scholarly journals Improving knowledge and confidence in the acute management of eating disorders and resulting complications

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S186-S186
Author(s):  
Sarah Fynes-Clinton ◽  
Clare Price ◽  
Louisa Beckford ◽  
Maisha Shahjahan ◽  
Brendan McKeown
Keyword(s):  
Eating Disorders ◽  
Clinical Information ◽  
Easy Access ◽  
Average Score ◽  
Junior Doctors ◽  
Refeeding Syndrome ◽  
Improvement Project ◽  
Positive Effects ◽  
The Creation ◽  
The Impact

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

The Introduction of An Intravenous Fluid Bundle to Improve the Prescribing of Intravenous Fluids Within a District General Hospital (Preprint)

2022 ◽  
Author(s):  
Abdul-Rahman Gomaa ◽  
Sharan Sambhwani ◽  
Jonathan Wilkinson
Keyword(s):  
Point Of Care ◽  
Kidney Injury ◽  
District General Hospital ◽  
Good Clinical Practice ◽  
Point Prevalence ◽  
Grand Round ◽  
Junior Doctors ◽  
Improvement Project ◽  
Increased Risk ◽  
The Impact

BACKGROUND Intravenous (IV) fluids are some of the most commonly prescribed day-to-day drugs. Evidence suggests that such prescriptions are rarely ever done correctly despite the presence of clear guidelines (NICE CG174). This is believed to be due to lack of knowledge and experience, which often breeds confusion and places patients at increased risk of harm. It also incurs avoidable costs to hospitals. OBJECTIVE This quality improvement project (QIP) aims to ensure that IV fluid prescriptions are: safe, appropriate and adhere to evidence-based NICE guidance. The project’s aims will be achieved through implementing multiple interventions that are categorised under: educational, changing prescribing habits and raising awareness. METHODS Review and improve the prescribing process of “IV fluid prescribing” via three simultaneous approaches.  Teaching sessions were delivered to all junior doctors in order to improve knowledge and awareness of appropriate IV fluid prescribing and promote familiarity with the current NICE IV fluid guidelines. This included a ‘feature session’ at our local hospital Grand Round. A point-of-care aide-memoire containing a summary of the information needed for correct prescription was designed and printed. This complimented the teaching sessions and supported good clinical practice. Using serial Plan-Do-Study-Act (PDSA) cycles, a novel “IV fluid bundle” was developed, fine-tuned and trialled on five wards, (three surgical, two medical). The aim of the bundle was to ensure that patients were clinically reviewed in order to assess their volaemic status in order that appropriate IV fluids could then be selected and prescribed safely. The impact of these interventions was assessed on the trial wards via a weekly point prevalence audit of the IV fluid bundles for the duration of the trial. Parameters looked at were: incidence of deranged U&E’s, incidence of AKI and the number of days between the latest U&E’s and the patient’s IV fluid prescription. RESULTS These interventions were assessed on trial wards via a weekly point prevalence audit of the new IV fluid prescription chart (bundle; IFB) for the duration of the trial. Parameters monitored were: incidence of deranged U&E’s, incidence of acute kidney injury (AKI) and the number of days between the latest U&E’s and the patient’s IV fluid prescription. Of all of the patients on the IV fluid bundle, 100% had a documented weight, review of both fluid status and balance. The incidence of deranged U&E’s decreased from 48% to 35%. Incidence of AKI decreased from 24% to 10%. The average number of days between the latest U&E’s and a fluid prescription decreased from 2.2 days to 0.6 day. CONCLUSIONS Prescribing IV fluids is a complex task that requires significant improvement both locally and nationally. With 85% uptake of the IFB, we were able to significantly improve all measured outcomes. Through carefully structured interventions geared towards tackling the confounding issues identified from previous audits and process mapping we have shown that prescribing IV fluids can be made safer.

scholarly journals EP.FRI.1023 Clinical Portal: a clinician-led IT solution to the ‘surgical list’

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cait Bleakley ◽  
Chloe Wright ◽  
Rola Salem ◽  
Kirk Bowling
Keyword(s):  
Patient Information ◽  
Single Point ◽  
Direct Consequence ◽  
Direct Access ◽  
Accurate Information ◽  
Junior Doctors ◽  
Post Intervention ◽  
It Systems ◽  
The Creation ◽  
The Impact

