Abstract number | Presentation Title | Abstract |
1 | A Nurse Navigator led lung nodule service; creating a gold standard in education and patient safety | This abstract is about the development of the Nurse led Lung Nodule Service in November 2022. The Lung Nodule team comprises of
Specialist Nurses, thoracic radiologists and respiratory physicians.
The Nurses having no prior radiological knowledge were trained by with a dedicated web-based PACS simulator which can host diagnostic quality CT scans and allows creation of structured reporting templates which can be used for training and assessment purposes. and also having weekly sessions with the radiologists.
The educational package has 3modules.
1. A teaching module,
2. A training module (comprising 58 CT cases with clinical vignettes) requiring the user to categorise lung nodules and recommend next steps, with immediate feedback provided on each case,
3. An assessment module (comprising 111 cases) where users test and evidence how well they can categorise solid nodules, with a summary of their accuracy provided on module completion.
Alongside the training package, the navigators received weekly teaching sessions with a thoracic radiologist for 4 months, including training on the use of nodule volumetry software and the indications for when this should be considered in lung nodule management.
The Nurse made an pre-teaching assessment and a post training assessment which showed significant improvement and confidence in their understanding of nodules.
Also, collection of patients discharged with the use of volumetry was collected during and after the Nurses training.
This is the first educational package to our knowledge to standardise teaching and training for incidental Lung nodules. The package can be used by allied health care, trainee and non-thoracic radiologists and respiratory physicians to improve knowledge and create a gold standard in assessment.
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2 | Improving detection and escalation of maternal early deterioration: the DREaMED multi-centre cohort study. | Background
In the United Kingdom, every year around 700,000 women give birth. Of these, at least 70 die and 8700 have a severe complication. Modified Obstetric Early Warning Scores (MOEWS) support the recognition of women at risk of clinical deterioration but are based on expert opinion. There is a wide variation in MOEWSs nationally and limited evidence of their impact on outcomes.
Aims
The aim of this programme is to prevent maternal morbidity and mortality and reduce inequalities in outcomes by developing, validating, embedding and testing an eMOEWS and its associated clinical escalation pathways. Four evidence gaps will be addressed: the lack of a validated morbidity definition for early intervention in maternity; an optimally developed vital-signs-based MOEWS for use where eMOEWS is not feasible; an optimally developed eMOEWS; and an evidenced escalation pathway.
Methods
A multi-centre cohort study of women who are pregnant or have recently been pregnant in 8-12 maternity units in England. The programme of work is divided into four initial workstreams (WS):
WS1 develop ‘severe morbidity’ and ‘pre-severe morbidity’ definitions for use with electronic data through a literature review and international Delphi process.
WS2 develop an 8-12 maternity unit dataset. Current MOEWS’ ability to identify newly defined ‘severe’ and ‘pre-severe’ events will be assessed.
WS3 develop an eMOEWS candidate variable list through a literature review and a further Delphi process. An optimal vital signs MOEWS and a multivariable eMOEWS will be developed and validated.
WS4 develop working eMOEWS web interfaces following user-centred design principles. Develop escalation and response pathways for women identified at risk by the eMOEWS.
In the final workstreams, we will conduct a controlled before-after study implementing the eMOEWS interfaces and escalation pathways in 4 hospitals.
Results
So far, as part of WS1, a “severe maternal morbidity” definition was developed. Its components are derived from work previously undertaken by the World Health Organization, definitions commonly included in prior publications describing “electronically-derived” severe maternal morbidity and a final review from an expert panel.
Conclusion
The DREaMED programme will improve the detection and escalation of maternal early deterioration and therefore improve and reduce inequalities of outcomes.
Ethics
This study was approved by South Central - Oxford C Research Ethics Committee (24/SC/0132) and by the Confidential Advisory Group (24/CAG/0060).
Funding
This study is funded by the National Institute for Health and Care Research (NIHR204430). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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3 | Does psychological and emotional care receive the same priorities within the clinical management of patients with a failing kidney transplant as they return to dialysis or re-transplantation? | Introduction
Transplantation is the treatment of choice for patients with End Stage Renal Failure (ESRF), as quality of life and survival is improved compared to dialysis therapies (Kaballo et al 2018), independence from medical treatments, reduced complications from renal failure alongside cardiovascular benefits (Lubetzky et al 2021). Data from the British Transplantation Society (BTS) (2023) demonstrates 30 - 40% renal grafts fail within the first 10 years with annual failure rate of 3%. Anxiety surrounding a failing graft influence poor compliance, thus potentially contributing to the graft decline (Davis and Mohan 2022). Advancements with medical management of patients with deteriorating renal graft dominates current literature, promoting longevity of their transplant delaying return to dialysis.
Method
Literature review highlighted gaps regarding the psychological care this group receive, providing a noticeable void requiring further investigation.
Discussion
As patients approach ESRF and the initial need for renal replacement therapy (RRT) or transplantation, their pathway is mapped with low clearance clinics, support from specialist AHP’s, psychologists and dieticians providing holistic care alongside supported decision-making pathway. Conversely, the pathway for patients approaching renal replacement therapy following transplantation varies due to insufficient protocols as every patient journey and comorbidities differ and a “one size fits all” approach is not feasible. This uncertainty alongside increased stress, emotion and grief for the loss of their independent life places an immense psychological burden upon the patient.
