Sustained Change in ADHD: Interventions and Variables That Lead to Durable Improvements in Symptoms and Quality of Life

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common conditions in childhood, but it also persists into adolescence and adulthood, showing prevalence rates from 5 [...]

A three-legged stool: Teachers’ views of Junior Cycle Physical Education curriculum change

The purpose of this paper was to examine Irish Physical Education teachers' views on curriculum change at the beginning of its implementation stage, with a particular focus on revision to the Physical Education curriculum and the new Wellbeing programme. In the light of these revisions, teachers were asked to make considerable changes to their beliefs and pedagogical approaches. Teacher change theory provided a lens through which to examine teachers' views. We reimaged the three aspects of teacher change as a triangle or ‘three-legged stool' where the three elements of curriculum materials/resources, pedagogy, and beliefs combine to offer a sense of security to sustain the impending changes. A survey and a series of semi-structured interviews provided data and in total 119 second level Physical Education teachers participated. Analysis was conducted using descriptive statistics of quantitative data and inductive and deductive analysis of qualitative data. Three themes were developed: A Learning Focus, Embracing Change, and Curriculum Enactment. Contrary to recent findings in the change literature, the teachers in this study welcomed curriculum changes as their beliefs aligned with the purpose of the reform of Physical Education. The results indicated that the new curriculum was catching up with teachers’ core beliefs about the purpose of Physical Education. However, in line with recent research, teachers were sceptical about ongoing support for resourcing and continued professional development. In conclusion, the ‘three-legged stool of sustained change has the potential to be unbalanced thereby maintaining teacher buy-in to the new reforms is potentially fragile.

EEG-based brain–computer interfaces exploiting steady-state somatosensory-evoked potentials: a literature review

A brain–computer interface (BCI) aims to derive commands from the user’s brain activity in order to relay them to an external device. To do so, it can either detect a spontaneous change in the mental state, in the so-called ‘active’ BCIs, or a transient or sustained change in the brain response to an external stimulation, in ‘reactive’ BCIs. In the latter, external stimuli are perceived by the user through a sensory channel, usually sight or hearing. When the stimulation is sustained and periodical, the brain response reaches an oscillatory steady-state that can be detected rather easily. We focus our attention on electroencephalography-based BCIs (EEG-based BCI) in which a periodical signal, either mechanical or electrical, stimulates the user skin. This type of stimulus elicits a steady-state response of the somatosensory system that can be detected in the recorded EEG. The oscillatory and phase-locked voltage component characterising this response is called a steady-state somatosensory-evoked potential (SSSEP). It has been shown that the amplitude of the SSSEP is modulated by specific mental tasks, for instance when the user focuses their attention or not to the somatosensory stimulation, allowing the translation of this variation into a command. Actually, SSSEP-based BCIs may benefit from straightforward analysis techniques of EEG signals, like reactive BCIs, while allowing self-paced interaction, like active BCIs. In this paper, we present a survey of scientific literature related to EEG-based BCI exploiting SSSEP. Firstly, we endeavour to describe the main characteristics of SSSEPs and the calibration techniques that allow the tuning of stimulation in order to maximise their amplitude. Secondly, we present the signal processing and data classification algorithms implemented by authors in order to elaborate commands in their SSSEP-based BCIs, as well as the classification performance that they evaluated on user experiments.

Transition Inequity: gendered employment trends in New Zealand’s energy industries

Energy industries are experiencing a period of rapid and sustained change as nations seek to meet climate policy targets. In Aotearoa New Zealand a gap in both information about and attention to the gendered dimensions of the proposed low-emissions transition has emerged. This silence has implications for the distributive impacts of any transition. We present data illustrating the sub-sector variation in women’s employment, pay, tenure and executive representation in both the electricity and fossil fuel industries. Recommendations are presented for more sustained policy attention to how an energy transition, given current gendered employment trends, is unlikely to be inclusive or just.

786 Virtual Teaching in the COVID Era: Providing Surgical Trainee Teaching Via Online Webinars and Video Conferencing

Introduction Core surgical training is dependent on a balance of lecture-based and procedure-based teaching. Due to the COVID-19 pandemic, from March 2020 teaching provided by the Northern Ireland Medical and Dental Training Agency (NIMDTA) for Core Surgical Trainees (CSTs) was cancelled. In lieu of this, a virtual teaching programme was developed to ensure this vital aspect of training was not neglected. Method Firstly, one-year free Affiliate membership to the Royal College of Surgeons of Edinburgh (RCSEd) was provided for all Northern Ireland CSTs, allowing access to RCSEd online webinars. Second, a weekly teaching schedule was developed with accompanying webinar – this was based on the MRCS curriculum. Third, consultants and senior registrars were recruited to conduct a virtual teaching session via videoconferencing. Feedback was collated and used to guide future topics covered. The teaching sessions were recorded for trainee dissemination with consent from the tutors. Results Ten teaching sessions were conducted over three months. While attendance was variable, overall feedback was very positive with requests for this virtual teaching to continue. As such, NIMDTA adopted the teaching programme as their new primary method of lecture-based teaching for all Northern Ireland CSTs. Conclusions Although prepared in a short space of time, a novel, highly successful teaching programme was developed in Northern Ireland to meet the training needs of CSTs. This has resulted in a sustained change to training in Northern Ireland and may be imperative in supporting surgical training in a foreseeably socially distanced world.