Abstract Aim Burnout amongst junior doctors is an emotive topic, with time pressures during busy on-call shifts negatively impacting efficiency and morale. Historically, within busy surgical firms the most junior team members commonly worked beyond scheduled hours. It has been highlighted within our trust that our IT systems significantly contributed to this. Thus leading to the creation of a clinician-led IT solution, enabling direct access to accurate information at a single point.  This study aims to measure the impact of the systems introduction on efficiency and shift experience of our junior doctors.  Methods 'Clinical Portal’ was introduced in August 2019. This IT system enables all patient information to be collated in one place, with the added benefit of simplifying the creation of patient lists. Number and duration of Exception Reports (ER) by on-call surgical juniors were measured for two months pre and post intervention. A qualitative survey was also distributed to this cohort to measure satisfaction and experience during on-call shifts within this period.  Results Following introduction of 'Clinical Portal', the total length of time included in ERs reduced. Surgical juniors expressed an improvement in their on-call experience, most notably dedicating less time to collating patient information and ward list formation. The overall experience improved despite time required to become proficient at using the new system.  Conclusions Streamlining of IT systems used during on-call shifts demonstrates improved efficiency amongst juniors reflected in a reduction of ERs. A direct consequence of these implemented changes is significant improvement in morale amongst our juniors. 

scholarly journals Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor

2022 ◽  
Vol 12 ◽  
Author(s):  
Vanessa Opladen ◽  
Maj-Britt Vivell ◽  
Silja Vocks ◽  
Andrea S. Hartmann
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Negative Affect ◽  
Negative Emotion ◽  
Body Checking ◽  
Eating Disorder Symptoms ◽  
Positive Effects ◽  
General Pathology ◽  
Before And After ◽  
The Impact

Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.

scholarly journals Impact of the European Working Time Directive on trainees and trainers 3 years post-implementation

2013 ◽  
Vol 37 (9) ◽  
pp. 286-289
Author(s):  
Farshad Shaddel ◽  
Subimal Banerjee
Keyword(s):  
Working Time ◽  
European Working Time Directive ◽  
Junior Doctors ◽  
Positive Effects ◽  
European Working ◽  
Negative Effect ◽  
Negative Impacts ◽  
Working Time Directive ◽  
The Impact

Aims and methodTo assess the views of trainees and trainers of the impact of the European Working Time Directive (EWTD). The study was conducted in two stages. First, a qualitative survey of trainees and trainers in the Oxford Deanery was carried out on the positive and negative aspects of the EWTD to identify key areas. Second, a self-completed questionnaire was developed separately for trainees and trainers and the results collated. Twenty trainers and nineteen trainees took part in the study.ResultsAbout 70% of trainees and trainers were aware of the EWTD objectives. Ninety per cent of trainers and 30% of trainees believed that the introduction of the EWTD was a negative development. Compared with 42% of trainees, 80% of trainers believed that the EWTD had not improved the quality of care and instead had a negative effect on doctor–patient alliance and continuity of care. Although 53% of trainees believed that the quality of training was not compromised by the introduction of the EWTD, 84% of trainers thought otherwise. Less hands-on experience and some doctors' roles being given to other professionals were the most stated negative impacts of the EWTD on the quality of doctors' training. Positive effects of the EWTD from both trainees' and trainers' points of view were a better work-life balance and less burnout for junior doctors.Clinical implicationsThe EWTD may not have been successful in achieving all of its intended objectives. Further studies on different sample groups would help clarify the wider impact of the EWTD.