Psychological stress is briefly mentioned within literature, with no focus upon the lived experience patients encounter daily. A literature review confirmed paucity with psychological care and support patients with a failing transplant receive as they return to dialysis, highlighting barriers to providing psychological care and recommendations for improving future service provision. This confirms further research is required for this patient group at this emotive time.
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4 | Exploring Discourse in Nursing Leadership: A Scoping Review | Background: Nursing leadership is integral to global healthcare transformation but remains a contested and evolving concept. This scoping review forms part of my doctoral research.
Objective: This review analyses how non-executive nursing leadership has been represented in the literature from January 2014 to August 2024.
Methods: This review followed the Arksey and O’Malley (2005) framework for scoping reviews. The databases Emerald, Sociological Abstracts, the British Nursing Database (BND), and CINAHL were searched for relevant literature. Inclusion and exclusion criteria screened the results to 20 papers. The Joanna Briggs Institute appraisal tools were used to review the 20 papers identified.
Results: Findings indicate that transformational and transactional leadership styles continue to dominate discourse but often fail to reflect the lived experiences of nurse leaders. Leadership is frequently framed aspirationally (Cutliffe & Cleary, 2005), yet in practice, nurse leaders encounter role ambiguity, excessive workloads, and systemic barriers that limit their ability to practice effectively. The systemic undervaluation of nursing leadership within healthcare structures persists, leading to limited recognition and support. Emerging leadership perspectives provide alternative frameworks. ‘Rebel leadership’ (Kok et al., 2023) enables nurse leaders to challenge constraints through strategic resistance and innovation, while ‘confident criticality’ (Clark & Thompson, 2023) encourages critical engagement with institutional narratives while maintaining professional confidence.
Discussion: The scoping review highlights the need for reflexivity and adaptability. While dominant leadership paradigms persist, emerging models offer alternative approaches that acknowledge power dynamics and structural constraints. These perspectives provide a more grounded and responsive conceptualisation of nursing leadership that aligns with real-world challenges rather than prescriptive ideals.
Conclusion: This scoping review contributes to the redefinition of nursing leadership by advocating for leadership models responsive to practical challenges. |
5 | A Scoping Review and Narrative Synthesis Exploring Service User Experiences of Being Diagnosed with EUPD | Aims-
This review aims to scope existing literature and explore the current understanding of the impact on service users, of receiving a diagnosis of Emotionally Unstable Personality Disorder (EUPD) . The objectives are to explore the interpersonal and intrapersonal responses to the diagnosis, and patient views and experiences of accessing treatment pathways.
Background-
EUPD is characterised by a pattern of instability of interpersonal relationships, self-image and marked impulsivity. Research suggests a trend of implicit bias against individuals with EUPD which leads to a lack of access to appropriate care, evidenced by themes like ‘passive and/or active denial of treatment’ and a discourse of this patient population ‘being untreatable’ (Sulzer, 2015, p8-p9).
There is an established correlation between increased levels of suicide risk amongst service users with an EUPD diagnosis (McClelland et al., 2023). Existing research suggests 5.9% of borderline [EUPD] patients died by suicide and most had not recovered before completing suicide (Temes et al., 2019).
Methods-
This paper performs a scoping review using a systematic literature search strategy. Papers that met the inclusion criteria were analysed using narrative synthesis. Our coding and analysis was based on Arksey & O’Malley’s framework for systematic scoping reviews.
Results-
Three themes and two subthemes were identified- service users’ experiences post diagnosis, their reactions post diagnosis (interpersonal and intrapersonal reactions) and their experiences of accessing treatment pathways. Findings suggest that some people feel a sense of relief post diagnosis while others feel stigmatised and discriminated against. Emphasis on therapeutic relationships is important for better treatment outcomes.
Conclusion-
The experience of the diagnostic journey for the service user who receives an EUPD diagnosis, is highly dependent on the therapeutic relationship with the professional. Fostering a shared understanding of the diagnosis and educating professionals on relational dynamics may lead to a greater likelihood of recovery. |
6 | Ethnic Minority Staff working in an acute NHS Trust and their experiences and perceptions of COVID-19 Vaccination | Aims
The overall aim of this study was to explore and analyse the experiences of Ethnic Minority Staff working in an acute NHS Trust and their experiences and perceptions of COVID-19 vaccination.
Objectives
1. To conduct an online survey and audio-recorded semi-structed interviews among ethnic minority staff about their experiences and perceptions of COVID-19 vaccination.
2. To explore and understand ethnic minority staff rationale for taking or not taking COVID-19 vaccine.
3. To produce research-informed recommendations to better protect and support ethnic minority staff from highly communicable infections.
Ethical Statement
The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the Medical Science Interdivisional Research Ethics Committee of the University of Oxford with reference R80686/RE001. Final approval to conduct this study was granted by the National Health Service (NHS) Health Authority (HRA) with refence 22/PRO0348. Data collection took place from May 2022 to September 2022 and informed consent was obtained from all individual participants.
