London Borough of Tower Hamlets

This study evaluated whether brief teaching sessions on transference-focused psychotherapy (TFP) could improve psychiatric trainees' attitudes and clinical confidence in managing patients with personality disorders. A mixed-methods design was used, combining pre- and post-training validated questionnaires with a focus group discussion. Two 4-h workshops covered TFP theory and techniques, and case discussions. Twenty-six participants completed paired questionnaires. Statistically significant improvements were observed in overall attitudes (Attitudes to Personality Disorder Questionnaire total score, P = 0.022) and enthusiasm towards patients with personality disorders (P = 0.003). Clinical confidence (Clinical Confidence with Personality Disorder Questionnaire) improved markedly (P < 0.001). Qualitative analysis identified high acceptability, valuing TFP concepts and enhanced emotional awareness, although participants desired more practical components. Even brief TFP training can positively influence trainees' attitudes and confidence in treating personality disorders. Incorporating TFP-informed training into psychiatric education may reduce clinician frustration and improve therapeutic engagement with this complex patient group.

This paper takes the reader through the development of two IOGP (International Oil and Gas Producers Organization) guidance documents related to subsea CCS (Carbon Capture and Sequestration) system design and technology. For more information on IOGP see Appendix 1. In developing the guidance, the team adopted a number of ‘new to IOGP’ Agile1 ways of working to achieve the target goal of issuing the initial guidance in under 12 months. This quick turnaround was seen as necessary to make the guidance quickly available to the offshore industry, which saw a significant increase in subsea project activity at that time. The paper starts by outlining the background and drivers of the guidance development, before moving on to look at the structure of each guidance document. Where relevant, Agile processes were used to drive the development process and keep it on track. The specifics of this and use cases are covered in some detail later in the paper. The paper concludes with reflection and lessons learned from the guidance development process. The paper is not intended to provide the reader with an introduction to Subsea CCS, as the guidance documents provide this! - and are freely available to download from the IOGP website.

Abstract Objective To compare clinical summaries generated from simulated patient primary care electronic health records (EHRs) by GPT-4, to summaries generated by clinicians on multiple domains of quality including utility, concision, accuracy, and bias. Materials and Methods Seven primary care physicians generated 70 simulated patient EHR notes, each representing 10 patient contacts with the practice over at least 2 years. Each record was summarized by a different clinician and by GPT-4. artificial intelligence (AI)- and clinician-authored summaries were rated blind by clinicians according to 8 domains of quality and an overall rating. Results The median time taken for a clinician to read through and assimilate the information in the EHRs before summarizing, was 7 minutes. Clinicians rated clinician-authored summaries higher than AI-authored summaries overall (7.39 vs 7.00 out of 10; P = .02), but with greater variability in clinician-authored summary ratings. AI and clinician-authored summaries had similar accuracy and AI-authored summaries were less likely to omit important information and more likely to use patient-friendly language. Discussion Although AI-authored summaries were rated slightly lower overall compared with clinician-authored summaries, they demonstrated similar accuracy and greater consistency. This demonstrates potential applications for generating summaries in primary care, particularly given the substantial time taken for clinicians to undertake this work. Conclusion The results suggest the feasibility, utility and acceptability of using AI-authored summaries to integrate into EHRs to support clinicians in primary care. AI summarization tools have the potential to improve healthcare productivity, including by enabling clinicians to spend more time on direct patient care.

Abstract Background. In the United Kingdom, local government is well-placed to conduct and apply research about the wider determinants of health. However, local authorities often lack sufficient research infrastructure to support research capacity, capability and culture. Since 2022, the UK National Institute for Health and Care Research has funded 30 Health Determinants Research Collaborations (HDRCs) to develop this infrastructure. HDRCs are hosted by local authorities collaborating with universities and other partners to strengthen a culture of evidence-informed decision making. HDRCs are conducting local evaluations, including baseline assessments of local authority research capacity, capability and culture. Methods. A national peer-support group was formed to support shared learning among teams evaluating HDRCs. Here, as embedded evaluators from 10 HDRCs, we present reflections on the planning, delivery, and interpretation of baseline assessments. Reflections were gathered via group discussions and written submissions. All 10 HDRC baseline assessments explored local authority research capacity, capability and culture, and two also studied early HDRC team collaboration. Results. Competing priorities during early HDRC implementation called for pragmatic and timely baseline assessment methods. Most HDRCs developed baseline surveys, though interviews and focus groups were conducted by some. Despite similar aims, methods varied substantially according to local contexts. Evaluators often adapted existing validated survey tools, e.g., from health settings, as none were identified for use across local government. Definitions of research also ranged from academic definitions to broader notions of evidence. Useful insights were gathered across diverse samples to aid implementation locally, however low response rates were received to all-staff surveys and heterogenous approaches limited comparison across HDRCs. Findings contributed to recommendations for evaluating and developing HDRC activities (e.g., communications and training provisions) appropriate for local authorities with stretched resources. Where measured, collaborations were functioning well, with recommendations to enhance communication. Conclusions. The early contexts and challenges of HDRCs influenced pragmatic baseline assessments. Methods were often chosen to capture baseline contexts rapidly, and they will be refined and complemented by additional evaluation methods as HDRCs progress. Developing new validated measures and an agreed definition of research for local authorities may strengthen understanding of research capacity, capability and culture across local government.

