NHS Forth Valley

With Complex Post Traumatic Stress Disorder (CPTSD) as a new diagnostic category, there is a diversity of interventions and influences on clinical practice, it is prudent that we gather information about current 'treatment as usual'. This study aims to address this need by describing the current clinical landscape of CPTSD treatments offered in NHS services in Scotland. An online survey was distributed via heads of service managers to clinicians working with adults. The survey posed questions about psychological therapy models, professional experience and, for the clinicians' latest 3 discharged cases, the length of therapy and perceived patient outcomes. Forty-nine clinicians, most of whom were clinical psychologists, took part and provided data about 139 clinical cases. Twenty-three different therapeutic models were cited by clinicians, with phase-based approaches described by 64% of clinicians. The modal number of sessions was 21-30. Most cases were described as completed, with 28% ending before therapy was completed, and a further 7% dropped out. Of those who completed therapy, 86% were judged to have improved after therapy, with 11% judged to have deteriorated. There is a wide variety of treatments available for complex PTSD, and innovative interventions and trials are required to support future clinical decision-making about the optimal treatment components and therapy length.

BackgroundHealthcare is a significant contributor to global emissions, with the sector accounting for large proportion of emissions worldwide. The NHS aims to achieve net-zero carbon emissions, necessitating constant evaluation of clinical practices that contribute to environmental waste. A key antimicrobial stewardship goal; IV to oral switch encompasses these key areas, with oral antibiotics presenting a potentially cheaper, time-efficient and less environmentally damaging option while maintaining effectiveness.ObjectivesThe aim of this evaluation was to compare the nursing time taken for preparation and administration of IV antibiotics versus oral antibiotics and to assess and quantify the associated clinical waste and potential environmental impact. A further aim was to compare the cost between preparations.MethodsA literature review was conducted to inform project design and contextualize findings. A data collection sheet was developed to record antibiotic type, route, preparation time, administration time and waste materials used. Observations were conducted over three days on a surgical ward within a district general hospital. Nursing staff were timed using a stopwatch during their preparation and administration of antibiotics. Equipment use was categorized (e.g. syringes, infusion bags, PPE) and quantified for each observed dose.ResultsThe data collected included 36 IV preparations, 28 IV administrations and 18 oral administrations. The average time required to prepare and administer IV antibiotics was 14.12 min, compared to 0.27 min for oral antibiotics, a 98.1% difference. Over one month, this equated to 295.81 h of nursing time for IV antibiotic tasks, versus 5.66 h if all doses were oral. Waste analysis showed IV antibiotics generated significant single-use plastic waste, including multiple syringes, water for injection vials, giving sets and PPE per dose. Flucloxacillin produced the highest volume of waste due to its high dosing. In contrast, oral antibiotics generated minimal waste. The associated cost was considerably higher per IV dose when compared to their oral equivalent.ConclusionsA substantially greater impact on nursing time was observed with IV antibiotic use versus oral. Oral antibiotics were additionally observed to cost less and produce minimal waste, when compared with IV, particularly where high daily doses were required. These findings are relevant given the existing workload pressures faced by nursing staff, where reducing time spent on IV preparation and administration could free capacity for direct patient care. Furthermore, the results highlight the importance of adopting more sustainable antibiotic prescribing practices. One solution is to reduce IV antibiotic burden by implementing prompt IVOST. Further research is needed to explore the wider impact across health boards and support national policies aligned with NHS sustainability goals.

