HDV viremia (no active infection), group IV: Both HBs Ag and Anti HDV Ab positive with HBV viremia (HBV infection), group V: Both HBs Ag and Anti HDV Ab are positive for HDV viremia (HDV infection), and group VI: Both HBs Ag and Anti HDV Ab positive with both HBV and HDV viremia (Dual infection). Results: A total of 237 subject’s data were analyzed with a mean age of 29.03±9.262 years (range of 12 to 66 years), with males 143 (60.3%) and females 94 (39.7%), but dual infection was more prevalent in females, but statistically these differences turned out to be insignificant (p-0.061). According to age group, almost 89.5% of subjects were below the age of 40, while only 10.5 % were &gt;40 years of age. Another significant finding in our results was that all 11 subjects in group VI (with dual viral infection) were under the age of 40 years. and this difference was statistically significant too (p 0.001), as shown in Table I. Conclusion: Our study highlighted that HDV is still prevalent in our part of the world and that it mainly affects younger age groups. Hence, it demands an urgent, extensive screening campaign of the masses to assess the exact HDV burden and offer preventive measures, including a vaccine against HBV. Otherwise, due to deficient treatment options, we have to lose the battle because this is the war and we are without weapons.

Early or late menarche is associated with reduced fecundability in the Norwegian Mother, Father and Child Cohort Study.

Is age at menarche associated with fecundability? Both early (<11 years) and late (>15 years) menarche is associated with decreased fecundability. Previous studies on age at menarche and fecundability have been inconclusive. Women with early or late menarche are at increased risks of gynaecological and autoimmune diseases that may affect their ability to conceive. We conducted a retrospective cohort study including 67 613 pregnant women, participating in the Norwegian Mother, Father and Child Cohort Study between 1999 and 2008, with self-reported information on age at menarche and time to pregnancy. We included planned pregnancies that were conceived either naturally or with the help of assisted reproductive technologies. We calculated fecundability ratios (FRs) with 95% CIs representing the cycle-specific probability of conception by categories of age at menarche. FRs were adjusted for participants' pre-pregnancy body mass index, highest completed or ongoing education level, and age at initiation of trying to conceive. We observed a 7% lower probability of conceiving during any given menstrual cycle up to 12 cycles in women with early or late menarche. Among women with menarche >15 years, the adjusted FR was 0.93 (95% CI: 0.90-0.97), and among women with menarche <11 years, the adjusted FR was 0.93 (95% CI: 0.89-0.99), when compared to women with menarche between 12 and 14 years. The study-population consisted of women pregnant in their second trimester, excluding those with persistent infertility. Recall of age at menarche and time to pregnancy may be inaccurate. Both early (<11 years) and late (>15 years) menarche was associated with decreased fecundability. Women experiencing early menarche or late menarche may be counselled accordingly. This study was funded by the Norwegian Institute of Public Health, Oslo, Norway, and by Telemark Hospital Trust, Porsgrunn, Norway and was partly supported by the Research Council of Norway through its centres of excellence funding scheme (project number 262700) and the Research Council of Norway (project no. 320656). The project was co-funded by the European Union (ERC, BIOSFER, 101071773). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible for them. M.C.M. has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement no. 947684). The authors report no competing interests. N/A.

1912 Reviewing the effect of COVID pandemic on changing clinical practice of administrating Zoledronic Acid to hip fracture patients

Abstract Introduction Reduction in outpatient appointments during the COVID-19 pandemic and patient concern surrounding risk of contracting COVID-19 by attending day-case settings, resulted in delayed or cancelled medical treatments including Zoledronic Acid infusions as management for Osteoporosis. This, alongside recent research concluding that these treatments can be given safely as early as 1-2 weeks post-fracture, lead to the adaptation of protocol at Hull University Teaching Hospitals Trust in 2021, to provide rapid loading of Cholecalciferol over 6 days, prior to administration of Zoledronic Acid on day 7. However, some concerns remain surrounding the potential interference with bone remodelling and healing. This completed audit cycle evaluates the logistics and safety of this new protocol. Methods All patients over 60, admitted with neck of femur fracture who received Zoledronic Acid infusion as inpatient or outpatient in 2019 and 2021 were included in the initial and repeat audit respectively. Electronic records for the following 12 months were analysed evaluating for further fragility fracture and mortality rate. Results There was an increase in patients receiving Zoledronic Acid as an inpatient treatment from 21% in the initial audit to 97% in the repeat audit. There was a slight increase in mortality rate at one year from 14% to 19%. The percentage of a further fragility fracture within one year, remained stable at 7%. Conclusion The increase in inpatient infusions suggests more patients with significant frailty who would otherwise not have been able to attend outpatient settings, have been able to receive treatment. The mortality results reflect this frailer audit population. The absence of a substantial increase in the rate of further fragility fracture at one year; supports the earlier administration of Zoledronic Acid as a management protocol.

