Author: Jason Curtis

Datix Incident Triage for UEC (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Kelly Booth, *Gemma Selby, *Michelle Causier

Citation:

SaTH Improvement Hub, August 2024

Abstract:

To introduce a process so the ED & QGT team would have oversight over every single incident by July 2024 as evidenced by the team having a real time awareness of themes and trends that could be shared with the areas.

Link to PDF poster

Enhanced Care and Supervision Provision (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Sam Matthews

Citation:

SaTH Improvement Hub, September 2024

Abstract:

To create a substantive Enhanced Care and Supervision team that would reduce bank and agency staffing spend for ECS and Improve the quality of ECS for patient safety and experience as evidenced by a reduction in agency spend and feedback from patients, family and staff by September 2024.

Link to PDF poster

Improvement - Swan Suite for Relatives Ward 15/16 (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Jules Lewis, *Rebekah Tudor

Citation:

SaTH Improvement Hub, September 2024

Abstract:

To improve the current relatives room & create a Swan suite on Ward 15/16 for relatives to allow staff to have open and honest conversations about end of life care. This will be achieved by September 2024. Official opening the room is planned for October 2024.

Link to PDF poster

Screening of Patients for Dementia (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Gemma Styles, *Karen Breeze

Citation:

SaTH Improvement Hub, August 2024

Abstract:

To increase the amount of patients in the hospital that receive a screening for Dementia by a medic or surgeon by 10 percent. To be completed by the end of May 2024 as evidenced by an increase in scores on the quality audit.

Link to PDF poster

Evolving to Involve: Transforming Observing Learners into Active Participants (2024)

Posted on by

Type of publication:

Poster presentation

Author(s):

*Dr Amy Ingham Farrow; *Dr Emily Thorley

Citation:

Journal of Healthcare Simulation 2024;4(Suppl 1):A67

Abstract:

Introduction:
As an educational modality, simulation “can improve the quality and impact of training provided to doctors now and in the future” [1] but is labour and time intensive due to the small group sizes required to achieve maximum efficacy [2]. Foundation doctors currently undertake two and a half days of multidisciplinary simulation, with scenarios constructively aligned to their curriculum [3]. The need for additional simulation opportunities that are accessible to larger groups of doctors was identified. These sessions would require a more efficient style of delivery to ensure the engagement of all participants, not just those selected to enter the simulation environment. Could the use of multi-modal teaching transform observing learners into active participants to reach a larger audience?

Methods:
The three-part session was designed as an immersive simulation with an integrated interactive prescribing tutorial. This targeted the acute management of a patient with diabetic ketoacidosis and the following twelve hours of their care. The tutorial tasked all attendees (not just those involved in the simulation) with using the Trust protocol to prescribe appropriate treatment at various intervals in response to simulated clinical findings.

Pre- and post-intervention questionnaires explored participants’ views on styles of teaching and examined any changes in clinical confidence and perceptions around the multi-modal teaching style.

Results:
Responses were collected from sixteen Foundation Year 2 doctors who attended the two-hour training afternoon as part of their teaching programme. Data indicated an increase in numbers who agreed or strongly agreed that actively watching scenarios was as valuable as taking part themselves. Additionally, doctors were more confident prescribing treatments based on Trust protocols and were more comfortable using Trust guidelines to manage an unwell patient. Naturally, some challenges arose, with minor changes needed before we repeat this with Foundation Year 1 doctors.

Discussion:
There is huge scope for development of scenarios that integrate different teaching methodologies into simulation-based training. The success of this session has confirmed that, in addition to actively involving larger numbers of participants, a multi-modal teaching style can provide an enhanced opportunity for participants to follow the management of a patient over a longer period than is ordinarily afforded by established simulation formats. It also highlighted the value of this approach in provision of responsive teaching to address prescribing safety incidents. The potential for designing scenarios which allow incorporation of clinical skills using task-trainers is also an exciting possibility.

References:
1. Purva M, Fent G, Prakash A. Enhancing UK Core Medical Training through simulation-based education: an evidence-based approach A report from the joint JRCPTB/HEE Expert Group on Simulation in Core Medical Training [Internet]. 2016. Available from: https://www.jrcptb.org.uk/sites/default/files/HEE_Report_FINAL.pdf

2. Au ML, Tong LK, Li YY, Ng WI, Wang SC. Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis. Nurse Education Today. 2023 Feb;121:105705.

3. UK Foundation Programme. UK Foundation Programme Curriculum 2021 [Internet]. 2021 May [cited 2024 Feb 28]. Available from: https://healtheducationengland.sharepoint.com/sites/UKFPOT/WebDocs/Forms/AllItems.aspx?id=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum%2FUKFP%20Curriculum%202021%5FOct22%20update%2Epdf&parent=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum&p=true&ga=1

Link to abstract [no password required]

Link to poster [no password required]

Monoclonal Gammopathy of Multisystemic Significance: A Challenging Diagnosis of Light Chain Amyloidosis (2024)

Posted on by

Type of publication:

Journal article

Author(s):

*Owolabi, Olasunkanmi; *Yera, Hassan O; *Jenkins, Kathryn; *Pakala, Vijay; *Kundu, Suman.

Citation:

Cureus. 16(10):e72010, 2024 Oct.

