Distilling the core meaning of medical engagement to three junior doctor staff groups in a Welsh Health Board

BMJ Leader ◽  
2020 ◽  
pp. leader-2020-000339
Author(s):  
Thomas Cromarty ◽  
Rachel Rayment ◽  
Patti Mazelan ◽  
Fred Barwell ◽  
Peter Spurgeon ◽  
...  
Keyword(s):  
Cultural Change ◽  
Junior Doctor ◽  
Junior Doctors ◽  
Health Board ◽  
Research Approach ◽  
List Type ◽  
Job Roles ◽  
The Core ◽  
Core Concepts ◽  
Core Issues

BackgroundHealth systems demonstrate that levels of staff engagement correlate with a variety of performance indicators, including mortality, morbidity, staff sickness. The purpose of this paper is to help healthcare managers and clinical leaders gain greater clarity in understanding the core concepts which drive medical engagement for junior doctor staff groups.MethodsA total of 245 members of medical staff completed the Medical Engagement Survey (MES) with a local focus in a participating Welsh University Health Board in April 2018. In this paper a ‘mixed-methods’ research approach is described. Both quantitative and qualitative data have been collected and analysed as part of the MES and these are interpreted and integrated with the aim of highlighting insightful links between the various methodological perspectives (as described by Shorten and Smith).ResultsThe findings reported are the results of the first purposive sample from an application of the MES targeted specifically at junior doctors.Though improvements in medical engagement often require a cultural change over the longer term, trainees have highlighted to the organisation valuable opportunities for quick wins. These capture the essence of what medical engagement really means to Junior Doctor Staff groups.Being kept informed in a flexible and timely manner about any changes in systems, job roles and rotas.Having more time outside ward duties to develop and progress effectively through training.Being undervalued by senior management and poor communication with medical staffing.ConclusionThe systematic surfacing of these core issues may potentially help keep sight of fundamental staff priorities when attempting to enhance levels of medical engagement. Although these views are from one Health Board, they mirror findings elsewhere. Disengaged junior doctors may be part of continuing the wider problem of lack of engagement in senior staff as they themselves become more senior and influential.

P28 Reducing medication errors – a tripartite approach. small steps – better outcomes

2018 ◽  
Vol 103 (2) ◽  
pp. e1.33-e1
Author(s):  
Patel Bhavee ◽  
Isaac Rachel ◽  
Vallabhaneni Pramodh
Keyword(s):  
Medication Errors ◽  
Improve Patient Safety ◽  
Medication Administration ◽  
Daily Basis ◽  
Junior Doctors ◽  
Health Board ◽  
Final Report ◽  
List Type ◽  
Microsoft Excel ◽  
Audit Form

AimPaediatric medication errors have everyday potential to cause unintended harm.1 Our aim was to reduce paediatric medication errors on a busy general paediatric medical ward.MethodA prospective audit was undertaken, using an audit form, looking at the number and severity of medication errors from May 2016 to July 2016. The severity of the errors was graded as per the EQUIP study.2 The results were analysed using Microsoft Excel.Action – A study afternoon was arranged in August 2016 to highlight the common themes behind the medication errors followed by a multidisciplinary brainstorming exercise to gather suggestions on reducing medication errors.An education package was introduced:Medical – all trainees were asked to complete a mandatory online module designed by the Royal College of Paediatrics and Child Health, which provides an overview of need for safe prescription practice in children and common themes leading to errors. Further teaching was provided in departmental teaching meetings and the lead paediatric pharmacist undertook targeted teaching.Nursing – an in house competency package was developed based around the principles of the ‘5 rights’ of medication administration, the Health Board controlled drug policy and the All Wales Policy for Medicines Administration, Recording, Review, Storage and Disposal. All staff were encouraged to complete this package. Through one on one sessions with the practice development nurse, staff were coached to follow the five Rs of Right Drug, Right Dose, Right Time, Right Route, and Right Patient.Pharmacy – Lead pharmacist introduced an education tool as advocated by Meds IQ called Druggle3 in the department, where at the end of the safety huddle the pharmacist discusses medication interventions on a daily basis that may have happened on the ward. Through this tool formative education was provided to junior doctors and nurses.Re–audit – After six months of intensive education, a prospective re–audit was undertaken between December 2016 and February 2017 using an audit form. The results were analysed using Microsoft Excel.ResultsThe results showed that 88.6% (141/159) of children admitted had medication errors. 61.2% (87/141) of errors were minor, 34.7% (49/141) significant, 2.8% (4/141) serious and 1.3% (1/141) potentially lethal.The results of the re-audit showed that 12.1% (57/470) of children had medication errors. 77.2% (44/57) of errors were minor and 22.8% (13/57) significant. There were no serious or potentially lethal errors reported.This showed an overall reduction of 76.5% medication errors in the children admitted following the introduction of the education package.ConclusionThe education package through the tripartite approach has achieved a substantial change in the overall rate of prescription errors. We believe medication errors are a significant but preventable cause of harm to children and young people. To ensure this change of practice is sustained we aim to continue the emphasis of education and change management to improve patient safety.ReferencesCass H. Reducing paediatric medication error through quality improvement networks; where evidence meets pragmatism. Arch Dis Child2016;101:414–416.EQUIP final report. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf [Accessed: 01/08/16].DRUG-gle (Druggle). http://www.medsiq.org/tool/drug-gle-druggle [Accessed: 01/08/2016].