Background
Evidence found inequalities between ethnic groups affected by COVID-19 with high mortality rates compared to the white people. This study sought to gain better understanding of ethnic minority staff experience and perceptions of COVID-19 vaccination during the pandemic.
Methods
A mixed methods design was used. Online survey was completed to explore participants demographics, religious beliefs, academic attainment, job roles, vaccination status and knowledge of COVID-19 transmission. Then audio-recorded semi-structured interviews were conducted on a subset of respondents exploring participants’ experiences and perception of COVID-19 vaccination. Descriptive statistics and thematic analysis were used to analyse quantitative and qualitative data respectively. Pillar integration process was used to synthesis the findings.
Results
Seventy-three ethnic minority staff completed the online survey but only 59 met the inclusion criteria and 9 were interviewed. Most of the respondents (94%) were vaccinated, 3% were still waiting for their first dose and 3% were unwilling to receive COVID-19 vaccination. Themes identified included anxiety, fear, isolation, lack of support, impact of faith and religious beliefs. Most of the interview participants, (89%) were against mandatory COVID-19 vaccination.
Conclusions
Most of the participants received COVID-19 vaccination and had good knowledge of the transmission of the virus. Findings highlighted participants’ strong opposition to mandatory COVID-19 vaccination. The main reasons for receiving COVID-19 vaccination were to protect their own health, families, colleagues and communities as well as to resume their social activities.
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7 | Research: The ‘Forgotten’ Pillar of Advanced Practice? | Research: The ‘Forgotten’ Pillar of Advanced Practice?
Carley Moore
Faculty of Health and Life Sciences, Oxford Brookes University, Marcham Road Health Centre
Abstract
Aim: The research pillar of advanced practice appears underdeveloped globally. Consequently, there is a need to map how stakeholders interpret and respond to the research pillar of advanced practice.
Design: Scoping review.
Data sources: CINAHL, PubMed, and the British Nursing Database were searched for evidence from 2013 to 2023. The search was re-run in September 2024.
Methods: The Joanna Briggs Institute method for scoping reviews was followed. Papers that reported how stakeholders interpreted and responded to the research pillar of advanced practice were included. Data were extracted, analysed, summarised, and presented in tabular form accompanied by a narrative synthesis.
Results: Ultimately, 18 papers from 22 countries were included, providing a global perspective on research in advanced practice, with data mapped into four categories. Research is considered essential for fulfilling the advanced practitioner role, but definitions and approaches vary based on historical, relational, and sociocultural factors. Efforts to support research in advanced practice span education and practice. However, conceptual, methodological, and theoretical gaps in the literature were identified.
Conclusion: The gaps in the literature resulted in a narrow and traditional perception of advanced practitioners' research activities, a lack of theoretical grounding, and an overall limit to our understanding. Further qualitative research based on a theoretical framework is needed to better understand the research activities of advanced practitioners.
Implications: Further research could reshape how we perceive and support advanced practitioners in their research activities, leading to more effective and impactful healthcare practices.
Impact: This scoping review contributes by providing an original and comprehensive international overview of how stakeholders have interpreted and responded to the research pillar of advanced practice. Understanding advanced practitioners' research activities is crucial for supporting them in the research pillar, thus leading to better care, outcomes, recruitment, and retention.
Supervisors: Dr Olga Kozlowska and Dr Marion Waite
Source of funding: Self
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8 | An exploration of nurse-patient interactions in acute hospital settings when Electronic Patient Record (EPR) system are used | Background: The introduction of Electronic Patient Record systems is changing contemporary nursing practice at a rapid rate. Electronic Patient Record systems use an anticipatory approach to address patients’ needs via digital prompts that promote patient safety and assure fundamental care needs are met. Electronic Patient Record systems are underpinned by a systems-based medical model that may conflict with a person-centred approach to care. It is widely accepted that quality nurse-patient interactions involve a compassionate nurse presence, open, two-way communication, and shared decision-making. There are few studies that explore the impact of Electronic Patient Records on nurse-patient communication. Research within nursing focuses on evaluating nurses’ Electronic Patient Record-use. Studies examining how nurses’ Electronic Patient Record-use impacts on the quality of nurse-patient interactions are lacking.
Aim: To explore how nurses' use of Electronic Patient Record systems in four UK acute hospital wards impacts on the quality of nurse-patient interactions.
Methods: This mixed methods study included observations using a published tool to evaluate the quality of nurse-patient interactions, as well as nurse and patient interviews. Following convenience sampling, 16 observations and 16 nurse and 16 patient interviews were conducted. Descriptive statistics and thematic analysis informed overall study themes.
Results: Key findings indicate that nurses’ use of Electronic Patient Record scripts promote a formulaic style of communication that has the potential to impact the fundamental tenets of nursing. Electronic Patient Record scripts were prioritised over open, two-way communication and shared goal-planning. Cumbersome computer systems monopolised nurses’ time and impeded face-to-face communication, which detrimentally impacted on the quality of nurse-patient communication.
Conclusion: Nurses and employers need to consider the unintended impact of nurses' Electronic Patient Record-use on the quality of nurse-patient interactions. Nurse educators need to encourage practices that promote quality nurse-patient interactions when nurses use Electronic Patient Record systems in acute care hospital settings.
