Ipswich Hospital

The burden of patient harm from unsafe care is disproportionately high in low-income countries, particularly in intensive care units (ICUs). Despite this, there is limited empirical evidence explaining the underlying challenges that make patient safety difficult to achieve in resource-limited ICUs. To explore the barriers to patient safety and incident-reporting in ICUs at Ethiopian university hospital. An exploratory qualitative descriptive study was conducted using in-depth interviews guided by a semi-structured protocol and informed by the Theoretical Domains Framework (TDF). Participants were purposively selected, and sample size was determined based on principles of data sufficiency. Reflexive thematic analysis with inductive orientation was employed following Braun and Clarke's approach. Thirty-nine healthcare professionals participated: 23 (59%) nurses, 13 (33%) physicians, and 3 (8%) clinical pharmacists. The mean age of participants was 32±5 years. Three overarching themes captured the barriers to patient safety and incident reporting in ICUs: (i) Fragile systems: Governance failure and resource constraints; (ii) Normalisation of deviance: teaching-hospital dynamics and clinical oversight, normalised communication lapses, and weak teamwork and relational context; and (iii) Silence trap: Fear in punitive and blame-oriented culture and lack of incident-reporting systems. Patient safety in Ethiopian ICUs is undermined by systemic, operational, and clinician-related obstacles. Structural and cultural barriers further hinder incident-reporting creating a vicious cycle where unsafe care remains hidden and opportunities for learning and improvements are lost. Breaking this cycle requires strong governance, coordinated resource investment, enhancing just culture, strengthening teamwork, establishing robust incident-reporting systems, and ongoing professional development focused on patient safety. Identifying barriers to patient safety and incident reporting in ICUs may enables targeted interventions that reduce preventable harm, improve care quality, and promote incident reporting and learning to sustain safe clinical practice.

Key content Amniotic fluid volume (AFV) is a vital measurement in the determination of fetal well‐being by means of ultrasound. There are many factors that determine AFV and, in many cases, complications affecting the fetus may manifest through change in its value. Isolated abnormal amniotic fluid index antenatally is relatively common, but its management remains contentious. The prevalence in the United Kingdom for isolated oligohydramnios is up to 5% of pregnancies, and isolated polyhydramnios complicates up to 2% of pregnancies. This article reviews and discusses the maternal and fetal implications of isolated oligohydramnios and polyhydramnios in the antenatal period, intrapartum and neonatal period. Learning objectives Overview of oligohydramnios and polyhydramnios and their aetiologies. Review threshold for timing of delivery and management of isolated oligohydramnios and polyhydramnios. Review of fetal and neonatal complications of oligohydramnios and polyhydramnios and their management.

Overactive bladder (OAB) symptoms are prevalent in patients with bladder outlet obstruction (BOO). Although the pathogenesis of OAB in men with BOO is still under investigation, OAB symptoms might persist following an outflow surgery. It is, thus, crucial to prognosticate preoperatively the outcome of a deobstructive operation. This review aims to systematically investigate the preoperative factors that could prognosticate the persistence of OAB symptoms following deobstruction surgery in males. This is a systematic review of the current literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Randomised controlled trials and observational studies of both prospective and retrospective design were considered eligible for the analysis. The Quality in Prognosis Studies tool was used for assessing the risk of bias. Thirty studies, involving 8043 patients who had persistent storage symptoms following surgical BOO relief, were included. Across adjusted analyses, older age and a higher baseline storage symptom burden were the most frequently associated factors, though findings were inconsistent. Urodynamic measures such as detrusor overactivity, bladder capacity, and detrusor contractility showed heterogeneous results, with some positive and some protective signals. Other factors (eg, prostate volume, prostate-specific antigen, maximum flow rate, postvoid residual, and comorbidities) were uniformly null. Overall certainty of evidence was very low, reflecting inconsistency, imprecision, and reliance on single-study signals. Current evidence is of limited quality; no preoperative factor demonstrated robust prognostic value. Older age and a greater storage symptom burden may be associated with persistence in some adjusted models, whilst urodynamic prognostic factors remain uncertain.

