Devon Partnership NHS Trust

Menopause is a transition experienced by all women that is considered a taboo subject in most workplaces globally. Menopause leads many women in healthcare to reduce their working hours, or to leave work, which means that patients and learners do not have access to their expertise. There is limited research exploring how healthcare staff experience menopause and the impact of the loss of senior women on junior staff. This study aimed to understand how the problem of the menopause at work in healthcare settings is characterised in the literature and to explore the implications of menopause at work. A scoping review was conducted using Arksey and O’Malley’s framework, including the 6th optional stage of stakeholder consultation. The searches were run on databases MEDLINE, EMBASE, PsycINFO, Social Policy and Practice and HMIC via OVID and CINAHL, via EBSCOhost combining terms for health personnel, workplace and menopause. We conducted thorough supplementary searches in addition to the database searches. Seventy-five articles from 13 different countries were included, of which 39 were empirical research. These revealed a vicious cycle: experiencing the menopause at work makes work more stressful and, when work is stressful, the experience of the menopause is exacerbated. Support interventions were widely discussed but there was no evidence of the interventions being tested for effectiveness. There were three main themes of implications for women experiencing menopause: implications for perception of self, implications for relationships at work and implications for work/career. There was minimal discussion about implications for colleagues and patients and none about implications for learners. We have highlighted a small body of empirical research on the topic of the menopause in the healthcare workplace and the implications of this. Further research is required to understand the effectiveness of the interventions being used and to understand the implications for health professions education.

Mục tiêu nghiên cứu: Nghiên cứu đặc điểm lâm sàng, cận lâm sàng của bệnh nhân (BN) TTP cấp và tìm hiểu tác động của chúng đến kết quả điều trị bằng thuốc tiêu sợi huyết alteplase. Đối tượng, phương pháp: Nghiên cứu hồ sơ bệnh án của 52 BN TTP cấp từ tháng 10/2019 đến tháng 4/2025 được điều trị thuốc tiêu sợi huyết alteplase tại Viện tim mạch Bệnh viện Bạch Mai. Kết quả: 17 BN nam và 35 BN nữ (67%), tuổi trung bình 61 ±18, tất cả đều có điểm sPESI ≥ 1 điểm (38% BN 2 điểm, 15% BN 3 điểm). 28 BN nguy cơ cao (53,9%), 24 BN nguy cơ trung bình-cao. 37 BN (71,2%) tiến triển tốt và xuất viện, 15 BN (28,8%) tiến triển nặng (tử vong, xin về không tiếp tục điều trị). Triệu chứng lâm sàng: khó thở (94%), đau ngực (75%), tần số tim > 100 lần/phút (73%), thở nhanh > 20 lần/phút (46%), SpO2 < 90% (46%), huyết áp tâm thu < 90 mmHg (31%). 100% BN phải hỗ trợ hô hấp khi vào viện (65,4% thở oxy qua sonde mũi, 32,7% phải thở máy xâm nhập, 1,9% thở máy không xâm nhập). Trên điện tâm đồ, 58% BN có hình ảnh S1Q3T3, 50% sóng T đảo ngược ở các chuyển đạo trước tim. Trên siêu âm tim, 33% BN có chỉ số thất phải/thất trái >1 và 15% phát hiện huyết khối trong buồng tim phải. 94% BN có huyết khối tĩnh mạch sâu chi dưới, 100 % BN có nồng độ hs troponin T > 0,1ng/mL và NT-ProBNP > 500 pg/mL. Những BN tiến triển nặng thường là những BN TTP nguy cơ cao (87%), suy hô hấp nặng khi nhập viện (SpO2 < 90%), phải thông khí nhân tạo xâm nhập (93%), tỷ số thất phải/thất trái > 1 (87%). Kết luận: Bệnh nhân TTP cấp được điều trị bằng thuốc tiêu sợi huyết đều có nguy cơ cao và nguy cơ trung bình cao. Bệnh nhân tiến triển nặng thường suy hô hấp nặng, phải thông khí nhân tạo xâm nhập, trên siêu âm tim thường tăng gánh thất phải nặng.