Chest Physiotherapy for Mechanically Ventilated Children: A Systematic Review

The aim of this study was to appraise and summarize the effects of chest physiotherapy in mechanically ventilated children. A systematic review was completed by searching Medline, Embase, Cinahl Plus, PEDro, and Web of Science from inception to February 9, 2021. Studies investigating chest physiotherapy for mechanically ventilated children (0–18 years), in a pediatric intensive care unit were included. Chest physiotherapy was defined as any intervention performed by a qualified physiotherapist. Measurements of effectiveness and safety were included. Exclusion criteria included preterm infants, children requiring noninvasive ventilation, and those in a nonacute setting. Thirteen studies met the inclusion criteria: two randomized controlled trials, three randomized crossover trials, and eight observational studies. The Cochrane risk of bias and the Critical Appraisal Skills Program tools were used for quality assessment. Oxygen saturations decreased after physiotherapy involving manual hyperinflations (MHI) and chest wall vibrations (CWV). Although statistically significant, these results were not of clinical importance. In contrast, oxygen saturations improved after the expiratory flow increase technique; however, this was not clinically significant. An increase in expiratory tidal volume was demonstrated 30 minutes after MHI and CWV. There was no sustained change in tidal volume following a physiotherapy-led recruitment maneuver. Respiratory compliance and dead-space increased immediately after MHI and CWV. Atelectasis scores improved following intrapulmonary percussive ventilation, and MHI and CWV. Evidence to support chest physiotherapy in ventilated children remains inconclusive. There are few high-quality studies, with heterogeneity in interventions and populations. Future studies are required to investigate multiple physiotherapy interventions and the impact on long-term outcomes.

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

Background Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. Methods A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context–mechanism–outcome configurations (CMOcs). Results From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. Conclusions This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO registration CRD42016039882.

130 Improving Documentation of Bowel Movement on Geriatric Wards

Introduction Constipation is a widely prevalent issue in older adults that may result in complications such as urinary retention, delirium and bowel obstruction. Previous studies have indicated that while stool charts are well completed by nursing staff, they are infrequently monitored by doctors. This project aimed to improve the documentation of bowel movement by doctors on ward rounds to 85%, by the end of a 3-month period. Methods Formulation of the project was achieved using group work and a fishbone diagram which focussed on how doctors can improve on documenting bowel movements. Baseline data were collected from inpatient notes on weekdays over a three-week period on a geriatric ward in Northern General Hospital, Sheffield. Interventions of posters and stickers of the poo emoji were placed on walls and in inpatient notes respectively as a reminder. Post-intervention data were collected on weekdays over two weeks, and then repeated a month later to assess for a sustained change. Results The data on bowel activity documentation were collected from 28 patients. The baseline data showed that bowel activity was monitored daily on the ward 56.25% of the time. There was a significant increase in documentation of 85.75% following the interventions. The sustainability study showed that bowel activity was documented on the ward 59.09% of the time. Conclusions This study shows how a strong effect on behavioural change can be accomplished through simple interventions such as stickers and posters. As most wards currently still use paper notes, this is a generalisable model that other wards can trial. However, this study also shows the difficulty in maintaining behavioural change over extended periods of time. Further PDSA cycles should examine the reasons behind the difficulty sustaining the change and implement new changes that aim to overcome them.

7 The Elephant in the Room: An Innovative and Effective Approach to Multidisciplinary Advance Care Planning Training

Background Exploring patients’ preferences for future care is known to reduce adverse health outcomes, limit transfers between care settings institutionalisation and improve quality of life. Patients value opportunities to have honest conversations. In the recent “Talking about Dying” report from the Royal College of Physicians (RCP), it was found that healthcare professionals (HCPs) find it challenging to start conversations with patients and families. Yet the report highlights a need for HCPs to be equipped with the skills and confidence to provide opportunities for advance care planning in primary care, inpatient and outpatient settings. Methods A multi-disciplinary faculty delivered simulation sessions to 115 candidates (50.4% doctors, 33% nurses and 16.5% allied health professionals) from primary and secondary care. Eight half-day sessions have taken place across North London. Each session started with an introductory lecture, followed by simulated scenarios between a professional actor and candidate within small multi-disciplinary groups. Group discussion was facilitated and feedback given. We focused on acknowledging the progressive, complex and unpredictable nature of frailty. Scenarios included resuscitation, re-admission to hospital, risk feeding, complex discharge planning and cultural values in older adults. Results 100% would recommend this multidisciplinary simulation to teach advance care planning. Only 15.6% of candidates felt confident or very confident with conversations; this improved to 90.5% following the simulation and was maintained at 69.5% three months later. Understanding when advance care planning is appropriate improved from 70% to 100%. Three months after the training, 86% stated they had a sustained change in practice in ACP as a result of the course. Conclusion We have demonstrated that our multidisciplinary simulation is an effective format of improving understanding and confidence in having advance care planning conversations. These results are evident both immediately after and at the three month follow up stage demonstrating a sustained change in practice.