Abstract Monolithic integration of active and passive photonics is the next step in miniaturization of semiconductor devices, to streamline their manufacturing and in doing so reduce their cost. However, Si’s inefficiency as a light emitter, and the high absorption from quantum wells or dots in III-V materials, requires that the two materials are heterogeneously integrated. This requires either regrowth or additional packaging steps, which add complication in scaling to mass manufacture, as well as high losses at material interfaces. This work proposes a solution whereby a monolithically grown GaAs/AlGaAs platform with both active and passive devices is achieved by using two vertically stacked waveguides, where only one of them contains quantum dots. In the gain section, where the InAs quantum dots emit light centred at 1300 nm, the waveguides are decoupled. By changing the relative environment of the two waveguides, light can be made to evanescently couple into the passive waveguide for low loss passive devices. This change can be brought about either by changing the local etch depth, or by the selective oxidation of Al0.98Ga0.02As underlayers. For the correct geometry, 94% of optical power can be successfully coupled between the active and passive waveguide. This coupling is simulated on FIMMPROP by Photon Design Ltd.

Safe Spaces offer a person-centred, non-clinical and welcoming place for adults experiencing a mental health crisis to seek support as an alternative to presenting to the Emergency Department (ED). The aim of the study was to evaluate the effectiveness of Queensland Health’s Crisis Support Spaces (CSS), which are a hospital-based Safe Space service that has been piloted in the state of Queensland in Australia. The research employed a mixed-methods design. Retrospective, de-identified program data was analysed from 2,235 consumers who accessed a CSS in Queensland during the period of 23/01/2021 to 31/10/2023. Outcome variables were computed using data from Queensland Health’s Consumer Integrated Mental Health and Addiction (CIMHA) and Emergency Data Collection (EDC) datasets. Within-groups t-tests were used to analyse pre- to post- intervention changes in psychological distress ratings, number of mental health related ED presentations and number of mental health related hospital admissions. In addition, 78 semi-structured interviews were undertaken with CSS consumers and carers, CSS staff and broader mental health system staff; these were analysed using applied thematic analysis. Consumers experienced a statistically significant, large sized reduction in psychological distress ratings at post-intervention (mean difference = -2.9; p <.001; d = 1.30). A statistically significant, large sized reduction was also observed in the number of mental health related hospital interventions at 6-months post-intervention for those consumers with a prior history of inpatient admissions (mean difference = -1.0; p <.001; d = 0.80). Furthermore, a statistically significant, small sized reduction was observed in mental health related emergency department (ED) presentations at 6-months post- intervention for those consumers with a prior history of ED presentations (mean difference = -0.8; p <.001; d = 0.37). Qualitative data provided insights into potential mechanisms through which the service may achieve its intended outcomes (e.g., providing a safe environment for consumers to de-escalate their psychological distress, teaching consumers skills to self-manage their mental health). The findings of this study provide mixed-methods evidence supportive of the effectiveness of CSS in helping consumers reduce their psychological distress and preventing mental health related ED presentations and hospital admissions.

Distal radius fracture (DRF), a common upper extremity injury treated in outpatient hand therapy clinics, can lead to chronic pain and limitations in daily activities. Treatment often emphasises biomechanical aspects, like range of motion and oedema, while overlooking broader factors influencing recovery. This study explores therapists' perspectives on the recovery process in public healthcare and the contextual influences on therapeutic practices for patients with DRF. Qualitative (Interpretive Description). Hand therapists in Australia's public healthcare system were recruited through professional associations. Focus groups and follow-up interviews were conducted to explore the therapist's perspectives on patient recovery and the contextual factors influencing practice and outcomes. Reflexive thematic analysis was applied to analyse the data and develop themes. 37 participants contributed to eight focus groups and seven follow-up interviews. Two categories aligned with the research aims: (1) Perspectives on patient recovery and rehabilitation following DRF and (2) Perspectives on contextual and environmental influences shaping therapeutic approaches. Four main themes were generated: (1) recovery looks and feels different for everybody, (2) fundamental components of effective therapeutic approaches, (3) therapist experience makes a difference, and (4) it's the system: some things are out of our control. Although therapists tended to prioritise a biomechanical approach for DRF, most acknowledged the importance of an individualised, biopsychosocial approach aligned with the International Classification of Functioning, Disability and Health framework. Experienced therapists shifted towards patient-centred care and recognised the significance of function in rehabilitation. However, contextual and systematic barriers within the Australian public healthcare system influence the therapeutic approach and recovery. Ongoing research is needed to refine practice and align therapist-patient expectations for DRF management.