The Balancing Act

R (on the application of E) v Bristol City CouncilQueen’s Bench Division (Adminstrative Court) Bennett J., 13 January 2005EWHC (Admin) 7

White Bear

White Bear is a feature film screenplay, developed and written over a period of four years. It tells the story of one womans flight and subsequent fight to protect herself and her family from a controlling religious organization. Discovering the Church is holding her sister captive, protagonist Brie Demott takes her son and sets out into the unknown, seeking help from the outside world. In the end she must attempt the rescue herself. Though she fails to free her sister, in the process she frees herself. The story examines the nature of courage and fear through the journey and transformation of its characters. It explores the nature of control at the heart of a religious organization and the repercussions that the renunciation of belief has on an individual and their family

‘It’s not in my job description’: An exploration of trainee clinical psychologists’ attitudes towards research and perceptions of DClinPsy research culture

© 2023 The British Psychological Society. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.53841/bpscpf.2023.1.366.20This project aimed to investigate attitudes towards research and perceived research culture among trainee clinicalpsychologists across the UK. This was achieved by exploring factors such as: research training environment,research attitudes, research self-efficacy, and professional identity. An online survey was completed by 44 traineeclinical psychologists who started training in 2020. The findings showed that UK trainee clinical psychologistsdid not perceive a strong research training environment, they did not hold strong attitudes towards research,or have positive research self-efficacy as indicated in previous research. It is of some concern that the role ofresearcher, as part of the identity of a clinical psychologist, was not seen to be instrumental by most trainees.Important differences in the results of this research compared to previous published literature are discussed, inaddition to a consideration of the implications of these findings for training and the post-qualification role ofclinical psychologists.Peer reviewe

Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)—protocol for an individually randomised parallel-group trial

Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating-with a high associated mortality rate-and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less effective for dynamic pain and can cause serious side effects, including nausea, constipation, delirium and respiratory depression. These may delay surgery, require further treatment and worsen patient outcomes. We completed a feasibility study of paramedic-provided fascia iliaca compartment block (FICB), testing the intervention, trial methods and data collection. The study (RAPID) demonstrated that a full trial was feasible. In this subsequent study, we aim to test safety, clinical and cost-effectiveness of paramedic-provided FICB as pain relief to patients with suspected hip fracture in the prehospital environment. We will conduct a pragmatic multi-centre individually randomised parallel-group trial, with a 1:1 allocation between usual care (control) and FICB (intervention). Hospital clinicians in five sites (paired ambulance services and receiving hospitals) in England and Wales will train 220 paramedics to administer FICB. The primary outcome is change in pain score from pre-randomisation to arrival at the emergency department. One thousand four hundred patients are required to find a clinically important difference between trial arms in the primary outcome (standardised statistical effect ~ 0.2; 90% power, 5% significance). We will use NHS Digital (England) and the SAIL (Secure Anonymised Information Linkage) databank (Wales) to follow up patient outcomes using routine anonymised linked data in an efficient study design, and questionnaires to capture patient-reported outcomes at 1 and 4 months. Secondary outcomes include mortality, length of hospital stay, job cycle time, prehospital medications including morphine, presence of hip fracture, satisfaction, mobility, and NHS costs. We will assess safety by monitoring serious adverse events (SAEs). The trial will help to determine whether paramedic administered FICB is a safe, clinically and cost-effective treatment for suspected hip fracture in the pre-hospital setting. Impact will be shown if and when clinical guidelines either recommend or reject the use of FICB in routine practice in this context. ISRCTN15831813 . Registered on 22 September 2021. [Abstract copyright: © 2022. The Author(s).

Implementing emergency admission risk prediction in general practice: a qualitative study

Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated, despite limited evidence about effects. In a trial evaluating the introduction of a Predictive Risk Stratification Model (PRISM), statistically significant increases in emergency hospital admissions and use of other NHS services were reported without evidence of benefits to patients or the NHS. To explore GPs' and practice managers' experiences of incorporating PRISM into routine practice. Semi-structured interviews were carried out with GPs and practice managers in 18 practices in rural, urban, and suburban areas of south Wales. Interviews (30-90 min) were conducted at 3-6 months after gaining PRISM access, and ∼18 months later. Data were analysed thematically using Normalisation Process Theory. Responders ( = 22) reported that the decision to use PRISM was based mainly on fulfilling Quality and Outcomes Framework incentives. Most applied it to <0.5% practice patients over a few weeks. Using PRISM entailed undertaking technical tasks, sharing information in practice meetings, and making small-scale changes to patient care. Use was inhibited by the model not being integrated with practice systems. Most participants doubted any large-scale impact, but did cite examples of the impact on individual patient care and reported increased awareness of patients at high risk of emergency admission to hospital. Qualitative results suggest mixed views of predictive risk stratification in general practice and raised awareness of highest-risk patients potentially affecting rates of unplanned hospital attendance and admissions. To inform future policy, decision makers need more information about implementation and effects of emergency admission risk stratification tools in primary and community settings. [Abstract copyright: © The Authors.