The impact of cognitive apprenticeship on the perceived growth of junior doctors

2020 ◽  
Vol 32 (7) ◽  
pp. 489-499
Author(s):  
Takuro Tsukube ◽  
Makoto Matsuo
Keyword(s):  
Professional Growth ◽  
Empirical Studies ◽  
Cognitive Apprenticeship ◽  
Junior Doctors ◽  
Snowball Sampling ◽  
Content Type ◽  
Clinical Supervisors ◽  
Positive Effects ◽  
Past Experiences ◽  
The Impact

Purpose Although cognitive apprenticeship has been widely used in various educational fields, few empirical studies have examined its effectiveness in a workplace context. This study aims to investigate the effects of cognitive apprenticeship on junior doctors’ perceived professional growth in hospitals. Design/methodology/approach A retrospective questionnaire survey was performed that asked surgeons (n = 87) and physicians (n = 92) to recall how they were instructed by their supervisors during the first five years after graduation from medical school. Findings The results of multiple regression analyzes showed that all dimensions of cognitive apprenticeship (modeling, coaching, scaffolding, articulation, reflection and exploration) had positive effects on each doctor’s perceived growth, regardless of the type of clinical practice (surgeon vs physician) or the period of supervision. It was also found that physicians experienced significantly more coaching and scaffolding, and opportunities for, articulation and reflection, than surgeons. Research limitations/implications Some of the data were collected through snowball sampling, and this study used a retrospective survey in which respondents were asked to recall past experiences. Practical implications Clinical supervisors in hospitals should adopt a cognitive apprenticeship model when supervising junior doctors. Surgical supervisors need to be more conscious of the benefits of cognitive apprenticeship. Originality/value This study confirmed that the six dimensions of cognitive apprenticeship had positive influences on the perceived growth of junior doctors, regardless of their clinical domains or period of supervision and that clinical domains influence the implementation of cognitive apprenticeship.

scholarly journals ANALISIS TEKNIK PENERJEMAHAN MAJAS IRONI DAN SARKASME DALAM NOVEL THE RETURN OF SHERLOCK HOLMES SERTA DAMPAKNYA TERHADAP KUALITAS TERJEMAHAN

2017 ◽  
Vol 2 (1) ◽  
pp. 69
Author(s):  
Irene Dinari ◽  
Mangatur Nababan ◽  
Djatmika Djatmika
Keyword(s):  
Figurative Language ◽  
Average Score ◽  
The Novel ◽  
Sherlock Holmes ◽  
Translation Quality ◽  
Positive Effects ◽  
Translation Techniques ◽  
Research Findings ◽  
The Impact

<p><strong>Background</strong>: This research is conducted by analyzing figurative language as irony and sarcasm in the novel entitled The Return of Sherlock Holmes (TROSH) and its translation in <em>Bahasa</em> Indonesia. The aims of this research are to (1) identify such types of figurative language as irony and sarcasm in the novel TROSH<em> </em>and its translation in <em>Bahasa Indonesia</em>, (2) identify translation techniques used when translating the irony and sarcasm, (3) find out the translation shifts appearing as effects of the application of the translation techniques, and (4) find out the effects of the translation shifts of irony and sarcasm on translation quality considering accuracy, acceptability, and readability.</p><p> </p><p><strong>Method</strong>: The method of this study is descriptive qualitative. The source of data is a novel entitled The Return of Sherlock Holmes and its translation. The result of questionnaires from the raters that asses the translations quality also belong to the source of data in this study. The data in this study are phrase, clause, or sentence that contain irony or sarcasm in the novel The Return of Sherlock Holmes. Beside that, the information about the quality of the translation from the raters and informants is also belonged to the data. The technique in conducting the data is done by analysing the document and the questionnaires.</p><p> </p><p><strong>Result</strong>: The research findings reveal that (1) 67 data of irony and sarcasm are found in the novel The Return of Sherlock Holmes and are divided into 6 subcategories consisting of ironical understatement, non-ironical falsehood, ironical interjections, illocutionary sarcasm, propositional sarcasm, and lexical sarcasm, (2) Several translation techniques employed are established equivalence, modulation, amplification, variation, transposition, linguistic compression, borrowing, reduction, linguistic amplification, compensation, adaptation, and particularization, while some others are couplets, triplets, and quadruplets, (3) the application of the aforementioned translation techniques leads to three possibilities such as the absence of translation shifts of irony and sarcasm, translation shifts to another figurative language, and translation shifts to nonfigurative language, (4) the translation shifts give moderate positive effects on the translation quality of irony and sarcasm found in the novel The Return of Sherlock Holmes with average score of 2.64.</p><p> </p><p><strong>Conclustion</strong>: <strong>Conclusion</strong>: The result of this study shows that established equivalence is often used in translating irony and sarcasm. The application of this technique gives a good quality in the translation of irony and sarcasm because that technique can be applied based on the context of situations in the target texts. Meanwhile, established equivalence may give a poor result of the translation quality if it is combined with another technique, for examples: reduction, transposition, and modulation. The impact of the quality is caused by the translation shifting of irony and sarcasm into another figurative language or denotative form. From the analysis of this study, it can be cncluded that the translation shifting of figurative language is one of the important thing in figurative language’s translation and translation quality assessment.</p><p> </p><p><strong>Keywords</strong>: irony and sarcasm, translation techniques, shift, translation quality</p>

