The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

Integrated Plant Nutrition System in Cotton – An Approach Towards Climate Change Mitigation

Agriculture is both affected by climate change but also contributes to it. As a sector, agriculture must therefore both adapt to changes and offers options for mitigation ie reducing greenhouse gas emissions and store carbon. The objective of the study is to explore the optimum level of plant nutrient for sustaining the desired crop productivity in hybrid cotton through optimization of benefit from all possible resources of plant nutrients in an integrated manner and to mitigate the green house gas emission through the adoption of Integrated Plant Nutrition System. The experiment was carried out in three locations with different soil fertility status with special emphasis to nitrogen levels in the soils. The fertilizer doses were fixed based on the soil test values and fertility grouping / indexing by International soil fertility evaluation and improvement programme. As part of organics, FYM was applied at two different levels, and the fertilizers were reduced accordingly. The results proved that application of organic manure @ 12.5 t ha-1 along with the recommended doses of nutrients proved superior in seed cotton production as well reduced nitrous oxide emissions.

EP.FRI.1012 One plus one equals four: how NELA inspired a quality improvement programme that produced 4 distinct positive outcomes

Aim To describe how NELA inspired an ‘improving emergency surgery’ quality improvement programme that produced improvements in 4 distinct areas of surgical practice. Methods This paper describes how Kotter's improvement methodology was implemented in a district general hospital to achieve NELA targets, reduce the negative appendicectomy rate in children, implement NICE guidance on early laparoscopic cholecystectomy for acute cholecystitis and consistently deliver the 'S' and 'A' of SAFER within the surgery department. Results As a result of a systematic quality improvement approach, Conclusions Incorporating NELA into a local 'improving emergency surgery' quality improvement programme has delivered important and wide-ranging benefits beyond emergency laparotomy, and protected the service from 'crowding out behaviour' where focus on a single quality improvement can come at the expense of quality in other areas.

SP3.2.18 Reducing the negative appendicectomy rate in children as part of the ‘improving emergency surgery’ quality improvement programme: an assessment of outcomes and balancing measures for unintended consequences

Aim To describe methodology of the quality improvement programme. To assess outcomes and balancing measures. Methods This paper describes how Kotter’s 8-step improvement model was applied in a District General Hospital. The primary outcome (negative appendicectomy rate) was assessed using GIRFT data over 6 years. Reducing negative appendicectomies might conceivably result in delayed surgery (with a potentially increased incidence of perforated/gangrenous appendicitis), increased length of stay (LOS) and increased readmissions due to delay-related complications. These were assessed by a retrospective audit of appendicectomies performed over the same 8-week period in 2016 and 2019. Results The negative appendicectomy rate in children fell from 16% in 2016-2017 (England average 12%) to 4% in 2017-2018. The improvement was sustained at 6% in 2018-2019 (England average 11%). The incidence of perforated/gangrenous appendicitis decreased by 6% from 23% in 2016 to 16% in 2019. Average LOS decreased from 4 days in 2016 to 3 days in 2019. There was 1 (3%) readmission within 7 days in 2016, and 2 (6%) in 2019. Reasons for readmission were postoperative small bowel obstruction due to omental band adhesion(1) and persistent pain (2). None were caused by delayed operation. Conclusions A sustained improvement in negative appendicectomy rate can be achieved by adopting a systematic quality improvement approach. Against expectations, the reduction in negative appendicectomy rate was associated with a slight decrease in average LOS and reduced frequency of perforated/gangrenous appendicitis. There was no significant increase in readmissions, and none were due to delayed operations.

Morphological Characterization of Twenty One Sweet Pepper (Capsicum annuum L.) Genotypes Collected from Native and Alien Sources

Sweet pepper is one of the most important nutritious vegetable and its demand is increasing day by day in Bangladesh indicating need to characterize and assess morphological variability for varietal improvement programme. Twenty-one sweet pepper genotypes from native and alien sources were characterized for twenty-six morphological traits using vegetative and reproductive appearances at Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh from October 2018 to March 2019. Marked variation was exhibited among twenty-six qualitative traits (26) studied. Twenty-two (22) characters showed undeniable variation among the genotypes. The presence of higher percentage (61.90%) of light purple color at node were observed indicated high amount of anthocyanin content. Leaf shape is used as genotypes identifier at vegetative stage and herein three types of leaves were found with dark green color (76.19%) that is highly correlates with yield. In case of flower, same level of stigma exertion (61.90%) with 100% white color corolla indicates higher number of fruit sett were exhibited. Entire genotypes exerted one or more exclusive characters especially fruit shape and color in Bangladesh perspective which could be used as an important breeding tools. Fruit color was observed in various categories at intermediate and mature stage as for instance yellow, green, purple, orange, red etc. in addition higher percentage of blocky fruit shape (38.09%) were observed and these are the consumer fascinating attributes of sweet pepper. However, selection of genotypes with desirable morphological trait can be used for their exploitation of future breeding programme.

Evaluation of Soybean (Glycine max L.) Genotypes on the Basis of Biochemical Contents and Anti-oxidant Enzyme Activities

Background: Soybean is an important leguminous crop. Abnormal weather has played an enormous role in the strident decline in crop yields. Drought is considered as a significant abiotic factor responsible for yield reduction in soybean. Methods: The present work was carried out in order to screen soybean genotypes for their drought tolerance ability by means of different biochemical and antioxidant enzymatic activities responses. Conclusion: On the basis of biochemical parameters and anti-oxidant enzymatic activities, soybean genotype viz., RVS-211-77, RVS-211-75, NRC-7, SL-96, NRC-136, AMS100-39, SL-96, RVS-2012-01, RVS-211-73 and JS97-52 have been identified with better performance and can be used as parents for further crop improvement programme to breed drought tolerant variety.

Phenological, Morphological and Yield based Characterization of Chickpea (Cicer arietinum L.) Germplasm Lines

Background: The characterization of chickpea genetic resources is a vital step to explore genetic variability in breeding programs. In the present study, we characterized 90 germplasm lines of desi chickpea collected across the Indian chickpea growing region. The identified trait-specific germplasm lines will be used as a valuable genetic resource for the chickpea improvement programme. Methods: An experiment was conducted in augmented design to characterize germplasm lines of chickpea for 13 qualitative and 17 quantitative agro-morphological traits under Bundelkhand agro-climatic conditions. Result: Ample variation was observed for qualitative and quantitative traits. The study revealed that the presences of high variability in qualitative and quantitative traits are useful in the identification of plant genotype for a specific trait, genetic purity analysis, germplasm conservation and also possible use of potential genotype in the breeding program.