A comprehensive high cost drugs dataset from the NHS in England - An OpenSAFELY-TPP Short Data Report

Background: At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, “high-cost drugs” (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients. Additionally, we aimed to make these data available to all approved researchers in OpenSAFELY-TPP. This report is intended to support all studies carried out in OpenSAFELY-TPP, and those elsewhere, working with this dataset or similar data. Methods: Working with the North East Commissioning Support Unit and NHS Digital, we arranged for collation of a single national HCD dataset to help inform responses to the COVID-19 pandemic. The dataset was developed from payment submissions from hospitals to commissioners. Results: In the financial year (FY) 2018/19 there were 2.8 million submissions for 1.1 million unique patient IDs recorded in the HCD. The average number of submissions per patient over the year was 2.6. In FY 2019/20 there were 4.0 million submissions for 1.3 million unique patient IDs. The average number of submissions per patient over the year was 3.1. Of the 21 variables in the dataset, three are now available for analysis in OpenSafely-TPP: Financial year and month of drug being dispensed; drug name; and a description of the drug dispensed. Conclusions: We have described the process for sourcing a national HCD dataset, making these data available for COVID-19-related analysis through OpenSAFELY-TPP and provided information on the variables included in the dataset, data coverage and an initial descriptive analysis.

Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre

Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit. Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August 20–21 Aprilwere analyzed. A descriptive statistical methodology was applied. Results: A total of 119 patients were identified with a mean age of 71.1 years (range 23–97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1–54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days—all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality. Conclusions: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes.

35 Implementation of a quality improvement initiative to reduce pain and anxiety associated with needle-related procedures in a Canadian paediatric emergency department

Primary Subject area Emergency Medicine - Paediatric Background Needle-related procedures such as intravenous (IV) insertion, venipuncture, and lumbar puncture (LP) are commonly performed in children, particularly in the emergency department (ED). Children consistently rate these needle-related procedures as very distressing. While topical anesthetics have been shown to be highly effective and are available, they are inconsistently used. The Children’s Comfort Promise was originally developed at the Minnesota Children’s Hospital. It requires nursing staff to use four strategies for children undergoing needle-related procedures: (1) topical anesthetic, (2) sucrose or breastfeeding if ≤ 12 months, (3) Comfort positioning (swaddling, skin-to-skin, or facilitated tucking if ≤ 12 months and sitting upright for children > 12 months), and (4) age-appropriate distraction. Objectives We sought to evaluate compliance with all 4 Comfort Promise strategies for managing children’s pain and anxiety during needle-related procedures in a Canadian paediatric ED. Design/Methods Implementation of The Comfort Promise in March 2020 included a focus group to perform a root cause analysis, designation of nurse champions, monthly steering committee and ED working group meetings, and didactic education sessions. Our institution’s decision support unit identified all encounters of children 0-17 years who underwent at least one needle-related procedure at our paediatric ED from January 1 to November 30, 2020. The outcome was compliance with all 4 Comfort Promise strategies. Balancing measures included adverse drug reactions and vasoconstriction. We used statistical process control to analyze the outcome from 2 months preceding and 7 months following implementation. Results From January 1 to November 30, 2020, 21,600 encounters were identified, of which 10,294/21,600 (47.7%) were female. Age ranged from 0-17 years with a mean (SD) of 6.9 (5.5) years. Needle-related procedures were performed in 730/21,600 (3.4%) encounters, most commonly IV insertion (289/730, 39.6%) and venipuncture for blood sampling (232/730, 31.8%). Half of all encounters had no compliance strategies electronically recorded (363/730, 49.7%). Compliance with all Comfort Promise strategies increased over the study period (Figure 1). Topical anesthetic increased from 3/35 (8.6%) to 35/83 (42.2%). Sucrose or breastfeeding increased from 0/6 (0%) to 2/16 (12.5%). Comfort positioning increased from 0/35 (0%) to 26/83 (31.3%). Distraction increased from 0/35 (0%) to 22/83 (26.5%). There were no adverse drug reactions or vasoconstriction. Conclusion Implementation of The Comfort Promise in a Canadian paediatric ED resulted in greater use of strategies, particularly topical anesthetic, to reduce needle-related distress in children. Ongoing compliance will depend on consistent electronic recording and provider education.