1144 How Much Does Colorectal Enhanced Recovery Program Education Affect Knowledge of Newly Joined Junior Doctors? A General District Hospital Re-Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dorra ◽  
T Alhammali ◽  
A Arnob ◽  
M Murtaza ◽  
N Essa ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
District Hospital ◽  
Substantial Improvement ◽  
Average Score ◽  
Junior Doctors ◽  
Surgical Department ◽  
Enhanced Recovery Program ◽  
Power Point Presentation ◽  
Recovery Program ◽  
The Impact

Abstract Aim Aim of the study is closing the audit loop on knowledge of colorectal Enhanced Recovery Program (ERP) among newly joined junior doctors in a general district hospital. Original audit showed shortage of awareness and knowledge among newly joined junior doctors. The recommendation was educating them regarding ERP and re-auditing. Method Education through a 30-minute power point presentation, on colorectal ERP, was done among newly joined junior doctors. This was followed by a 12-point questionnaire for testing the knowledge of colorectal ERP protocol among 5 newly joined junior doctors (Senior House Officers, Foundation year 2 and Foundation year 1) in our surgical department in August 2020. Results The responses showed an increase in doctors’ knowledge to 90 % (re-audit) from 52.9% (original audit). An increase of about 40% in their knowledge. The average score of their knowledge was 10.8/12 (90 %). One doctor (20 %) scored 12 out of 12 (12/12), two (40 %) scored 11/12 and two (40 %) scored 10/12. Conclusions The study showed that education of newly joined junior doctors resulted in a substantial improvement in their level of knowledge of colorectal ERP, almost up to the local hospital guidelines target (100 %). The study recommends this education to be an integral part of their induction program not only locally but also nationwide. It highlights the impact of education on colorectal ERP implementation.

scholarly journals 2510

2017 ◽  
Vol 1 (S1) ◽  
pp. 20-21
Author(s):  
Amber L. Allen ◽  
Christopher Barnes ◽  
Kevin S. Hanson ◽  
David Nelson ◽  
Randy Harmatz ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Open Source ◽  
Web Sites ◽  
Hospital System ◽  
Improvement Project ◽  
Clinical Quality ◽  
Development Framework ◽  
The Creation ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: To create a searchable public registry of all Quality Improvement (QI) projects. To incentivize the medical professionals at UF Health to initiate quality improvement projects by reducing startup burden and providing a path to publishing results. To reduce the review effort performed by the internal review board on projects that are quality improvement Versus research. To foster publication of completed quality improvement projects. To assist the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety in managing quality improvement across the hospital system. METHODS/STUDY POPULATION: This project used a variant of the spiral software development model and principles from the ADDIE instructional design process for the creation of a registry that is web based. To understand the current registration process and management of quality projects in the UF Health system a needs assessment was performed with the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety to gather project requirements. Biweekly meetings were held between the Quality Improvement office and the Clinical and Translational Science – Informatics and Technology teams during the entire project. Our primary goal was to collect just enough information to answer the basic questions of who is doing which QI project, what department are they from, what are the most basic details about the type of project and who is involved. We also wanted to create incentive in the user group to try to find an existing project to join or to commit the details of their proposed new project to a data registry for others to find to reduce the amount of duplicate QI projects. We created a series of design templates for further customization and feature discovery. We then proceed with the development of the registry using a Python web development framework called Django, which is a technology that powers Pinterest and the Washington Post Web sites. The application is broken down into 2 main components (i) data input, where information is collected from clinical staff, Nurses, Pharmacists, Residents, and Doctors on what quality improvement projects they intend to complete and (ii) project registry, where completed or “registered” projects can be viewed and searched publicly. The registry consists of a quality investigator profile that lists contact information, expertise, and areas of interest. A dashboard allows for the creation and review of quality improvement projects. A search function enables certain quality project details to be publicly accessible to encourage collaboration. We developed the Registry Matching Algorithm which is based on the Jaccard similarity coefficient that uses quality project features to find similar quality projects. The algorithm allows for quality investigators to find existing or previous quality improvement projects to encourage collaboration and to reduce repeat projects. We also developed the QIPR Approver Algorithm that guides the investigator through a series of questions that allows an appropriate quality project to get approved to start without the need for human intervention. RESULTS/ANTICIPATED RESULTS: A product of this project is an open source software package that is freely available on GitHub for distribution to other health systems under the Apache 2.0 open source license. Adoption of the Quality Improvement Project Registry and promotion of it to the intended audience are important factors for the success of this registry. Thanks goes to the UW-Madison and their QI/Program Evaluation Self-Certification Tool (https://uwmadison.co1.qualtrics.com/SE/?SID=SV_3lVeNuKe8FhKc73) used as example and inspiration for this project. DISCUSSION/SIGNIFICANCE OF IMPACT: This registry was created to help understand the impact of improved management of quality projects in a hospital system. The ultimate result will be to reduce time to approve quality improvement projects, increase collaboration across the UF Health Hospital system, reduce redundancy of quality improvement projects and translate more projects into publications.