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9 | The Division of Cardiovascular Medicine Research Nurse and Research Support Team | The Division of Cardiovascular Medicine (CVMed) at the University of Oxford is a leading research and clinical department that integrates cutting-edge scientific research with clinical expertise in the field of cardiovascular disease. The division operates within the Radcliffe Department of Clinical Medicine (RDM), part of the Medical Science Division within the University of Oxford.
CVMed has a strong emphasis on advanced cardiovascular imaging technologies, particularly non-invasive imaging techniques for diagnosing and monitoring heart conditions. This includes the development and application of MRI, CT, and echocardiography which operate through its three clinical research facilities; OCMR, AMIIC and CCRF at the John Radcliffe Hospital.
The Division of Cardiovascular Medicine Research Nurse and Research Support Team (RN&ST) manage a diverse portfolio of studies, ranging from clinical application of basic science research, through to clinical trials involving investigational products The portfolio encompasses a diverse range of cardiovascular health issues;
Arrhythmia
Atherosclerotic Disease and inflammatory processes
Cardiomyopathy
Cardiometabolic Disorders
Congenital Cardiovascular Disease
Molecular Genetics & Molecular Biology of Heart Muscle Disease
Heart Failure
Heart Valve Disease
Hypertension
Heart Disease in Women and Pregnancy
Hypertrophic Cardiomyopathy and Inherited Cardiovascular Disease
Obesity and Heart Disease.
The Research Nurse and Research Support Team consists of cardiac research nurses, a cardiac research midwife and specialist cardiac clinical research practitioners. Together, they bring essential expertise, knowledge and skills to support the research process. "Our goal is to ensure that study participants receive the highest standard of care and professionalism, making their involvement in research a safe, informed, and positive experience".
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10 | How can occupational therapy and physiotherapy practice placements be optimised to enhance the experience of practice educators in an acute hospital setting? |
Background: Practice placements are crucial in shaping future OTs and physiotherapists. A significant shortage of qualified professionals has resulted in a decline in the availability of practice placements offered. By exploring the barriers and facilitators that optimise placement outcomes and enrich the experience for practice educators, strategies to enhance the provision of placements can be identified enabling development and expansion of the future workforce.
Objective: To identify the barriers and facilitators related to providing OT and physiotherapy practice placement, to enhance outcomes and the experience for practice educators within the acute hospital setting.
Methods: This service improvement project was part of an MSc, approval from Oxford Brookes Faculty Ethics was obtained.
Semi-structured interviews were conducted, and thematic synthesis of the data was completed to identify common themes. These themes then contributed to the discussion and formation of recommendations for future practice.
Results: Eight participants were interviewed and a reflexive thematic approach (Braun and Clarke, 2006) was used to analysis the data resulting in the identification of three main themes and six subthemes that contribute to the outcome and experience of PP.
Conclusion: Many barriers and facilitators contribute to the quality and experience of OT and physiotherapy practice placements not only for the practice educators, but for stakeholders involved. Implementing strategic measures to optimise the facilitators and address the barriers to providing placements is crucial for enhancing the quality, experiences and quantity of practice placements being provided. Failure to address this issue may result in significant repercussions for the experiences and well-being of both practice educators and students, as well as for the overall quality and sustainability of practice placements.
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11 | Audit of Oxford University Hospitals Mesothelioma Service. | Aims and Objectives:
Analysis of patients diagnosed and treated for mesothelioma at OUH, compared to national data.
Background:
OUH is a tertiary cancer centre treating patients from across Southeast England. Mesothelioma is a rare cancer, with around 2700 cases nationally and 28-35 patients diagnosed through OUH each year. Standards for mesothelioma service provision are British Thoracic Society guidelines and National Mesothelioma Audit (NMA).
Methods:
We undertook a manual review of electronic clinical records and systemic anti-cancer therapy prescriptions of mesothelioma patients through OUH between 1st January 2017 and 31st October 2023. Follow-up was censored at 31st December 2023. Data included pathological diagnosis; histological subtype; stage; performance status; MDT discussion; proportion undergoing SACT; survival by treatment regimen. This was compared with NMA and trial data.
Results/Findings:
A total of 198 patients (161 [80.9%] male, 37 [19.1%] female) were diagnosed and/or treated through the service. Mean age at diagnosis was 77.6 years (range 33-95). Those with pathological data (93%) were above the national (88%). Of those histologically confirmed, all but two cases (1.13%) had subtyping (compared to 31% untyped nationally): 130 (70.62%) epithelioid, 23 (12.43%) sarcomatoid, 28 (15.25%) biphasic, one (0.56%) desmoplastic. 75.6% had staging recorded. 96.8% were discussed at MDT, compared to 89% nationally. 87 patients (43.7%) underwent first-line platinum-pemetrexed chemotherapy (47 received carboplatin; 28 cisplatin) compared to 40% nationally. 20 patients received second-line nivolumab, with four subsequently commencing third-line treatment of rechallenge platinum-pemetrexed on progression. 14 patients treated in the last two years commenced first-line ipilimumab/nivolumab, two subsequently receiving second-line platinum-based chemotherapy on progression.