P164 Back to school - Supporting invasively ventilated children to return to the classroom

Introduction Integration of children with high health needs into the education system, such as those who are invasively ventilated, requires careful planning. Methods We retrospectively reviewed data bases and medical records from January 2004 until December 2020 to profile school age children who, following insertion of a tracheostomy to facilitate invasive ventilation, required assistance in entering or returning to the education system. Results 44 children received invasive respiratory support. Five (11%) remain under the legal school age of 6 years. Fourteen (32%) children entered main stream education – Private or state schools. Three (7%) children attended main stream schools with extra assistance in a support unit. Eighteen (41%) children attended Special Schools that met their individual underlying health care needs. Four (9%) children received either home schooling or attended hospital school. All children received appropriate education according to cognitive ability and none were placed in an inappropriate school setting due to their need for extra support with respiratory health. Discussion High use of health technologies can be perceived as a barrier to the normal classroom so negotiation with education authorities should be part of the patient journey. Support for (re-)integration to the school system includes recruitment and training of support staff and appropriate assessments of ability to provide a safe environment whilst maintaining appropriate level of supervision. Collaboration between the hospital and the education facility is key to the successful integration of children into the education system.

Automatic assistance system for visual control of targets

The article discusses the possibility of creating a system for automating the process of searching and assessing the danger of targets using machine vision and existing ship systems. The technologies for processing images from the ship’s camera system are analyzed: object recognition by a ready-made convolutional neural retrained network, as well as object detection by SURF algorithms. The parameters of the danger of goals within the framework of the problem to be solved have been analyzed and developed, and a structural analysis has been elaborated. The functionality of the automatic operation of the system as a closed circuit has been considered. To achieve the technical result in the system as an integrated part of the ship’s equipment based on cognitive information processing, a composite information object from the ship’s sensors and control systems was introduced. It is decomposed into blocks in which the associated logical information processing takes place using basic modules consisting of adaptive cells-approximators as learning elements capable of independently processing information. The following units are included in the local area network: an information support unit (ISU), a decision making unit (DMU), a command-organizational unit (COU) with an operator’s workstation. The ISU is connected by a two-way communication output with aggregate LAN units, the other output is connected in series with a situation determination unit and the “model of the surrounding space” block. The survey was carried out on board a modern LNG gas carrier using ship systems.

Academic writing among first-term students in the nursing programme at the Swedish Red Cross University College − A description of a three-term transprofessional project in collaboration with the library and the student support unit at Södertörn University

Background and objectives: The academization of the nursing education has emphasized the need for students to acquire academic literacies both for educational and clinical reasons. However, for long being a practical profession, nurse students do not always reflect on the importance of being academic literate. This aim of this article was to describe the teaching of introductory academic writing to first-term students in the Swedish Red Cross University College’s nursing programme, implemented as a transprofessional collaboration project involving the Swedish Red Cross University College and the library as well as the student support unit at Södertörn University.Methods: A model was used for implementing teaching of academic literacies to first-term nursing students embedded in a discipline-specific course. The model consisted of two seminars, one introductory seminar focusing on academic writing and how to search for, read, appraise, and use research articles and one feedback seminar. Peer feedback was performed by the students. In between the seminars, the students began to work on their course assignment and later finalized the assignment using the feedback provided by teachers and peers.Results: The transprofessional collaboration in teaching academic literacies was described as successful. Teachers and students found the embedding of academic writing in a subject-specific course as useful, although – from a student perspective – demanding and partly difficult. The provision of feedback was regarded as helpful and encouraged the students to finish their assignments. Although being a team of teachers, the large class sizes resulted in an extensive workload and stressful situations. Yet another challenge, important for the sustainability of the model, was to win support for teaching academic literacies among all teachers in the nursing programme.Conclusions: The transprofessional collaboration when teaching academic literacies to first-term nursing students have indicated advantages and challenges, of which both are of importance to consider carefully in the further planning and implementation of the project.