Neonatal Hematological Abnormalities Associated with Maternal Pre-eclampsia at Birth

Background: Pre-eclampsia (PE) can cause hematological abnormalities that can further exacerbate the existing morbidity in newborns. This study aimed to investigate neonatal hematological abnormalities associated with maternal pre-eclampsia at the time of birth. Methods: This cross-sectional was conducted from January 2023 to July 2023, involving 122 neonates born at the Department of Pediatric Medicine, Sohail Trust Hospital in Karachi, Pakistan. It analyzed neonates of either gender, aged from birth to 24 hours of life, and born to pre-eclamptic mothers, and their demographic details were recorded. At delivery, 2 ml of umbilical venous blood was collected by a trained pediatric nurse and then sent to the institutional laboratory. Hematological changes like leukopenia, thrombocytopenia, or neutropenia were noted. To assess the influence of various factors on hematological outcomes, chi-square tests were applied, with a significance threshold set at p&lt;0.05. Results: In a total of 122 neonates, the mean age was 8.14±6.49 hours. The mean gestational age was 38.87±3.15 weeks. There were 68 (55.7%) neonates who were male. Low birth weight (LBW) was less than 2500 grams in 45 (36.9%) newborns. Thrombocytopenia, leukopenia, and neutropenia were identified in 32 (26.2%), 25 (20.5%), and 23 (18.9%) neonates respectively. Stratification of leukopenia concerning study variables revealed that gestational age and LBW had a significant association (p=0.0036, p=0.0072) with leukopenia. Moreover, neutropenia also had an association with LBW (p&lt;0.0001). Conclusion: These findings underscore the importance of early hematological screening for neonates born to pre-eclamptic mothers to facilitate timely diagnosis and care.

How do hospitals respond to payment unbundling for diagnostic imaging of suspected cancer patients?

Payments for some diagnostic scans undertaken in outpatient settings were unbundled from Diagnosis Related Group based payments in England in April 2013 to address under-provision. Unbundled scans attracted additional payments of between £45 and £748 directly following the reform. We examined the effect on utilization of these scans for patients with suspected cancer. We also explored whether any detected effects represented real increases in use of scans or better coding of activity. We applied difference-in-differences regression to patient-level data from Hospital Episodes Statistics for 180 NHS hospital Trusts in England, between April 2010 and March 2018. We also explored heterogeneity in recorded use of scans before and after the unbundling at hospital Trust-level. Use of scans increased by 0.137 scans per patient following unbundling, a 134% relative increase. This increased annual national provider payments by £79.2 million. Over 15% of scans recorded after the unbundling were at providers that previously recorded no scans, suggesting some of the observed increase in activity reflected previous under-coding. Hospitals recorded substantial increases in diagnostic imaging for suspected cancer in response to payment unbundling. Results suggest that the reform also encouraged improvements in recording, so the real increase in testing is likely lower than detected.

Identifying where hospital and community trusts are managing general practices in England: a service mapping study.

Organisations providing secondary care in the NHS in England have historically not also provided primary health care, but this is changing. Data on where this kind of 'vertical integration' is happening are lacking, making it difficult to evaluate its impact. To compile a comprehensive list of instances of secondary care trusts running general practices in England, to enable evaluation of the impact of such arrangements. This service mapping study comprises review, collation, synthesis, and analysis of published information describing secondary and primary care provision in the NHS in England in March 2021. Desk-based collection, including hand-searching, of secondary care organisations' statutory annual reports. Triangulation via comparison with national data on general practices, the general practice workforce and practice contracts. It was possible to construct a database of all instances of trusts running general practices in England as of 31 March 2021. We have identified 26 trusts running a total of 85 general practices, operating across a total of 116 practice sites. These practices have on average fewer patients and fewer GP full-time equivalents than other general practices, and before becoming vertically integrated were performing less well in the Quality and Outcomes Framework. We recommend that national statistics recording the details of general practices contracting with the NHS should include whether each practice is owned by another organisation and whether that is an NHS trust, another public body, or a private organisation. Such data are required to enable evaluation of the impacts of this kind of vertical integration.