Conclusion:
Demographics of OUH mesothelioma population broadly reflect national averages. A higher proportion of patients were discussed at MDT and received pathological subtyping, than the national average. A higher proportion of those with PS:0-1 received SACT than nationally; median OS with carboplatin/pemetrexed exceeded that of cisplatin/pemetrexed. |
12 | The impact of socioeconomic deprivation on the likelihood of receiving bystander cardiopulmonary resuscitation and community defibrillation in out of hospital cardiac arrest in the UK: A Rapid Evidence Review |
Public access defibrillators and cardiopulmonary resuscitation are key to the ‘chain of survival’ during a cardiac arrest (Nolan et al, 2006). However,
research within the United Kingdom has found national inequalities in the placement of public access defibrillators and bystander cardiopulmonary
resuscitation (BCPR) with areas of higher levels of deprivation having a greater incidence of cardiac arrest but fewer occurrences of BCPR and defibrillation (Brown et al, 2019).
Aims: This review aimed to assess the association between level of deprivation and likelihood of receiving BCPR and community defibrillation for patients suffering out of hospital cardiac arrest within the United Kingdom.
Methods: A rapid evidence review was conducted. CINAHL and PubMed were searched from 2013 to July 2023, only studies conducted in the UK and reported in English were included. Critical appraisal and narrative synthesis were
performed.
Findings: Five retrospective studies were included for final review. Representing (n=138 176) patients suffering out of hospital cardiac arrest (OHCA). Studies reported on the likelihood of BCPR (n=2), AED distribution (n=2) and survival determinants of traumatic and medical OHCA (n=1). Three studies analysed national data (n=3), the remaining two studies analysed individual ambulance trust data (n=2). Studies found that OHCA incidences were lowest in the areas of lowest deprivation, quintile 1 representing the most deprived population had the lowest rates of BCPR with higher OHCA incidences compared to quintile 4 and 5. AED locations did not align with trends in OHCA incidences.
Conclusion: These findings show the need for further research within the United Kingdom surrounding OHCA inequalities. Research should focus on high-risk areas characterised by high incidences of OHCA and BCPR and AED use. Including, qualitative investigations into the population's understanding and awareness of CPR and defibrillation
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13 | Evaluation of the Children’s Hospital at Home Oxfordshire Service, considering Nurse Led Efficiencies to increase Capacity and Patient Flow over a 3 year Period | Title
Evaluation of the Children’s Hospital at Home Oxfordshire Service, considering Nurse Led Efficiencies to increase Capacity and Patient Flow over a 3 year Period
Aims and Objectives
To review patient activity including home visits, phone assessments and number of patients. The impact of Nurse led developments in the service will be reviewed, considering activity and capacity.
Background
The Children’s Hospital at Home Service was created in 2021 with nursing provision from the Community Children’s Nursing (CCN) Service. The service has established clinical pathways, bronchiolitis, wheeze, jaundice and IVAB running 7 days a week, 8am to 8pm. Patients are referred via GPS, ED and acute setting with medical oversight sitting with the acute paediatricians in OUH. Nursing staff have been supported in completing the Enhanced Paediatric Nursing Skills Course which led to service innovations including, a nurse led discharge pathway, implementation of use of SBAR and development of a QI project in developing a community triage tool.
Methods
Data on patient activity was collected from September to January, comparing Winter 2021 and Winter 2024.
Results
Winter Patients Seen Home Visits Phone Assessments Average Length of Stay (days)
2021 97 152 244 3.97
2024 402 502 1173 2.8
Conclusion
Nurse Led developments and medical confidence in the service have enabled patient activity to increase. The reduced length of stay demonstrates the increased skills of the nursing team, with nurse led discharge creating increased capacity effectively.
Future plans include using the seasonality of paediatric activity supporting the CCN team to complete planned work in the summer months, therefore providing increased staffing from the CCN’s to support increased capacity in the winter months.
The use clinics during peak pressure would enable an increased number of children to be supported by the service without additional staffing.
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14 | Improving bladder care in maternity services | Aims and Objectives
• Reduce incidents of urinary retention following labour and birth
• Increase compliance with completion of fluid balance charts
Background
The maternity safety team noticed an increase in incidents of potentially avoidable large volume urinary retention which had the potential to cause long term harm. An audit was undertaken in 2023 the findings of which suggested that some higher risk women were not offered catheterisation in the immediate postnatal period. This led to the revision and implementation of new clinical guidance and education. New pathways were introduced for low, medium and high risk women, based on intrapartum events. Education about bladder care and the new pathways was included on mandatory training since September 2024.
Following implementation of this guidance and education a further audit has been undertaken.
A review was undertaken of all reported cases via ulysses of urinary retention >1litre.
Results/Findings
A reduction in acute incidents of urinary retention during the audit period (23 reported incidents in original audit reduced to 14)
Of the women who experienced retention the majority (9/14) were identified as or should have been high risk.
Fluid balance chart completion remains a challenge - audit results suggest increase in partial completion.
Conclusion
The results of the audit suggest improvement in identification and management of women who are at higher risk of bladder injuries from urinary retention. Further work is required to ensure compliance with the guidance and pathways, completion of fluid balance documentation and management of TWOC.