ABSTRACT This paper discusses the implementation of the London Borough of Tower Hamlets Health Impact Assessment (HIA) Policy and presents the results of a process evaluation aimed to assess its implementation and gain understanding on the benefits and challenges brought by the HIA Policy. Following a case study approach, a process evaluation was undertaken comprising in-depth interviews with Public Health and Development Management and focus groups with consultants, who conducted HIAs. Submitted HIAs (64) were reviewed and analytically assessed against key criteria. The HIA implementation was internally evaluated as part of a capacity building programme. The evaluation showed that whilst there was a consensus on the importance of embedding health considerations in developments and that a good partnership had been developed between health and planning teams, several barriers to effective implementation existed. These included: lack of capacity to carry out the HIA among planners, lack of national policy levers and other mechanisms to integrate HIA into planning, lack of community engagement by developers and problems carrying out monitoring and evaluation. The evaluation underscored the need to strengthen the partnership between Health and Planning while improving the HIA process and better integrating health in planning policies at local, regional, and national levels.

Abstract Background Free school meals offer a crucial safety net for children facing poverty and food insecurity. In the London Borough of Tower Hamlets in England, where over half of local children experience poverty, child-centred policies like universal free school meals have been implemented to support all children, regardless of family income. Despite World Health Organization recommendations for whole-school approaches to food, many schools have yet to implement them. The Food Improvement Goals in Schools I study, funded by ActEarly, evaluated the “Fantastic Food in Schools” programme, aiming to improve whole-school approaches to healthy food, including universal free school meals, in Tower Hamlets’ primary schools. Methods Informed by material, relational and symbolic factors, we explored how food provision and interventions were perceived and practiced in six primary schools. A focused ethnography was conducted over 210 hours across seven months in 2023, involving observations of interventions, sharing lunches with children and over 100 informal conversations. We carried out semi-structured interviews with 16 staff, 20 parents and 12 mini-groups with 43 children, using creative methods. Data were analysed thematically and interpreted through panels with community researchers. Results Universal free school meals were perceived to promote equity and health, particularly given the UK cost-of-living crisis. Child-centred interventions engaged children and families, encouraging healthy eating at school and at home. Schools served as spaces to explore food’s cultural significance, helping navigate the complexities of children’s preferences, familiarity, identities, healthier eating and needs in a diverse community. School menus improved, given collaborative efforts from catering services and kitchen staff. Yet, resource challenges and growing parental expectations to address systemic issues like food insecurity highlight the need for greater funding and policy-based support. Conclusions Universal free school meals and whole-school approaches to food can enable equitable cultural inclusion in diverse, urban areas like Tower Hamlets, supporting Sustainable Development Goal 2: Zero Hunger. However, these initiatives require increased funding and targeted financial incentives for schools to implement them effectively. Local authorities need the backing of educational policy to prioritise and secure the necessary resources to promote healthy eating and ensure equitable access to nutritious food for all children.

Complex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Health inequalities are where we see differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable (1). They need a long-term systemic response to support people to value their health and wellbeing (2). These social, economic environmental, cultural and commercial factors, known as the wider determinants of health, are unequally distributed across the UK population (3). This is despite numerous attempts to address them at a local, national and internationally (4, 5).

General practice has one of the most diverse medical training programmes in terms of sex and ethnic background. However, this diversity of race and ethnicity is not reflected in academic GP careers, with just 17% (n = 81/473) of academic GPs being from racially minoritised groups, according to the Medical Schools Council. To determine whether GP academic clinical fellow (ACF) trainees from racially minoritised backgrounds are proportionally represented, compared with the non-academic training programme, using the annual GP ACF conference as a proxy. A retrospective analysis of conference programmes from national academic GP training conferences from 2018-2023 and demographic data obtained from Health Education England (HEE). Using conference programmes and online searches, demographic information on conference speakers was obtained and a freedom of information request was made to HEE for the demographics of GP ACFs for corresponding years. This was compared with demographic data of GP trainees and academics. On average, there were 40 speakers each year at the conference. White females (average 20.2 speakers each year) were the most well represented group, followed by White males (average 12.5), Asian females (average 3.3), Asian males (average 1.8), Black males (average 0.7), and Black females (average 0.3). HEE data from 2022 revealed that 27 (71.1%) of the 38 (excluding five who did not state their ethnicity) ACFs were White British. GP academia should be more representative of the non-academic GP training scheme. Work needs to be done to understand and overcome the structural barriers to recruiting from racially minoritised groups.