scholarly journals Improving the confidence and competence of junior doctors in conducting seclusion reviews

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S156-S157
Author(s):  
Mostafa Shalaby ◽  
Mehtab Rahman
Keyword(s):  
High Risk ◽  
Junior Doctor ◽  
Simulation Training ◽  
Junior Doctors ◽  
List Type ◽  
Confidence Levels ◽  
Effective Interventions ◽  
Before And After ◽  
Average Confidence ◽  
Quality Improvement Interventions

Aims•To improve the quality and consistency of medical seclusion reviews at St Charles Hospital and across the Trust.•To ensure at least 80% compliance with minimum standards for seclusion review documentation by the end of December 2020.•To increase doctors' mean perceived competence and confidence scores to 4.5/5 by the end of December 2020MethodSeclusion is commonly used to manage patients at high risk of aggression or violence, but is a high risk and very restrictive intervention. As such, it requires regular nursing and medical reviews. Work has been done recently at St Charles to improve the timeliness and effectiveness of nursing reviews including detailed guidance. Medical reviews are usually performed by junior doctors, many with limited experience in psychiatry. There is •A lack of consistent local or national guidance for junior doctors undertaking seclusion reviews•The quality and scope of these reviews is not consistent•There may be a need to ensure that there is more standardization and to improve junior doctors' confidence – and therefore patient safety and experience – overall.•The following interventions were used to improve the quality of seclusion reviews at the hospital:•Minimum standard guidelines•Presenting in Restrictive interventions meeting.•Feedback from PICU consultants for guidelines•Changing guidelinesFuture plans: •Guidelines teaching (Early November)•Re-audit and new survey (Early November)•Simulation training (Mid November)•Seclusion teaching video (Early December- to be ready for Induction)•Re-audit and new survey (Beginning of April)ResultSurveys were conducted before and after quality improvement interventions were put in place. The average confidence levels of junior doctors increased from 38.5% to 87% following these interventions.ConclusionRevision of seclusion guidelines, junior doctor teaching and simulation training are effective interventions to improve junior doctor confidence levels in conducting seclusion reviews.

scholarly journals Studying international doctoral researchers: nexus analysis as a mode of inquiry

2020 ◽  
Vol 2 (2) ◽  
pp. 35-57
Author(s):  
Melina Aarnikoivu
Keyword(s):  
Higher Education ◽  
Decision Making ◽  
Viable Alternative ◽  
Research Approach ◽  
Bottom Up ◽  
The Core ◽  
Communication Interaction ◽  
Core Concepts ◽  
Nexus Analysis

In this paper I argue how nexus analysis (Scollon & Scollon, 2004), as a holistic, qualitative mode of inquiry, can offer a fruitful activist research approach to study international doctoral researchers. To do this, I will introduce and explain the core concepts of nexus analysis and afterwards empirically demonstrate how nexus analysis can be done in practice by presenting a case study on international doctoral researchers in a particular nexus—at a Finnish university. The overall aim of this paper is to present nexus analysis as a viable alternative for those higher education researchers who want to study communication, interaction, and language-related challenges of international doctoral researchers from a bottom-up perspective and, in this way, potentially even challenge the existing decision-making practices.

scholarly journals 919 Surgical Voice Restoration – Improving Out of Hours Management: A Multidisciplinary Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
J McCord ◽  
B Roberts ◽  
S Browning
Keyword(s):  
Junior Doctor ◽  
Working Hours ◽  
Standard Of Care ◽  
Junior Doctors ◽  
Health Board ◽  
Contributing Factors ◽  
Improvement Project ◽  
Out Of Hours ◽  
Voice Restoration

Abstract Aim Swansea Bay University Health Board have a caseload of 37 surgical voice restoration (SVR) laryngectomies. These patients are excellently managed during working hours, by a SALT-led service. Concerns were raised regarding the quality of out of hours management: the aim of this project was to identify and address the factors contributing to the difference in care received. Method A questionnaire was sent to current junior doctors to assess knowledge and confidence when managing SVR patients. Phone interviews were conducted with SVR patients to discuss the issues from a patient’s perspective. The junior doctor team and SALT team liaised to identify contributing logistical issues. Results The junior doctor survey indicated both experience and confidence were low, including amongst senior trainees. 58.3% were unfamiliar with equipment used to change a speech valve. Patient interviews revealed several issues, such as delays to treatment and unnecessary admissions. Logistical concerns included inability to access equipment out of hours and an absence of departmental guidelines. Conclusions This project demonstrates a collaborative approach between junior doctors and SALT, to improve the quality of care for a sub-set of patients with highly specialised needs. We identified the contributing factors for the disparity in services and tailored interventions to provide the junior doctors responsible for out of hours care, with the knowledge and skills to provide a better standard of care.