Endotracheal intubation is an important pre-hospital intervention in critically ill patients. However, it can be a challenging skill, and previous studies have highlighted varying success rates. The European Resuscitation Council (ERC) have set a clear target of a greater than 95% success rate within two attempts, for all clinicians who provide endotracheal intubation during cardiac arrest. This service evaluation looks to explore the impact of training and education on the intubation performance of critical care paramedics. Retrospective data was collected from a single service over a six year period, from April 2019 to December 2024. During that time period, a number of educational or organisational interventions were introduced, with the aim of improving endotracheal intubation success rates. Data from all intubation attempts for patients in cardiac arrest by critical-care paramedics working with the Devon Air Ambulance Trust were recorded. The primary outcome was the rate of success of endotracheal intubation within two attempts. Secondary outcomes included the rate of first-pass success and the number of patients who had a failed first intubation attempt and did not receive a subsequent attempt. A Chi-squared statistical test was used to judge the significance of change between data from the years 2019 and 2024. 390 patients were included and reviewed. Between 2019 and 2024, success rates within two attempts improved by 7.9% points (χ2 = 4.205, p = 0.040), while first-pass success rates improved by 18.4% points (χ2 = 7.125, p = 0.0076). The success rate within two attempts at endotracheal intubation in 2024 was 97.7%. Over the whole time period, intubation was successful within two attempts in 94.6% (n = 369) of patients, while the first-pass success rate was 82.6% (n = 322). Of the 68 patients who had an unsuccessful first intubation attempt, 19.1% (n = 13) did not receive a second attempt. Implementation of a training and education programme was associated with a significant improvement in endotracheal intubation success rates within the service. With dedicated training, critical care paramedics demonstrate safe and effective endotracheal intubation for patients in out-of-hospital cardiac arrest, meeting the ERC recommendations of a greater than 95% success rate within two attempts at intubation.

BackgroundNewly qualified doctors who are at the beginning of their professional careers are now at a significant risk of burnout. This is in-keeping with doctors in the UK who are concerned about developing burnout during the UK Foundation Programme (UKFP). The UKFP is the first role doctors have working within the National Health Service (NHS). This research aims to explore factors within the UKFP which contribute to newly qualified doctors experiences of burnout.MethodsSemi-structured interviews were conducted with 7 foundation doctors within one NHS trust to explore their experiences of burnout. A thematic analysis was then carried out using the data collected from these interviews.ResultsThe majority of doctors interviewed were able to discuss their own experiences of burnout and how it has impacted their role as a newly qualified doctor. Some doctors believe that working as a foundation doctor directly contributed to their experiences of burnout. Whereas other doctors considered wider issues within the NHS such as bullying and staffing issues to be contributing factors. In contrast, the community aspect of the UKFP was considered to be a protective factor against burnout.ConclusionsBurnout is a real concern amongst foundation doctors and many doctors will experience burnout at the beginning of their career. Therefore, further research is needed to identify effective support measures which can be implemented within the UKFP and used to support doctors as they begin their career in the NHS.

PurposeThis paper aims to focus on concerns unique to international medical graduates (IMGs) and doctors from global majority groups pursuing a career in psychiatry in the UK. It specifically addresses challenges affecting the differential attainment of IMGs in passing the Clinical Assessment of Skills and Competencies (CASC) examination – the final assessment for attaining Membership of the Royal College of Psychiatrists, affording entry to specialty training programmes.Design/methodology/approachReflections are provided on learning from a CASC examination preparatory course specifically developed for IMGs in psychiatry, particularly those from global majority groups. The rationale for the course is set out as well as some of the challenges in designing and developing the course.FindingsBy reflecting on the experience of developing the course, the intersection of medical education, differential attainment and cultural disparities in training is addressed, alongside the role of group practice in exam preparation and support tailored to the needs of IMGs from global majority groups.Originality/valueThe reflections provided illuminate possible means of innovation to support the progression of IMGs and doctors from global majority backgrounds in the CASC, as a high stakes examination in medical training, and to support action to improve overall outcomes for this community in the field of psychiatry.

Bipolar disorder is a potentially lifelong and disabling condition characterised by episodes of mania or hypomania and episodes of depressed mood. In recent decades the focus of management has shifted towards supporting patients towards self-recovery. The author of this article conducted a narrative review of the qualitative literature to explore the experiences of self-recovery among adult patients with bipolar disorder. Six themes emerged from the thematic synthesis – relapse prevention, acceptance, social and professional support, lifestyle, psychological therapy and psychoeducation. Understanding the psychosocial factors that influence recovery in bipolar disorder can guide recovery-oriented interventions, potentially leading to enhanced well-being and quality of life for patients.

In the context of the large-scale introduction and development of new roles within the psychological professions which are first outlined, this article explores a number of emerging frameworks which may be useful in meaningfully aligning these new roles with each other, with the wider family of psychological professions, and with other professional groups commonly employed in the NHS. The role of frameworks that enable clear comparison of shared and distinctive features of roles and highlight inter-dependencies will be explored in the context of their potential to reduce confusion, support career pathways and maximise the impact that psychological professions can have within the NHS and beyond. This article will also seek to explore how psychologists can help to support the ongoing development, implementation and wider understanding of these new roles within the extended family of Psychological Professions in England.

BackgroundOne-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited.AimsTo enumerate risk factors associated with constipation in this population.MethodA questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation.ResultsOf the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender.ConclusionsPeople with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.