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Transgenes associated with genetically changed creatures found non-invasively by means of enviromentally friendly Genetic make-up.
yright © 2019 Burke E et al.Purpose The Reverse Mentoring for Equality, Diversity and Inclusion (ReMEDI) programme was rolled out in Guy's and St Thomas' NHS Foundation Trust in 2018 and paired senior white leaders (mentees) with black and minority ethnic (BME) staff (mentors) to help them explore their mentees' practices in relation to equality, diversity and inclusion. Background The authors, two BME staff, participated in the first cohort of the programme. We reverse mentored a senior white male director, who we met six times over a 6-month period. Methods We used a variety of methods to gain information about and to appraise our mentee, including one-to-one interviews, observations of his team meetings and visual inspections of his department. Main findings We noted a number of positive practices in our mentee's various levels of operation, which we classified as individual, departmental, organisational and symbolic. These findings included the use of gender inclusive language and compliance with BME staff targets. Conclusions This exercise was very useful to our mentee, however, more time with our mentee would have provided greater insight. It would also be helpful to obtain feedback from our mentee's BME staff, to provide a 360-degree view and complete appraisal of his performance. © 2020 Royal College of Physicians.Introduction The successful achievement of training requirements at core medical training level is central to gaining the competence and confidence to progress to higher specialty training. Achieving such requirements is, however, challenging in the context of busy medical rotas and numerous rota gaps. Solution/methodology To develop an online resource for core medical trainees which would facilitate the completion of such training requirements and provide information and support for those progressing to higher specialty training. Outcome The online resource has been well received in Wales with 478 users and regular use of the site being reported using Google Analytics. Qualitative feedback has also been favourable. Conclusion The use of digital resources, flexible training and focus on trainee-led innovation can positively affect the training of medical trainees. In the advent of internal medicine training, the support of the Royal College of Physicians is greatly appreciated in expanding this trainee-led innovation across the UK such that it can support a larger number of trainees.The NHS Long Term Plan aims to transform how we tackle cardiovascular disease by improving the detection and treatment of high-risk conditions. One in five strokes are linked to atrial fibrillation (AF) and it is estimated that 500,000 people in the UK have undiagnosed AF. To increase detection of AF, in 2017 NHS England commissioned the Academic Health Science Networks to procure 6,000 mobile electrocardiography (ECG) devices, which were distributed to community settings across the county. The Health Innovation Network as the Academic Health Science Network for south London was responsible for the distribution of approximately 400 mobile ECG devices to a range of settings. A total of 14,835 pulse rhythm checks were performed, detecting 597 people with possible AF. This project provides insight into effectiveness of a wide range of settings in providing opportunistic testing for AF using mobile ECG devices. © 2020 Royal College of Physicians.A problem was identified where patient care was affected because of delays in receiving specialist cardiology input. This report describes the experience of developing a specialist cardiac assessment where senior cardiac nurses were trained to provide a 24-hour presence in the emergency department (ED). We describe the service and our evaluation of the service. These dedicated specialised nurses can optimise patient management including admission or safely discharge patients with relevant follow-up when necessary. The team also runs three clinics per week with consultant support. The team of 10 nurses provides a cardiology opinion to approximately 400 patients a month in the ED and 100 patients a month in the acute medical unit (AMU). Eighty-seven per cent of patients are seen in the ED within 30 minutes of referral. Approximately 40% of patients reviewed are accepted directly into cardiology beds thus avoiding admission to the AMU. It has been estimated that 6 bed-days are saved each day, which translated to an estimated £400,000 each year. The team also provides outpatient rapid access services which generates £121,792 income for the directorate. We demonstrate that a cardiac nurse assessment team can provide a cost-effective 24-hour presence in the ED. © Royal College of Physicians 2020. All rights reserved.Objectives In 2015, three London cardiac centres, with different transfusion infrastructure support, merged to form the Barts Heart Centre. We describe the impact on transfusion rate, blood usage and interoperator variation. Design Data was collected on all adult patients undergoing cardiac surgery during 2014 as well as 2016, using the National Institute Cardiovascular Outcomes Research (NICOR) data set. Measurements and main results Over the two time periods, a total of 3,647 cardiac procedures were performed (1,930 in 2014 and 1,717 in 2016). There were no significant differences in type of surgery or patient comorbidity between the two epochs of time. Overall, red blood cell transfusion at 24 hours and until hospital discharge reduced significantly in 2016 (odds ratio 0.77; 95% confidence interval 0.68-0.89; p=0.0002). Interoperator variability (adjusted for comorbidities) reduced after merger from standard deviation 0.394 (standard error (SE) 0.096) to 0.269 (SE 0.082), p=0.001. Conclusion Clinical and