<h3></h3> The administration of blended diet (BD), instead of commercial enteral formula was, until recently, considered out-with standard safe practice.¹ BD is increasingly considered as an alternative strategy for feeding in patients with Gastrointestinal Dystonia (GID). There is limited data on NTBM in the long-term BD population. We aimed to retrospectively review NTBM for BD within our regional service and make recommendations for practice from this data. Patients commenced on BD between 1/1/17–1/5/24 were identified from five regional dietetic databases. Baseline demographics, diagnoses, patient complexity and the presence of GID were gathered. Patients were established on BD by local process which includes; dietetic assessment of nutritional requirements, risk assessment and an educational package. BD volumes were prescribed in combination with enteral feeds and titrated upwards as tolerated; individualised dietetic plans were reviewed for nutritional adequacy and adjusted via MDT forum. BD patients were defined as either full or partial BD (commercial enteral formula used in combination with BD). Local guidance recommends NTBM at baseline,6 months, and annually thereafter for; U+E, LFT, Bone Profile, PTH, Vitamins A, B12, D, E, zinc, copper, selenium, magnesium, FBC, ferritin and folate.²Patients were screened for inflammatory response using serum albumin and C-reactive protein. 85 patients were established on BD. 25 (29%) of these patients had GID. 23 (27%) patients received concurrent vitamin supplementation. 65 patients received partial BD. 24 (28%) patients received full BD. 5 patients had NTBM as per guidelines, 44 patients had an initial set at 6 months, and 26 patients had an initial set 1 year after commencing BD. Abnormalities in NTBM identified ≥6 months after commencing BD are outlined in table 1. The frequency and severity of NTBM abnormalities compare favourably with previous review of enteral or orally fed patients with neuro-disability.³ We postulate that these favourable outcomes with NTBM reflect careful patient selection and intensive dietetic support. Under this pathway, we postulate that routine NTBM for Vitamin E, Copper and Selenium are not required in BD, and that NTBM is required only annually if first NTBM are within normal limits. Whether adjuvant enteral formula alongside BD diet helps to normalise micronutrients, or if vitamin supplementation is required warrants further research. <h3>References</h3> Durnan S, Kennedy A, Kennedy D, Stanley R, Donohoe S, Thomas S, <i>et al</i>. Practice Toolkit: The Use of Blended Diet with Enteral Feeding Tubes. British Dietetic Association. 2021. NHS Quality Improvement Scotland. Best Practice Statement; Caring for children and young people in the community receiving enteral tube feeding. 2007. Brooks M, Paxton CE, Cardigan T, Wilson DC, Barclay AR. Regular blood monitoring for enterally fed children?: a systematic review. <i>JPGN</i>. 2014;<b>Supp 1</b>(58):S4.

To examine patient satisfaction with long-acting injectable buprenorphine (LAIB) as opioid agonist therapy (OAT) during custody, the effect on prisoner behavior and illicit drug use in custody, and the impact on healthcare utilization within OAT programs in Scottish prisons. This observational, service evaluation included 134 adult patients (≥18 years) with opioid dependence. Clinically appropriate patients were stabilized on monthly LAIB. The following outcomes were evaluated at 12, 24, and 52weeks: patient satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM), patient-reported craving using a 100 mm visual analog scale (VAS), and opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS). Patient-reported illicit drug use and disciplinary actions were recorded. Retention on LAIB for 12 months or until release/transfer was 93.8%. Patient satisfaction with LAIB was high, with median global TSQM scores >80 at all timepoints in the whole population and in those transferred after reduction from high-dose methadone (>30 mg/day). Compared with the first 4weeks, craving significantly decreased at Weeks 12 and 24; the decrease at Week 52 was not statistically significant. COWS scores were also significantly lower at all timepoints. Levels of illicit drug use and disciplinary actions were low throughout. Healthcare worker contact time saved with LAIB versus methadone was estimated at ~100minutes per patient monthly. As of June 30, 2024, ~228hours in total are estimated to have been saved per month across the Forth Valley prison estate. This service evaluation demonstrates high levels of patient satisfaction with LAIB in the prison setting, with minimal disruption to patient comfort or behavior even during treatment transition. Provision of LAIB has reduced healthcare hours required to deliver OAT medication in the Forth Valley prison estate, allowing the reprioritization of some healthcare resources toward other health-promoting goals.