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15 | Applied Pharmacology Workshop for Clinical Research Nurses | Aims and Objectives
To assess the impact of an Applied Pharmacology workshop on the knowledge and confidence of clinical research nurses (RNs) and practitioners.
Background
Pharmacology related training for RNs is limited, restricted primarily to undergraduate training which focuses on knowledge relevant to managing patients in a clinical care setting. This is despite their crucial role in supporting the development, evaluation, management and reporting of new medications, agents and molecules. Training and development opportunities for clinical research delivery teams in multiple areas exist but educational opportunities focusing on drug development and associated pharmacology are currently lacking.
The NIHR Oxford Clinical Research Facility hosted a national workshop for clinical research nurses/practitioners working in early phase delivery teams across the UK to provide theoretical and practical pharmacology knowledge that enhances the delivery of early phase clinical research.
Methods
Attendees were asked to complete a questionnaire requesting demographic information as well as perceived confidence with pharmacology topics; indicating how they felt their confidence and knowledge was pre and post workshop.
Results/Findings
The survey showed attendees ranged in years of experience from more than 20 years to 2 years. Attendees indicated the study day improved their understanding of Pharmacology by over 50%. This was evident in responses related to their knowledge and confidence with describing pharmacokinetics and pharmacodynamics and in explaining processes for managing patients, identifying safety concerns and understanding sampling regimes.
Conclusion
The NIHR Oxford CRF-led workshop provided the opportunity for research delivery teams to expand and consolidate their theoretical pharmacology knowledge, linking this with daily practice in early phase clinical research facilities. Attendees reported improved depth of understanding as well as heightened confidence in applying their pharmacology skills. Given the dearth of pharmacology focused training opportunities for research delivery teams further educational opportunities in this area would be valuable.
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16 | Including Private Patients in Clinical Research | Aims:
To assess if patients seeking private healthcare are willing to participate in clinical research.
Background:
The number of patients in the UK seeking private healthcare has grown considerably since the covid-19 pandemic and in the face of record NHS waiting lists (BMJ 2023). NHS consultants in Dermatology and Sexual Health, already working collaboratively in the management of challenging, chronic genital conditions, recently begun delivering private services as part of a pilot hosted by EMCRF. EMCRF routinely embeds research within outpatient clinics, inviting patients attending for standard care to participate in relevant studies. This pilot aims to assess whether patients who access private healthcare can also be offered the opportunity to participate in research – ensuring equitable access and that research is representative of the whole patient population, regardless of the care pathway.
Methodology:
Patients attending the clinic were asked to complete an on-line questionnaire. Demographics, treatment objectives and clinical research preferences were recorded.
Results:
Over a 2-month period, n=33 patients were presented with the questionnaire. Of these, 64% were females with 73% presenting with genital conditions. Almost half (48%) reported seeking private healthcare due to dissatisfaction with the current NHS pathways; and 70% had already seen other clinicians about this problem. 61% (n=20) were self-funding their appointments, rather than using insurance.64% said they either would (n=17), or might (n=4) be interested in participating in research relevant to their visit.
Conclusion:
As the nature of the NHS and clinical research within it faces many changes; understanding where and how to reach potential participants becomes more important. Creating relevant and accessible research opportunities is essential and including those who seek support beyond the NHS could be integral in the future. The patient population attending our clinic are often disheartened with current healthcare treatments but remain largely supportive of participating in clinical research.
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17 | Do people with aphasia find slower speech easier to understand? | Aims
• To explore whether people with aphasia (PWA) find slower speech easier to understand.
• To explore whether there is an optimum speech rate for facilitating comprehension for PWA.
• To identify potential factors that may influence the effectiveness of this strategy for improving comprehension for PWA.
Background
Many PWA report that slower speech is easier to understand. However, empirical research on this strategy’s efficacy is inconsistent. 150 words per minute (wpm) is considered average in English. A “Goldilocks zone” has been suggested, hypothesising unnaturally fast or slow speech as being more challenging to comprehend. This strategy’s efficacy may depend on factors relating to the individual, the communication partner, or the social or linguistic context.
Methods
A quasi-systematic review of quantitative research. Literature was systematically searched using five databases, forwards and backwards citation, grey literature and hand searching. The TIDiER framework (Hoffmann et al., 2014) and SWiM analysis (Campbell et al., 2020) were utilised for intervention descriptions and data synthesis. Vote counting based on direction of effect was used.
Results
495 papers were identified, with fourteen meeting eligibility. Studies were heterogenous in methodologies and participant populations. Seven studies reported overall positive effects of slowed speech rate. Five out of six studies that included speech samples of approximately 120wpm reported positive effects. Speech rates under 120wpm reported positive or no effects, while speech rates over 150wpm reported negative or no effects. Potentially influencing factors are considered.
Conclusion
Reduced speech rates of 120wpm may be beneficial for PWA, and potentially a “Goldilocks zone”. Slower speech rates (under 120wpm) are unlikely to be detrimental and faster speech rates (over 150wpm) are unlikely to be beneficial. The overall efficacy of this strategy is likely to be variable, with many potentially influencing factors. An individualistic approach, considering patient preference, is indicated. Further research needs are discussed.