organisational factors can improve transfusion service. © Royal College of Physicians 2020. All rights reserved.Mechanical thrombectomy (MT) is a very effective, but highly time dependent, reperfusion technique in the management of acute ischaemic stroke caused by large artery occlusion. MT is provided by 24 neuroscience centres (NSCs) in the UK which receive patients directly ('mothership') and via transfer from district general hospitals (DGHs), the 'drip and ship' pathway. NSCs currently provide a within hours service but are working on service expansion to enable 24/7 availability. DGHs, too, will need to prepare for this service expansion to ensure good outcomes for their patients. We discuss options for service expansion in a DGH and regional stroke network in south-west England and use Sentinel Stroke National Audit Programme data and discrete event simulation to model and compare alternative workflow options to aid the planning process. We suggest that our modelled options could be considered by all NHS DGHs in their preparation for MT service expansion. © Royal College of Physicians 2020. All rights reserved.Ambulatory emergency care (AEC) units can treat a wide variety of patients referred from the emergency department (ED) and acute general practitioners, helping to ease ED pressures and reduce unnecessary hospital admissions. We developed a simulation model to assess the potential benefits of expanding the size and opening times of the AEC unit at Derriford Hospital in Plymouth, both separately and in combination. The model predicted that an expanded size of AEC unit could help to improve the effectiveness of the unit, but not as much as extending the opening hours of the unit, which was predicted to result in a significant impact on the number of patients that can be seen and treated in the AEC unit. The hospital used the evidence generated by the model to support a business to case to extend opening hours of the AEC unit, and open the AEC unit at the weekend. © Royal College of Physicians 2020. All rights reserved.Emergency department (ED) presentation with chest pain accounts for approximately 20% of acute hospital admissions, and delays in the investigation and management of these patients increase the pressure on emergency and medical departments. We implemented a pathway within our trust to improve the efficiency of acute chest pain management. This included the development of a chest pain management algorithm, a short-stay heart assessment centre and a policy to immediately transfer acute coronary syndrome patients to cardiology. The introduction of the chest pain pathway resulted in fewer admissions from the ED with chest pain (34.2% vs 19.0%; p less then 0.0001), a reduction in time from ED attendance to cardiology transfer (9.3 hours vs 5.7 hours; p less then 0.0001) and a reduction in time to angiography (62.5 hours vs 26.6 hours; p less then 0.0001). Length of stay was reduced for cardiology patients (4.7 days vs 2.4 days, p less then 0.001) and mean length of stay for all patients attending ED with chest pain was reduced by 8.3 hours (27.5 hours vs 19.1 hours; p less then 0.0001). The changes have significantly improved the management of acute chest pain within our trust and we would suggest that adoption of these changes in other trusts could significantly improve the quality of the care for these patients throughout the NHS. © Royal College of Physicians 2020. All rights reserved.Most doctors in the UK train in urban areas and tertiary centres are considered centres of excellence for training, with rural district general hospitals often seen as a training backwater. However, there are huge benefits to training in rural areas, particularly with an ageing population, increased medical complexity and a shift of care from hospitals to the community. This article examines the benefits of rural training and looks at its role in producing the 'expert generalists' of the future. © Royal College of Physicians 2020. All rights reserved.As the surgical workforce, surgical techniques and patient expectations change, the Royal College of Surgeons of England is actively engaged in taking forward the recommendations of its Future of Surgery Commission. Here the commission's chair articulates the implications for smaller hospitals and the need for achieving interoperability and safe sharing of patient data across different systems, so enabling immediate access to patients' records across healthcare organisations; extension of regulation to surgical care practitioners, reflecting the recent decision to regulate physician associates and physician assistants; introducing a UK-wide registry of surgical devices, with tracking for implantable devices; implementing a robotics strategy to help the NHS plan and purchase new surgical robotics, as well as monitor their use and the effect on outcomes; and investing in genomic medicine and artificial intelligence for diagnostics, and in stem-cell research for treatment. © 2020 Royal College of Physicians.Smaller hospitals internationally are under threat. The narratives around the closure of smaller hospitals, regardless of size and location, are all constructed around three common problems - cost, quality and workforce. The literature is reviewed, demonstrating that there is little hard evidence to support the contention that hospital merger/closure solves these problems. The disbenefits of mergers and closures, including loss of resources, increased pressure on neighbouring organisations, shifting risk from the healthcare system to patients and their families, and the threat hospital closure represents to communities, are explored. Alternative structures, policies and funding mechanisms, based on the evidence, are urgently needed to support smaller hospitals in the UK and elsewhere. © Royal College of Physicians 2020. All rights reserved.
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