IntroductionFirst-line antibiotics for disease caused by nontuberculous mycobacteria (NTM) are often poorly effective. Bedaquiline is an attractive therapeutic option. Evidence regarding its clinical efficacy is limited. We report outcomes from the largest UK case series of patients with NTM disease who received bedaquiline.MethodsClinicians in NTM centres were contacted to ascertain whether they had used bedaquiline to treat NTM disease. Inclusion criteria for cases were microbiological confirmation of NTM infection and treatment for NTM disease with bedaquiline. Retrospective chart review was undertaken to collate demographics, investigations, regimens and outcomes.ResultsSeventeen patients (10 female; 7 male; median age decile 45–54 years) across 11 hospitals were identified. The commonest pre-existing lung conditions were bronchiectasis (n=5, 29%) and cystic fibrosis (n=4, 24%). Four individuals (24%) had HIV infection; three of whom had AIDS. Nine (53%) had NTM pulmonary disease, three (18%) single-site extrapulmonary disease and five (29%) disseminated disease. NTM disease occurred most frequently secondary to Mycobacterium abscessus (MAB) (n=8, 47%) and Mycobacterium avium complex (MAC) (n=6, 35%).The commonest indication for bedaquiline was NTM treatment failure (n=13, 76%). The BTS MDR TB CAS recommended bedaquiline in seven cases. Bedaquiline was started a median 18.0 (interquartile range (IQR) 4.3–25.5) months after NTM treatment initiation. Median bedaquiline treatment duration was 7.5 (IQR 5.6–12.0) months.Symptoms completely resolved in five (29%) cases, partially resolved in six (35%) and did not change in two (12%). Complete radiological resolution was observed in three (18%), partial resolution in four (24%) and no radiological change in five (29%). Persistent culture conversion was achieved in four (24%) individuals (three MAC, one MAB). Four (24%) individuals (three MAB, one MAC) failed to culture convert.Adverse events associated with bedaquiline included QTc interval prolongation (n=4, 24%), hepatotoxicity (n=3, 18%) and nausea (n=2, 12%). Four individuals (24%) had no bedaquiline-related side effects. Three deaths that occurred while taking bedaquiline were not attributed to the drug by the treating clinicians.ConclusionsAdding bedaquiline to NTM treatment regimens is associated with variable treatment outcomes. Prospective clinical studies evaluating the efficacy of bedaquiline in this context appear warranted.

Abstract Issue/Problem The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) roadmap for the professionalisation of the public health workforce has noted ethics as a pillar for professionalisation. It also highlights the need for code of ethics and professional conduct for all public health professionals and institutions. The Global Network for Academic Public Health (GNAPH), in collaboration with EUPHA, ASPHER, and the UK Faculty of Public Health has been working together for a code of ethics. Description of the problem The WHO/ASPHER group asked for a framework to be developed by the expert group as part of the rollout of the professionalisation agenda. The objective of this work was to develop a guide that is applicable to different countries within Europe to develop their own of code of ethics and conduct. A modified Delphi approach to building consensus amongst professionals in ethics included law, academia, and public health professionals. The questions sought to be answered were what and how to develop a framework and what should be included in the guide for creating a public health code of ethics. Results Throughout this method we developed five values, and twelve principles that are essential for the development of a code of ethics through a consensus building exercise. This framework was the first of its kind as part of the professionalisation agenda for different regions. There will be ongoing work piloting this framework in practice with various professional groups and institutions. Lessons Throughout this process, the need and demand across the public health community for ethical education and development of code of ethics was made evident. Collaboration between academics, ethicist, lawyers, and public health professionals and policy makers were key in developing a public health code of ethics. Identifying the challenges with monitoring and evaluating of its implementation a public health code of ethics. Key messages • Ethics, and a code of ethics are an essential component of the professionalisation agenda of the public health workforce. • There is need for continued collaboration and partnership with public health professionals and institutions in enacting its implementation and evaluation.

To explore knowledge and attitudes of medical students before and after exposure to a technology-enhanced learning and teaching (TELT) session about electroconvulsive therapy (ECT). Adequate knowledge of and attitudes toward ECT is essential for medical students. However, the impact of teaching on knowledge and attitudes is infrequently studied. Fourth- and fifth year medical students at the University of Glasgow were provided with an online questionnaire before and after engaging in a remote TELT session, led by a consultant psychiatrist with expertise in ECT. The online teaching session used resources developed by a multidisciplinary team who specialize in ECT. The teaching session lasted around 1 hour. The questionnaire contained 3 sections: baseline demographics, knowledge of ECT, and attitudes toward ECT. Changes in scores were analyzed. Sixty-seven students completed the teaching session. Response rate to the precourse questionnaire was 68.7% (n = 46), and the postcourse questionnaire was 44.8% (n = 30). Prior to engaging with the learning materials, 9 students reported no knowledge of ECT and a third believed that ECT did not cause a seizure. In general, students who had personal experience of mental illness (friend, relative, or self) had more positive attitudes toward ECT and higher knowledge scores. In general, an increase in knowledge and attitude scores was found in the postcourse questionnaire. Exposing medical students to a TELT session focused on ECT during their psychiatric placement appeared to improve knowledge and attitudes surrounding ECT.