Factors associated with poorer outcomes for posterior lumbar decompression and or/or discectomy: an exploratory analysis of administrative data.

This study aimed to identify factors associated with poorer patient outcomes for lumbar decompression and/or discectomy (PLDD). We extracted data from the Hospital Episodes Statistics database for the 5 years from 1st April 2014 to 31st March 2019. Patients undergoing an elective one- or two-level PLDD aged ≥ 17years and without evidence of revision surgery during the index stay were included. The primary patient outcome measure was readmission within 90days post-discharge. Data for 93,813 PLDDs across 111 hospital trusts were analysed. For the primary outcome, greater age [< 40years vs 70-79years odds ratio (OR) 1.28 (95% confidence interval (CI) 1.14 to 1.42), < 40years vs ≥ 80years OR 2.01 (95% CI 1.76-2.30)], female sex [OR 1.09 (95% CI 1.02-1.16)], surgery over two spinal levels [OR 1.16 (95% CI 1.06-1.26)] and the comorbidities chronic pulmonary disease, connective tissue disease, liver disease, diabetes, hemi/paraplegia, renal disease and cancer were all associated with emergency readmission within 90days. Other outcomes studied had a similar pattern of associations. A high-throughput PLDD pathway will not be suitable for all patients. Extra care should be taken for patients aged ≥ 70years, females, patients undergoing surgery over two spinal levels and those with specific comorbidities or generalised frailty.

Association between Cervical Muscle Weakness and Functional Limitations due to Headache in Doctors

Background: Headaches and neck discomfort are prevalent issues, particularly among healthcare professionals, and are often related to muscular weaknesses and postural anomalies. The intricate relationship between cervical muscle strength and the frequency and intensity of headaches necessitates a deeper understanding for effective management and treatment strategies. Objective: The primary objective of this study was to investigate the association between cervical muscle weakness and functional limitations due to headaches in doctors, considering the impact of long working hours and the physical demands of the medical profession. Methods: A cross-sectional study was conducted among doctors working at Akhtar Saeed Trust Hospital, Farooq Hospital, and AMDC in Lahore from June to December 2022. Participants with conditions like fibromyalgia, history of head and neck trauma, or degenerative cervical spine disease were excluded. The strength of cervical muscles was assessed using Manual Muscle Testing, and the intensity of headaches was evaluated using the Headache Impact Test (HIT-6) questionnaire. The sample size was calculated to be approximately 150, with data analysis performed using SPSS version 25. The study employed descriptive statistics, Chi-square tests, and parametric tests to analyze the data. Results: The study found significant correlations between cervical muscle strength and headache impact. Among participants with moderate cervical flexor strength, HIT scoring ranged from 30 in the 36-50 range to 28 in the 60-78 range. For strong cervical flexors, the range was 34 in the 36-50 to 6 in the 60-78 range. Similar patterns were observed in cervical extensors and side flexors. The Chi-square values were significant across all muscle groups (18.45 for flexors, 32.164 for extensors, 50.175 for right side flexors, and 45.30 for left side flexors), all with a p-value of 0.000. Conclusion: The study demonstrates a significant association between cervical muscle strength and the impact of headaches, indicating that weaker cervical muscles are associated with higher headache frequency and severity. These findings suggest the need for targeted muscle strengthening and posture correction interventions among doctors to mitigate the risks of headache and neck discomfort.

New Public Management and hospital efficiency: the case of Norwegian public hospital trusts

New Public Management-inspired reforms in the Norwegian hospital sector have introduced several features from the private sector into a predominantly public healthcare system. Since the late 1990s, several reforms have been carried out with the intention of improving the utilization of resources. There is, however, limited knowledge about the long-term, and sector-wide effects of these reforms. In this study, using a panel data set of all public hospital trusts spanning nine years, we provide an analysis of the efficiency of hospital trusts using data envelopment analysis (DEA), as well as a Malmquist productivity index. Thereafter we use the efficiency scores as the dependent variable in a second-stage panel data regression analysis. We show that during the period between 2011 and 2019, on average, efficiency has increased over time. Further, in the second-stage analysis, we show that New Public Management features related to incentivization are associated with the level of hospital efficiency. We find no association between degree of competition and efficiency.

