Can the child witness provide accurate testimony?

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Assessing a Temporary Isolation Room From an Infection Control Perspective: A Discussion Paper

Introduction Assessing the functionality and infection control implications of new technologies presents significant challenges. In this discussion paper, we present our approach to assessing infection control aspects of a new isolation room, the RediRoom™ (prototype). We report how we evaluated this room, lessons learnt and suggestions for future evaluations in this area. Methods There is no documented method for evaluating a novel temporary isolation room. We combined a range of existing tools to undertake a technical assessment. Three approaches were used, an assessment against standards or guidelines; professional assessment; and a cleaning assessment. Results To assess compliance against existing recommendations related to the built environment and isolation rooms, elements contained within Australasian and United Kingdom guidelines were used. We were able to identify which elements in these guidelines were of the most value and relevance. An ultraviolet (UV) solution with fluorescent light assessment was used to assess the ability to clean surfaces. This approach was a useful objective measure. A professional assessment is potentially subjective, but provides an opportunity to identify other potential issues and benefits. In this study, the RediRoom™ performed well against all three approaches. We identified limitations in using existing guidelines for a temporary isolation room. Conclusion In our study, the use of video and video reflexive ethnography for the professional assessment would have been useful. We propose a revised list of assessment against which new isolation solutions or technologies could be assessed, with the view of others continuing to build on this

Faith-based alcohol treatment in England and Wales: new evidence for policy and practice

While the historical importance of religion in alcohol treatment is well known, the size, scope and significance of contemporary activities remain unclear. Here we begin to address this gap in knowledge by presenting results from a mixed methods study of faith-based alcohol treatment in England and Wales. The paper begins by mapping location, religious affiliation, organisational structure and service provision. We then discuss evidence regarding challenges, opportunities and tensions bound up with faith-based organisations ‘filling gaps’ left by long term restructuring of alcohol service provision, recent ‘austerity’ funding cuts and relationships between secular and faith-based organisations. In the final substantive section, we engage with questions of ethics and care by focusing on the internal workings of a subset of faith-based programs that make requirements for religious participation. Drawing on the variegated experiences of service-users, we reflect on the ethics of religious conversion in faith-based alcohol treatment. The conclusion offers policy and practice relevant insights and outlines areas for future research on religion, austerity, and alcohol treatmen

“It’s All About Balance…” Women’s Experience of Having One Breast

The aim of this thesis is to explore the experiences of women who have one breast, or who have the potential to be left with one breast, following a mastectomy for the treatment of breast cancer. Paper 1 is a qualitative literature review that explores women’s decisions to have a breast reconstruction or a contralateral prophylactic mastectomy (CPM) following a diagnosis of breast cancer. Through their decisions to have elective surgery, women avoid the possibility of having to manage a life with one breast. Twelve papers were critically appraised and synthesised using a thematic analysis. Women processed their decisions in similar ways irrespective of the surgical procedure. A breast reconstruction or CPM enabled women to move on from having cancer. Paper 2 is an empirical research paper that explores the experiences of seven women who have one breast after having a mastectomy. Women were interviewed and transcripts were analysed using Interpretative Phenomenological Analysis. After having a mastectomy, breasts were experienced to lose their meaning in a way that a reconstructed breast could not replace. Women described their experiences of using a breast prosthesis which served to restore women’s physical and social selves. Women focused on aspects of their lives which they valued over the loss of their breast. This enabled them to move on from cancer without having a breast reconstruction. Paper 3 provides a reflective commentary on Papers 1 and 2 which describes the ethical and methodological processes of conducting this research. The researcher reflects on her own positon within a breast cancer culture

Mental practice with interactive 3D visual aids enhances surgical performance

Background: Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. Methods: 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. Results: The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. Conclusion: These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance

Improving the impact of pharmacy interventions in hospitals

The clinical and pharmaceutical interventions of pharmacy professionals are considered impactful inputs towards optimised patient care and safety, by rationalising prescriptions, enhancing therapeutic choices and reducing and preventing medication errors and adverse effects. Pharmacy interventions (PIs), related to the identification, prevention and resolution of drug-related problems, should be recorded for optimal clinical governance and potential health outcomes. Between October 2020 and October 2021, the community hospitals at Powys Teaching Health Board recorded 158 PIs, corresponding to 0.4 interventions per staff per week. Only two members of the team were recording these PIs. Poor indicative PIs can result in lost opportunities for medication optimisation and prescribing rationalisation, increased costs and unidentified training potential. The aims of this project were (1) to record 180 interventions between 22 November 2021 and 8 April 2022 (20 weeks), corresponding to an average threefold increase, compared to the interventions recorded between October 2020 and October 2021 (52 weeks); (2) to have all hospital pharmacy staff recording at least one intervention during the same period. The number of interventions recorded and the number of pharmacy staff recording each intervention were two process measures. The project was completed through two Plan-Do-Study-Act cycles and applied theory on managing change in healthcare. The most successful intervention influencing positively the process measures was the implementation of a new Pharmacy Intervention Record Tool (xPIRT) toolkit that included an online recording tool (xPIRT) and an interactive panel with up-to-date results from all interventions recorded (xPIRT Dashboard). Motivating change was proven to be one of the best determinants of user satisfaction and engagement that contributed to meet the project’s targets. xPIRT Dashboard provided staff the capacity to act on possible personal motivators and the possibility to improving care with medicines on their wards. The implementation of xPIRT toolkit was able to increase the representativity and significance of PIs recorded by the hospital pharmacy team, and it is expected to be used for personal professional development, demonstrating team activity and impact, service planning, prescribing practice optimisation and to identify education/training needs. This toolkit can be easily applied and adapted to other health organisations, settings and services