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18 | Implementation of Communication Partner Training into an Inpatient Neurorehabilitation Service | Aims and Objectives:
This project aims to implement a complex behavioural intervention (Better Conversations Communication Partner Training, CPT) into the neurorehabilitation service at the Oxford Centre for Enablement (OCE). The objectives are that every eligible patient will be offered CPT as an intervention by the end of the study period, and that all staff will feel confident to deliver it as part of routine practice.
Background:
CPT is a Speech and Language Therapy intervention with a strong evidence base for its effectiveness in improving the conversations between adults with acquired neurological conditions and their communication partners. However, it is also recognised in the literature that there are many barriers to its effective implementation into services. Implementation Science aims to systematically identify and overcome such barriers to facilitate adoption of best research evidence into practice.
Methods:
This project will use implementation science methods to implement and evaluate the introduction of CPT into the neurorehabilitation service at the OCE. This will include the Theoretical Domains Framework (TDF), and Behaviour Change Theory based on the COM-B model, to identify capabilities, opportunities and motivation for behaviour change. The project will also use iterative feedback from the staff, patients and family, to continue to identify barriers and facilitators to implementation throughout the project.
Results/Findings:
Thus far, we have used the Theoretical Domains Framework to identify that the biggest barrier to implementation was the skill, knowledge and confidence of the staff. The team have therefore undergone training from the developers of the intervention. The next steps will include local training to overcome barriers related to environmental context and resources, and developing checklists and guidelines to support memory, attention and decision making.
Conclusion:
This project begins properly in April 2025 so the conclusions are not yet known. Progress will be presented at the conference. |
19 | Musculoskeletal impairments following critical illness: a qualitative case study of the experiences of patients, their families and healthcare professionals. | Introduction
More than half of critical care survivors experience at least one or more elements of post intensive care syndrome. Patients then struggle to function in daily life, with high rates of new unemployment and healthcare utilisation.
Qualitative investigations to date have portrayed negative experiences in social support when patients transition back into the community. There are multiple specific healthcare problems contributing to poor physical function with musculoskeletal (MSK) ill health being evident in 59% of critical care survivors.
Objectives
Primary aim: to gain an in-depth understanding of the lived experiences of patients living with MSK impairments following critical illness. Secondary aims: to explore the lived experiences of families and healthcare professionals in supporting patients.
Methods
A multicentre qualitative case study was undertaken inclusive of semi-structured interviews with patients, family members and healthcare professionals (REC Ref: 21/NS/0143). Service questions and documentation analysis were also collected; and integrated through framework analysis.
Results
11 patient participants, four family members and 13 staff were interviewed. Five themes were identified: I had to cradle my body due to the pain; I needed my strength back so I could move freely; The patients reported, so we referred on…; Their complexity is challenging, and they longed for structured rehab; and I just want to be back to normal for myself and my family. Case study analysis shows variation in service delivery across staffing and intervention delivery.
Conclusions
Musculoskeletal ill health following critical illness is problematic, contributing to patients' struggle to engage with daily activities, family time and return to work. Staff feel they recognise the need for intervention to address these complex problems, often making onward referrals. However, this does not appear to translate into patients receiving interventions. Future post-ICU rehabilitation services need to address management of MSK problems, and experience of these should be explored.
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20 | Investigation of the Dosimetry Differences Between Pre-Therapy SPECT/CT and Post-Therapy PET/CT Scan in Selective Internal Radiation Therapy (SIRT) | Aims and Introduction: The success of SIRT relies on accurate dosimetry to optimise tumour absorbed dose while minimising liver toxicity. Previous work has shown a difference between prescribed and delivered dose using 99mTc-MAA SPECT/CT and 90Y PET imaging. This study investigates differences in pre- and post-therapy dosimetry. (HRA 346450)
Background: SIRT is a type of radiation therapy used to treat tumours in the liver by injecting Y-90 microspheres through the hepatic artery. Two procedures are carried out: a workup delivering 99mTc-MAA into blood vessels to model liver vasculature and activity distribution, and a procedure to deliver a treatment dose. The 99mTc-MAA is used to plan the activity of microspheres required to deliver the prescribed dose.
Methods: For twenty patients, the absorbed dose to volumes of interest (VOIs) were calculated using a new software and compared to results from an in-house spreadsheet for validation. The difference between pre-therapy and post-therapy absorbed doses was calculated. The impact on absorbed dose of post-therapy segmentation methods, SPECT/CT and PET/CT partial volume effects (PVE)s, and interoperator variability were investigated.
Results: Despite overall correlation between pre- and post-therapy tumour absorbed doses large differences were observed (<84.9Gy). Analysis of volume segmentation methods showed a difference in tumour absorbed dose between pre- and post-therapy (<64Gy) across the 3 methods. Correcting for PVEs significantly changed the absorbed dose difference (p<0.001). Absorbed doses to the perfused and tumour VOIs varied largely with an average range across the operators of 59.2Gy and 78.0Gy respectively.
