An exploration of the teaching and learning opportunities to promote resilience in the primary classroom.

This self-study action research investigated: what are the learning and teaching opportunities available in my first class classroom to promote resilience? Inspired by the growing interest surrounding resilience, well-being and mental health in children, this study grew out of a personal interest with the aim of introducing resilient approaches to teaching and learning in my classroom. Interventions were introduced in the form of increased interaction time, Fun FRIENDS programme, mindfulness activities and visual art lessons. The self-study action research model of this study allowed me to examine my own practices while working alongside the children as co-researchers. Qualitative data was collected and analysed using a reflective journal, surveys, classroom observations, visual data methods and finally feedback from critical friends. By engaging in reflective practice, a living theory was developed that demonstrates my core values. Findings include insights into the following: Teacher modelling of resilience Developing meaningful relationships in the classroom Cross-curricular links Promoting learner agency Resilience is developed from ‘ordinary rather than extraordinary processes’ (Masten, 2001). Considering that ‘no one is exempt’ (Grotberg, 1995, 5) from adversity, I believe that resilience is an essential life-long skill for young and old that must be nurtured throughout a child’s education so that children can effectively cope with the inevitable stresses of daily life. I strongly abide by the influential words of Laurence Stenhouse who argues that “it is teachers who will in the end change the world of the school by understanding it” (1981:104). It advocated my firm belief that teachers are one of the greatest assets of any education system. We, teachers stand on the frontline in the transferral of skills and values and so have a significant role in how knowledge is absorbed by our students

Preterm Premature Rupture of the Membranes (PPROM):a study of patient experiences and support needs

BackgroundPreterm prelabour rupture of membranes (PPROM) is a common obstetric condition but outcomes can vary depending on gestation. Significant maternal and fetal complications occur including preterm birth, infection, abruption, cord prolapse, pulmonary hypoplasia and even death. Although the need for psychological support is recognised it is unclear how much is actually offered to women and their families. This study aimed to survey the views of women and their families who have undergone PPROM in order to understand the care and psychological burden these families face.MethodsAn online survey was conducted, recruiting women via social media with collaboration from the patient advocacy support group Little Heartbeats. Responses were collated where fields were binary or mean and standard deviations calculated. Framework analysis was used to identify and analyse themes in free text responses. Results180 PPROM pregnancies were described from 177 respondents. Although care was variable and respondents were from across the world there were common themes. Five themes were highlighted which were: a lack of balanced information regarding the condition, support in decision making and support with the process, specific psychological support and ongoing psychological consequences of PPROM.ConclusionThis survey highlights areas in which care needs to be improved for women with PPROM. Previous studies have shown that providing good care during the antenatal period reduces long term psychological morbidity for the whole family. The need for support, with regard both to information provided to women and their families and their psychological support needs to be addressed urgently.<br/

Combined point of care nucleic acid and antibody testing for SARS-CoV-2 following emergence of D614G Spike Variant

Rapid COVID-19 diagnosis in hospital is essential, though complicated by 30-50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant now dominates the pandemic and it is unclear how serological tests designed to detect anti-Spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95CI 57.8-92.9%) by rapid NAAT alone. Combined point of care antibody test and rapid NAAT is not impacted by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Funder: Addenbrooke's Charitable Trust, Cambridge University Hospitals; FundRef: http://dx.doi.org/10.13039/501100002927Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff

Measuring and improving patient safety in general practice in Ireland

Due to the large volume of primary care consultations and increasing patient complexity, there is substantial potential for unintentional patient harm. Measuring and monitoring of safety is essential to identify the contributory factors to patient harm and to strengthen safety systems to reduce the risk of future harm. Whilst proactive safety assessment methods are emerging in primary care, General Practitioners (GPs) report difficulty in knowing how to improve patient safety. A multi-method approach was taken to examine how patient safety can be measured, monitored and improved in primary care and how GPs can use this information to improve patient safety. Study 1 is a systematic review of the safety climate (SC) survey instruments that have been utilized in primary care. It considers the reliability and validity of these measures and their suitability for use in primary care settings. Study 2 reports the findings from a survey of perceived SC across primary care practitioners and staff in Ireland and compares the findings to similar SC surveys conducted in primary care in England and Scotland. These findings highlight the negative impact of workload on perceived SC across the three studies. Study 3 describes the feasibility of implementing a patient safety intervention developed to proactively improve safety in primary care. It specifically addresses the impact of the intervention on SC and the acceptability of the intervention to GPs and practice staff. Finally, study 4 identifies contributory factors to patient safety incidents in primary care using the critical incident technique interview approach. The findings from these four studies highlight the importance of choosing measurement instruments that are valid, reliable, feasible and context-specific. These studies demonstrate that there are a wide range of approaches to support safety improvement in primary care. The challenge is how to encourage and support the use of these techniques in busy GP practices

Measuring and improving patient safety in general practice in Ireland

Due to the large volume of primary care consultations and increasing patient complexity, there is substantial potential for unintentional patient harm. Measuring and monitoring of safety is essential to identify the contributory factors to patient harm and to strengthen safety systems to reduce the risk of future harm. Whilst proactive safety assessment methods are emerging in primary care, General Practitioners (GPs) report difficulty in knowing how to improve patient safety. A multi-method approach was taken to examine how patient safety can be measured, monitored and improved in primary care and how GPs can use this information to improve patient safety. Study 1 is a systematic review of the safety climate (SC) survey instruments that have been utilized in primary care. It considers the reliability and validity of these measures and their suitability for use in primary care settings. Study 2 reports the findings from a survey of perceived SC across primary care practitioners and staff in Ireland and compares the findings to similar SC surveys conducted in primary care in England and Scotland. These findings highlight the negative impact of workload on perceived SC across the three studies. Study 3 describes the feasibility of implementing a patient safety intervention developed to proactively improve safety in primary care. It specifically addresses the impact of the intervention on SC and the acceptability of the intervention to GPs and practice staff. Finally, study 4 identifies contributory factors to patient safety incidents in primary care using the critical incident technique interview approach. The findings from these four studies highlight the importance of choosing measurement instruments that are valid, reliable, feasible and context-specific. These studies demonstrate that there are a wide range of approaches to support safety improvement in primary care. The challenge is how to encourage and support the use of these techniques in busy GP practices