scholarly journals 939 Two Is Not Always Better Than One: A Quality Improvement Project Assessing Efficiency and Financial Implications Associated with Using Two Different Electronic Systems in A Busy Orthopaedic Department

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Kutuzov ◽  
H Shah ◽  
R Chaudhry ◽  
Y C Tan ◽  
D Nathwani
Keyword(s):  
Time Management ◽  
Financial Burden ◽  
Clinical Information ◽  
Junior Doctors ◽  
Electronic Systems ◽  
Hourly Wage ◽  
Improvement Project ◽  
Orthopaedic Department ◽  
Surgical Department ◽  
Local Trauma

Abstract Introduction Ensuring correct documentation and safe handover is key to the running of a successful surgical department. At Imperial College Healthcare Trust, this process has been made easier through various electronic systems available to our Orthopaedic department: our in-house CERNER system and out-of-house system eTrauma, the latter of which is predominantly used. The aim of this project was to assess our efficiency in terms of time management between the two systems, as well as financial implications of saved time. Method Multiple members of the Orthopaedic team timed themselves when entering information regarding a referral or an admission into both systems. This allowed us to estimate the financial implications of moving away from eTrauma. Results An average referral took 165 seconds (n = 27) to input information onto eTrauma, versus 38 seconds (n = 25) for CERNER. Time taken to document an admission was 127 seconds (n = 33) and 26 seconds (n = 31) respectively. The current hourly wage for our junior members is £22.84 per hour or 38p per minute. Moving away from eTrauma to CERNER will save around £1.50 for every 2 referrals and 2.5 admissions, solely from documentation. This is excluding the other benefits of CERNER, such as quick access to relevant clinical information, pathology results and imaging. Conclusions Leaving eTrauma behind will reduce the time spent on documentation by orthopaedic junior doctors. This will result in increased efficiency and will lessen the financial burden on an already overstretched budget. Our formal data will contribute to decision making and future resource allocation in our local Trauma and Orthopaedic Department.

scholarly journals Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands

2020 ◽  
Author(s):  
Jet D. Termorshuizen ◽  
Hunna J. Watson ◽  
Laura M. Thornton ◽  
Stina Borg ◽  
Rachael E. Flatt ◽  
...  
Keyword(s):  
United States ◽  
Eating Disorders ◽  
Eating Disorder ◽  
The Netherlands ◽  
Binge Eating ◽  
Well Being ◽  
The United States ◽  
Free Text ◽  
Positive Effects ◽  
The Impact

ABSTRACTWe received rapid ethical permission to evaluate the early impact of COVID-19 on people with eating disorders. Participants in the United States (US, N=511) and the Netherlands (NL, N=510), recruited through ongoing studies and social media, completed an online baseline survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with diagnoses. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover.

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