Withybush General Hospital

Pour une institution culturelle, la connaissance de son territoire et de ses acteurs et la manière dont elle interagit avec eux est essentielle. Le projet Dyneco-ICC étudie comment elles travaillent et évoluent au sein de leur écosystème, et plus particulièrement les liens qu’elles développent avec les acteurs privés et les industries culturelles et créatives.

ABSTRACTIntroductionFatigue is an important and distressing symptom for many people living with chronic musculoskeletal (MSK) conditions. Many non-pharmacological interventions have been investigated in recent years and some have been demonstrated to be effective in reducing fatigue and fatigue impact, however there is limited guidance for clinicians to follow regarding the most appropriate management options. The objective of this scoping review is to understand and map the extent of evidence in relation to the impact of non-pharmacological interventions on MSK condition-related fatigue across the lifespan.Methods and analysisThis scoping review will include evidence relating to people of all ages living with chronic MSK conditions who have been offered a non-pharmacological intervention with either the intention or effect of reducing fatigue and its impact. Databases including AMED, PsycINFO, CINAHLPlus, MEDLINE, EMBASE and Scopus will be searched for peer reviewed primary research studies published after 1stJanuary 2007 in English language. These findings will be used to identify factors associated with successful interventions and to map gaps in knowledge.Ethics and disseminationEthical approval was not required for this review. Findings will be disseminated by journal publication, conference presentation and by communicating with relevant healthcare and charity organisations.Article SummaryStrengths and limitations of this study-Patient and Public Involvement and Engagement (PPIE) workshops at key time points will ensure that the protocol, review findings and subsequent discussion are relevant to stakeholders and reflect lived experience of MSK-fatigue-All studies will be reviewed, and data extraction checked by a minimum of two researchers-The effectiveness of specific interventions and methodological quality of included studies is not covered in this scoping review-Only evidence available in English will be reviewed

BackgroundAnticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission.MethodsWe included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge.ResultsOn admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications.ConclusionsOur cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.

Kar says that patients deserve honesty about the limits of the NHS.1 To quote Enoch Powell: …

The aim of this study was to investigate nurse and allied health professional experiences and attitudes toward critical care research in Wales. Data were collected related to demographic characteristics, involvement in and understanding of research, perceived influences and attitudes towards research. We calculated means (ranges) for continuous variable and frequencies (proportions) for discrete variables and performed an exploratory factor analysis. Response rate was 55% (n = 575). Most respondents (84%) had participated in research less than five times in the previous 12 months, yet 91% believed research led to improved care patients. Only 32% respondents felt they were encouraged by managers to participate in research. Only 25% respondents had undertaken research training. Few respondents (29%) reported receiving adequate information regarding study progress or results (25%). Linear regression models indicate that a higher level of formal education was associated with a more positive view of research across all attitude factors. Promotion of research by colleagues and recognition/ opportunities for involvement in critical care research, were positively associated with the acceptability and experience of research. A number of factors have been identified that could be targeted to improve recruitment to critical care research, including identification of staff to promote research, improved communication of study progress and findings and management encouragement to attend research training. Staff attitudes were positive towards the benefit of research on patient care in Wales.

Abstract Background: Consenting patients for trauma procedures following hip fracture is a key stage in the treatment pathway from admission to the operating theatre. Errors in this process can result in delayed procedures which may negatively impact patient recovery. The aim of this project was to identify and reduce errors in our consenting process for patients with capacity. Methods: Consent forms for all adult patients with capacity admitted for surgical repair of traumatic hip fracture were reviewed over a 4-week period. The baseline measurement (n=24), identified errors in three key process measures: clarity of documentation, failure to record procedure-specific risks and not offering a copy of the consent form to the patient. Pre-printed stickers and targeted teaching were then introduced as quality improvement measures. Their impact was evaluated over subsequent 4-week review of the same patient demographic, with further refinement of these interventions being carried out and re-evaluated for a final cycle.Results: Cycle 1 (n=26) following targeted teaching demonstrated a reduction in abbreviations from 38% to 20%, while doubling the documentation of discussion of procedure-specific risks from 31% to 72%. More patients were offered a copy of their consent form, rising from 12% to 48%. Cycle 2 (n=24) saw the introduction of pre-printed “risk of procedure” stickers. Although clarity measures continued to improve, quality of pre-procedure risk documentation remained static while the number of forms being offered to patients fell to 8%.Conclusions: Our project would suggest that while pre-printed stickers can be useful memory aids, specific teaching on consenting produces the greatest benefit. The usage of such tools should therefore be limited, as adjuncts only to specific training.