The Core Concepts, Skills, and Components Curriculum: Increasing Trauma Expertise in Practitioners

2008 ◽  
Author(s):  
Christopher Layne ◽  
Abigail Gewirtz ◽  
Chandra Ghosh Ippen ◽  
Renee Dominguez ◽  
Robert Abramovitz ◽  
...  
Keyword(s):  
The Core ◽  
Core Concepts

Jumping, Climbing and Suspensory Locomotion

2018 ◽  
Keyword(s):  
Energy Storage ◽  
Elastic Energy ◽  
The Core ◽  
Power Amplification ◽  
Core Concepts

Jumping, climbing and suspensory locomotion are specialized locomotor mechanisms used on land and in the air. Jumping is used for rapid launches from substrates. Climbing and suspensory movements enable locomotion up, under and through vertically-structured habitats, such as forests. Elastic energy storage is particularly important for jumping and catapult systems and we address the core concepts of power amplification that are exemplified in nature’s extreme jumpers. We examine the diverse mechanisms of attachment that characterize animals that can grasp and adhere to a diversity of structures. We conclude the chapter by examining the integration of biological capabilities with engineering innovations in these systems.

Improved Jitter Buffer Management for WebRTC

2021 ◽  
Vol 17 (1) ◽  
pp. 1-20
Author(s):  
Yusuf Cinar ◽  
Peter Pocta ◽  
Desmond Chambers ◽  
Hugh Melvin
Keyword(s):  
Voice Quality ◽  
Buffer Management ◽  
Voice Over Ip ◽  
The Core ◽  
Management Algorithm ◽  
Core Concepts ◽  
Novel Strategy

This work studies the jitter buffer management algorithm for Voice over IP in WebRTC. In particular, it details the core concepts of WebRTC’s jitter buffer management. Furthermore, it investigates how jitter buffer management algorithm behaves under network conditions with packet bursts. It also proposes an approach, different from the default WebRTC algorithm, to avoid distortions that occur under such network conditions. Under packet bursts, when the packet buffer becomes full, the WebRTC jitter buffer algorithm may discard all the packets in the buffer to make room for incoming packets. The proposed approach offers a novel strategy to minimize the number of packets discarded in the presence of packet bursts. Therefore, voice quality as perceived by the user is improved. ITU-T Rec. P.863, which also confirms the improvement, is employed to objectively evaluate the listening quality.

“Leaving No One Behind” as a Site of Contestation and Reinterpretation

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Sakiko Fukuda-Parr ◽  
Thea Smaavik Hegstad
Keyword(s):  
Social Protection ◽  
Inclusive Development ◽  
Vulnerable Groups ◽  
Transformative Change ◽  
The Core ◽  
2030 Agenda ◽  
Social Opportunities ◽  
A Site ◽  
Core Issues ◽  
Distribution Of Income

Abstract One of the most important elements of the 2030 Agenda and the SDGs is the strong commitment to inclusive development, and “leaving no one behind” has emerged as a central theme of the agenda. How did this consensus come about? And what does this term mean and how is it being interpreted? This matters because SDGs shift international norms. Global goals exert influence on policy and action of governments and stakeholders in development operates through discourse. So the language used in formulating the UN Agenda is a terrain of active contestation. This paper aims to explain the politics that led to this term as a core theme. It argues that LNOB was promoted to frame the SDG inequality agenda as inclusive development, focusing on the exclusion of marginalized and vulnerable groups from social opportunities, deflecting attention from the core issues of distribution of income and wealth, and the challenge of “extreme inequality.” The term is adequately vague so as to accommodate wide ranging interpretations. Through a content analysis of LNOB in 43 VNRs, the paper finds that the majority of country strategies identify LNOB as priority to the very poor, and identify it with a strategy for social protection. This narrow interpretation does not respond to the ambition of the 2030 Agenda for transformative change, and the principles of human rights approaches laid out.

Equality and Equity in Chinese Higher Education in the Post-massification Era: An Analysis Based on Chinese Scholarly Literature

2021 ◽  
pp. 1-22
Author(s):  
Qiang Zha
Keyword(s):  
Higher Education ◽  
Literature Review ◽  
Bibliometric Analysis ◽  
Chinese Higher Education ◽  
Scholarly Literature ◽  
The Core ◽  
Research Questions ◽  
Changes Over Time ◽  
Core Issues ◽  
Over Time

Abstract This paper examines several research questions relating to equality and equity in Chinese higher education via an extended literature review, which in turn sheds light on evolving scholarly explorations into this theme. First, in the post-massification era, has the Chinese situation of equality and equity in higher education improved or deteriorated since the late 1990s? Second, what are the core issues with respect to equality and equity in Chinese higher education? Third, how have those core issues evolved or changed over time and what does the evolution indicate and entail? Methodologically, this paper uses a bibliometric analysis to detect the topical hotspots in scholarly literature and their changes over time. The study then investigates each of those topical terrains against their temporal contexts in order to gain insights into the core issues.

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