P26 User experience of a clinical decision support system in the form of a mobile app in supporting antimicrobial stewardship

Abstract Background There are advancements in the use of technology in modern healthcare. Healthcare professionals use various digital platforms such as electronic medical records, e- prescriptions, websites and smartphone apps to enable prompt access to clinical information. Healthcare professionals are likely to refer to their smartphones for prompt clinical information or guidance that are easily accessible in contrast to paper guides, handbooks and desktop computers. Some studies have shown that mobile application guidelines within a smart phone app increase adherence to prescribing guidelines by clinicians. Furthermore, benefits of a smart phone app are the ability to update them more quickly than paper-based information and the ability to improve clinical decision-making within the form of an electronic clinical decision support system (CDSS). Despite the increased use of digital information there are limited studies in this area on the use of CDSS within smart phone antimicrobial apps. More evidence is needed to better understand healthcare usage of such apps in the area of antimicrobial stewardship. Microguide V1 (M1) is a smartphone antimicrobial app currently in widespread use in UK hospitals designed to provide access to local prescribing guidelines. However, M1 does not have a support tool to ‘direct’ or map prescribers to a specific treatment plan for their patients based on symptoms or suspected diagnosis. Microguide V2 (M2) is an updated version that includes an additional decision support tool that helps to identify the correct antibiotic to prescribe based on patient’s clinical symptoms. Objectives To evaluate clinician experiences with both versions of the app within Mid and South Essex University Hospitals (MSE) Trust. In MSE, the M1 is currently in use but M2 is being adopted from November 2023 onwards as part of strategies to improve antimicrobial stewardship, and to help with meeting Commissioning for Quality and Innovation (CQUIN) targets for IV to oral switching of antibiotics). Methods A mixed methods approach was devised utilizing an online survey and interviews pre- and post-introduction of M2. Questions were aligned to the COMB-B behaviour model approach influencing change. Topics covered were awareness, experience, barriers, concerns and prescribing behaviour. All prescribers within the Trust working on adult inpatient wards were eligible for participation. Results A pre-implementation survey of M2 was conducted between January and October 2023. A total of 473 people accessed the online survey, with 24 responses, but only a total of 15 participants fully completed the survey. The roles of the participants were 6 pharmacists, 3 nurses and 6 doctors. In terms of awareness of the app, 87% stated yes and 38% agreed that the app increased their awareness of antimicrobial stewardship. Two-thirds (67%) of participants used the app in supporting prescribing decisions, whilst a third had never used it. Nearly 40% of participants agreed that the app encouraged them to challenge inappropriate prescribing and almost half (46%) agreed that that they felt comfortable accessing the app at patient’s bedside. The interview analysis is still ongoing. Conclusions The results so far provide evidence that M1 is being accessed by prescribers in making clinical decisions and they find it useful. The obvious and major limitation of this study was the small number of responses, and this is partially explained by winter pressures and industrial action by nurses and doctors. This led to reduced availability of participants.

P16 Centre of excellence on antimicrobial stewardship in Central Uganda

Abstract Background Supported by a Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS 2) grant, our partnership team comprising members from Makerere University, Nottingham Trent University, Buckinghamshire Healthcare NHS Trust and Entebbe Regional Referral Hospital (ERRH) seeks to scale up and enhance sustainability on antimicrobial stewardship (AMS) in Central Uganda. Building on the achievements of our previous CwPAMS projects, this current initiative aims at strengthening, human, animal and environmental health practitioners’ capacity on AMS in health facilities and the community, as well as promoting increased use of microbiology and prescribing data to inform clinical decisions. Objectives To establish a centre of excellence on antimicrobial stewardship in Central Uganda using a One Health approach with a focus on capacity building, mentorship of lower-level facilities, and knowledge transfer. Methods This project uses a One Health approach involving professionals from the domains of human, animal and environmental health. ERRH, the project hub, is currently mentoring lower health facilities (spokes) in AMS. AMS champions have been identified in each of these health facilities who are leading ongoing activities. The project has also employed CwPAMS AMS assessment tools during scoping visits to assess the baseline conditions at seven lower-level health facilities (one regional referral hospital, two district hospitals, three health centre IIIs and two health centre IIs). AMS workshops have so far been held in two districts (Nakaseke and Butambala) including two general hospitals. Results The project held inception meetings that brought together different stakeholders in AMS. Scoping visits and AMS assessments have been successfully completed across seven health facilities, highlighting different AMS practices, challenges and intervention strategies. Furthermore, mentorship has so far resulted in establishment of AMS committees, identification of AMS champions, and adoption of the prescribing companion app at five of the seven mentored lower-level health facilities. AMS workshops held in the two districts resulted in increased knowledge on antimicrobial practices among the participants. The post assessments from the workshops showed that 73.4% of the participants had learnt the key importance of surveillance in AMS, 89.6% of the participants recognized the role of public awareness in promoting AMS, and 79.8% understood the value of infection prevention and control in promoting AMS in comparison with 51.7% at the pre-assessment (Figure 1). In addition, the online Community of Practice on AMS we established for health professionals in Uganda has seen a notable increase in membership, growing from 420 to over 600 members. Conclusions By engaging directly with front-line health practitioners using a hub and spoke mentorship model, the early stages of this project have provided more information on the prevailing AMS challenges in Uganda, particularly knowledge and training gaps, while revealing promising opportunities such as the existing health care structures and supportive policies. AMS capabilities of health practitioners have been improved by participation in the project, but further work is needed to limit the development of AMR in Uganda.