The aim of this study was to explore Welsh adults’ experiences of the transition into survivorship from initial active systemic anti-cancer treatments for haematological cancers. An exploratory, qualitative descriptive study consisting of in-depth, face-to-face interviews was designed. A convenience sample of adults in Wales, UK, who had completed their initial systemic anti-cancer treatment for haematological cancer was recruited from one University Health Board. Data were generated in digitally recorded, individual, face-to-face interviews during 2017. Interviews were fully transcribed and analysed using a qualitative thematic approach.Seven people participated in interviews. Thematic analysis revealed three themes: encountering ambiguity, the pursuit of normality and navigating treatment completion. The transition from patient to survivor was characterised by trepidation and uncertainty. While participants sought to resume a sense of normality in their lives, they were beset by enduring treatment effects. They felt insufficiently prepared for these effects and were uncertain about the availability of the ongoing supportive care which met their individual needs. Participants articulated that they desired much more from haematology providers in preparing them for life beyond initial SACT.

Background: Patients with inflammatory bowel disease (IBD) require long term follow up. However, many patients attending routine clinic appointments are in remission and require only verbal assessment of their condition. It was noted that the nurse led IBD clinics were often overbooked and access to appointments when required was difficult. Telephone reviews for those with Coeliac disease were already being carried out successfully and it was felt that this may also be a suitable alternative to traditional face to face clinic appointments for patients with stable IBD. Methods: Over a three month period 50 patients scheduled to attend the nurse-led IBD clinic were invited to receive a telephone review rather than face to face consultation. Blood request forms were sent to patients along with the appointment letter notifying them of the time and telephone number they would be contacted on. They were asked to have the blood tests done 1–2 weeks prior to their review. Following the 3 month trial period all patients who had been invited to participate in the telephone clinic were sent a questionnaire to evaluate their satisfaction with the telephone reviews. Results: Of the 50 patients invited to have a telephone review, two had requested to be seen in clinic, of the remaining patients the Clinical Nurse Specialist (CNS) had been unable to contact 3 patients. Two had normal blood results and returned answer phone messages to notify the CNS that they were symptomatically well. 32 questionnaires were returned (64%). There was a fairly even spread of patients in terms of duration of the disease with 16 having IBD for <10 years and 17 patients >10 years. Male and female ratio was also even with 16 male and 14 female (2 had not answered). Two patients who returned the questionnaire had not completed all sections as they had requested to be seen in clinic. Of the 30/32 patients who had received a telephone review general satisfaction was high and the majority would be happy to continue with this method of follow-up. 26 (87%) were happy to continue telephone reviews, 1 (3%) was undecided and 3 (10%) preferred to come in to clinic. In an overall rating for the telephone review 1–10 (1 being very poor) 24 (80%) rated it as 8 or above. Conclusions: The telephone reviews were well received by patients and offer an acceptable alternative to the traditional clinic follow up appointments for those with stable IBD. The level of satisfaction with all aspects of the telephone review was high. Offering telephone reviews meets the recommendations of the IBD Standards in terms of providing choice to patients and maintaining patient-centred care.

This spring, the French will either reelect Nicolas Sarkozy for another five years or, for only the second time since General Charles de Gaulle inaugurated the Fifth French Republic in 1958, opt fo...