Abstract:

We present a case of a 51-year-old woman diagnosed with light chain amyloidosis associated with monoclonal gammopathy of undetermined significance (MGUS). Initially, she presented with symptoms of heart failure, including palpitations, chest tightness, and shortness of breath, which were attributed to myocarditis based on cardiac magnetic resonance (CMR) imaging findings. However, her condition rapidly deteriorated, with recurrent admissions for worsening heart failure, cardiogenic shock, and stroke. A cardiac biopsy ultimately confirmed light chain amyloidosis, a rare complication of MGUS, which has a long-term risk of 0.8% in patients with light chain MGUS. Despite aggressive treatment, including chemotherapy and biventricular assist device implantation, her condition continued to decline, and she became ventilator-dependent and subsequently passed away. This case highlights the importance of considering amyloidosis in patients with MGUS and underscores the need for early diagnosis and intervention to prevent catastrophic outcomes.

Link to full-text [open access - no password required]

Enhancing Junior Doctors' Preparedness and Satisfaction in Trauma and Orthopaedics: A Quality Improvement Project With the Development of a Comprehensive Guidebook (2024)

Posted on by

Type of publication:

Journal article

Author(s):

Mohammed, Ghulam Dastagir Faisal; *Younis, Zubair; Amin, Jebran; Mansoor, Zaina; Lingnau, Leonie; Jesudason, Edwin P.

Citation:

Cureus. 16(9):e70061, 2024 Sep.

Abstract:

BACKGROUND: Junior doctors often feel underprepared for their trauma and orthopaedics (T&O) rotation due to limited exposure during medical school and inadequate support. This project aimed to enhance junior doctors' preparedness and satisfaction during their T&O rotation by developing a comprehensive guidebook that addresses key orthopaedic knowledge and logistical challenges. METHODS: A quality improvement project (QIP) was conducted at Ysbyty Gwynedd Hospital. Initial surveys identified factors contributing to poor experiences during the trauma and orthopaedics rotation, including limited knowledge of orthopaedic emergencies and a lack of useful reference resources. A guidebook was developed and refined through multiple plan-do-study-act (PDSA) cycles. The guidebook covered topics such as orthopaedic emergencies, common injuries, referral pathways, and hospital logistics, presented in an accessible flowchart format. RESULTS: The primary objective of achieving 75% satisfaction among junior doctors was successfully met, with satisfaction increasing from four (40%) to eight (80%) doctors in the most recent survey. Secondary outcomes included a marked improvement in the understanding of quality improvement projects, rising from three (30%) to eight (80%) doctors. Orthopaedic knowledge also saw a significant enhancement, increasing from four (40%) to nine (90%) doctors. Confidence in handling night on-call duties improved dramatically, with all 10 doctors (100%) reporting increased confidence, compared to four (40%) doctors initially. Additionally, seven doctors (70%) expressed a greater interest in pursuing a career in orthopaedic surgery. CONCLUSION: The comprehensive guidebook significantly improved junior doctors' preparedness and satisfaction during their T&O rotation. While the guidebook is a valuable resource, ongoing mentorship and hands-on experience remain essential for long-term success. Replication of this project across other departments and hospitals is recommended to assess its broader applicability and impact.

Link to full-text [open access - no password required]

Hypoxia-associated gene signatures are not prognostic in high-risk localised prostate cancers undergoing androgen deprivation therapy with radiotherapy (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Reardon, Mark D; Bibby, Becky As; Thiruthaneeswaran, Niluja; Pereira, Ronnie R; Mistry, Hitesh; More, Elisabet; Tsang, Yatman; Vickers, Alexander; Reeves, Kimberley; Henry, Ann; *Denley, Helen; Wylie, James; Spratt, Daniel; Hakansson, Alex; Ryu, Monica; Smith, Tim Ad; Hoskin, Peter J; Bristow, Robert; Choudhury, Ananya; West, Catharine Ml.

Citation:

International Journal of Radiation Oncology, Biology, Physics. 121(3):752-760, 2025 Mar 01.

Abstract:

PURPOSE: Men with high-risk prostate cancer (PCa) are treated with androgen deprivation therapy (ADT) and radiotherapy, but the disease reoccurs in 30% of patients. Biochemical recurrence of PCa after treatment is influenced by tumour hypoxia. Tumours with high levels of hypoxia are aggressive, resistant to treatment, and have increased metastatic capacity. Gene expression signatures derived from diagnostic biopsies can predict tumour hypoxia and radiosensitivity, but none are in routine clinical use, due to concerns about the applicability of these biomarkers to new patient cohorts. There has been no or limited testing in cohorts of high-risk PCa. METHODS AND MATERIALS: We generated transcriptomic data for cohorts of high-risk PCa patients. Patients were treated with ADT followed by external beam radiotherapy with or without a brachytherapy boost. Biomarkers curated from the literature were calculated from pre-treatment biopsy gene expression data. The primary endpoint for survival analyses was biochemical recurrence-free survival (bRFS) and the secondary endpoints were distant metastasis-free survival (DMFS) and overall survival. RESULTS: The performance of the selected biomarkers was poor, with none achieving prognostic significance for bRFS or DMFS in any cohort. The brachytherapy boost cohort received shorter durations of ADT than the conventionally fractionated or hypofractionated cohorts (Wilcoxon rank sum test, p=2.1×10-18 and 2.3×10-10 respectively) and had increased risk of distant metastasis (log-rank test, p=8×10-4). There were no consistent relationships between biomarker score and outcome for any of the endpoints. CONCLUSIONS: Hypoxia and radiosensitivity biomarkers were not prognostic in high-risk PCa patients treated with ADT plus radiotherapy. We speculate that the lack of prognostic capability could be caused by the variable hypoxia-modifying effects of the ADT that these high-risk patients received before and during definitive treatment with radiotherapy. A deeper understanding of biomarker construction, performance and inter-cohort transferability in relation to patient characteristics, sample handling and treatment modalities is required before hypoxia biomarkers can be recommended for routine clinical use in the pre-treatment setting.

Link to full-text [open access - no password required]