P02 Evaluating antibiotic prescribing in pancreatitis: a single-centre retrospective case series

Abstract Background Procalcitonin (PCT) has been shown to safely reduce antibiotic use in respiratory tract infections but there is little evidence for other potentially infected body systems. A recent randomized controlled trial (RCT) demonstrated the safety and efficacy of PCT in reducing antibiotic use in patients with pancreatitis. Objectives We aimed to review antibiotic prescribing in patients with pancreatitis and to estimate the potential impact of PCT on rates of antibiotic prescribing at the Royal Cornwall Hospital Trust (RCHT). Methods Patient care episodes for pancreatitis between June 2022 and May 2023 were identified using pancreatitis ICD-10 codes. An audit tool was developed using the inclusion criteria used in the RCT. Electronic notes systems were used to collect the following: patient demographics, whether diagnostic criteria for pancreatitis were met, clinical specialty, pancreatitis severity, presence of necrosis, indications for antibiotics and course lengths. Results 121 patient care episodes were identified, of which 76 (63%) were analysed. Of these, 61 (80.3%) met the diagnostic criteria for pancreatitis and analysed; median age 57 (IQR 26), 28 (45.9%) female, 51 (83.6%) managed under surgeons and 10 (16.4%) under medicine. 15 (19.7%) patient episodes were excluded: 14 did not meet diagnostic criteria for pancreatitis and 1 on long term immunosuppression. 30 (49.2%) patients with a clinical diagnosis of pancreatitis were prescribed antibiotics; 5 (16.7%) for pancreatitis and 16 (53.3%) for extra-pancreatic indications: respiratory tract 3 (18.8%), cholecystitis 7 (43.8%), suspected cholangitis 1 (6.3%), other intra-abdominal infection 5 (31.3%). The indication for antibiotics was unclear in 9 episodes (30.0%). Of those prescribed antibiotics for pancreatitis, 4 (80%) were appropriately prescribed for suspected infected necrotic pancreatitis (patients with pancreatic or extra-pancreatic necrosis who deteriorate (physiologically or blood results) or fail to improve after 7-10 days), 1 (20%) was inappropriate. The overall rate of antibiotic prescribing in the PROCAP study were 31% in the PCT group and 47% in the usual care group (non-PCT); the rate of antibiotic prescribing in the usual care group was found to be comparable to our data (47.0% verses 49.2%). However, the majority of antibiotic prescriptions in our cohort were for extra-pancreatic infections, not pancreatitis. It is not possible to determine the proportion of antibiotics prescribed for pancreatitis in the PROCAP study and therefore we are unable to compare our findings. Conclusions Rates of antibiotic prescribing for patients at RCHT with pancreatitis are comparable to those in the PROCAP non-PCT guided treatment group which might suggest that adoption of PCT in our hospital could reduce antibiotic prescribing, as per the findings of the PROCAP study. Rates of antibiotic prescribing for pancreatitis at RCHT are low, with the majority of prescribing for extra-pancreatic indications, although the indication was unclear in approximately one third of episodes. The PROCAP study does not report rates of prescribing for pancreatitis which prevents estimating the impact of PCT on antimicrobial prescribing for pancreatitis at RCHT. Whether PCT has a role in reducing antimicrobial prescribing for patients with pancreatitis at RCHT is unclear.