Conclusions: The results from this study reveal good confidence in 99mTc-MAA SPECT/CT pre-therapy dosimetry for estimation of the absorbed dose to the normal liver in SIRT. However, there are large tumour absorbed doses differences between pre- and post-therapy causing sub-standard delivery of treatment due to a variety of factors including the PVE, segmentation methods and inter-operator variability. |
21 | Service re-evaluation of patient and clinician experience of goal setting practice in a Level 1 specialist inpatient rehabilitation service | Background
Rehabilitation is successful when person-centred and people’s unique beliefs are identified. Following a service evaluation in March 2024, changes to goal setting practice were implemented; the Rivermead Life Goals Questionnaire was re-introduced, paperwork was streamlined to include patient-rated goal achievement, training was introduced and meetings scheduled by the treating team to improve attendance.
Aim
1. To understand patient and clinician experience of goal setting following changes to practice
Methods
Bespoke surveys were provided to all patients and clinicians with an information sheet outlining the background and aim.
Results
12 patients (75%) completed the survey. 10 had completed a life goals questionnaire, 2 did not remember. 12 strongly agreed/agreed their goals reflected what was important to them. 10 reported a written summary of goals was very important/important, 9 had one. 12 had fortnightly goal setting meetings, all felt this was frequent enough. Inclusion in goal setting increased patients’ motivation and improved understanding of why they practise certain tasks. Patients want their complete team to attend the meetings, especially nurses.
18 clinicians (72%) completed the survey. 15 always set goals with their patients, 10 always attend goal setting meetings. 16 always review patient goals and when goals have been achieved, 10 always set new goals. 14 feel goal meetings improve communication with the inter-disciplinary team (IDT). 12 always use EPR documentation and 14 always agree to print the patient goal summary. 15 think goal setting with patients has a high impact on goal achievement and progress. All think the meetings are valuable for patients’ rehabilitation. Full attendance by the treating team and more practice at documentation are suggested improvements.
Conclusion
Person-centred meaningful goals can positively impact progress in rehabilitation.
Clinicians now work more cohesively as an IDT towards an agreed set of goals. Goal setting training will continue to be delivered.
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22 | Using a physiotherapist-led behaviour change intervention to promote exercise adherence in people with vertebral fragility fracture: a qualitative study | Aims and objectives: Our aim was to explore the longitudinal experience of participating in a physiotherapy-led exercise adherence programme as part of the OsteoPorosis Tailored exercise adherence INtervention (OPTIN) trial.
Background: Vertebral fragility fractures (VFF) are associated with back pain, fatigue and functional disability, as well as low mood, decreased quality of life and limitations in activity and social participation. National guidelines recommend exercise and general activity for people with osteoporosis and VFF to maintain muscle strength, balance, and posture, improve physical function and prevent falls; however, adhering to prescribed exercise is challenging.
Methods: In a longitudinal qualitative study, we conducted semi-structured interviews with participants at three timepoints: (1) within the first 2 weeks of initial assessment, (2) at the end of the 16-week intervention, and (3) a year after baseline. We analysed data using reflexive thematic analysis. Ethical permissions were granted by West of Scotland Research Ethics Committee (21/WS/0071).
Findings: We interviewed 12 participants (female n=10, 83%) with a mean age 76.1 (60 – 92) years old from the OPTIN exercise intervention arm. All participants were diagnosed with osteoporosis and had a least one VFF. Participants were recruited from four different NHS trial sites, and we completed 35 interviews. From participant data, we distilled 5 themes: (1) One size does not fit all; (2) My mind and body can be in conflict or work together; (3) Expanding my circle of support; (4) Transitioning from an exercise programme to a lifestyle change; and (5) Moving from fear to empowerment.
Conclusion: Our findings suggest that the OPTIN exercise adherence intervention facilitated physical and psychosocial improvements by educating, tailoring, empathising and allying with the participant. Short term adherence to an exercise programme may be a bridge to becoming more confident to integrate more activity into life longer term.
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23 | Mechanisms of Vaginal Breech Birth, Risk Factors for Adverse Neonatal Outcomes | Background
Breech presentation complicates 3-4% babies at term (Royal College of Obstetricians and Gynaecologists (RCOG), 2017) . The Term Breech Trial (Hannah et al, 2000) reported that breech vaginal births have higher risk of adverse neonatal outcomes compared to being delivered by caesarean. This resulted in increased caesarean section for breech presentation (50%-80%). The Term Breech Trial had several limitations and caesarean section has associated risks itself, clinicians are now challenging what has now become normal practice (Glezerman, 2006).
Aim
To examine if there is any correlation between mechanisms of vaginal breech birth and adverse neonatal outcomes.
Methodology/Methods
A clinical audit of retrospective data prospectively collected between 2014 – 2024, from women completing a spontaneous vaginal breech birth. Mechanisms of vaginal breech birth audited against adverse neonatal outcomes reported in NHS England Maternity Statistics (2023-2024) and Resuscitation Council UK (2021).
Results
Data was collected and analysed for 144 vaginal breech births. Women who delivered in the upright position were less likely to need any assistance with the birth.
More babies needed admission to the Neonatal Unit, 11% (n=16) and inflation breaths, 26% (n=37) compared to national data of cephalic vaginal deliveries.
9% (n=13) babies Apgar scores were 0-6 at 5 minutes compared to 1.3% reported nationally in 2023-2024.
Quicker first and second stages of labour and timing of the active second stage was consistent with current literature.
Discussion and Conclusions
Breech birth presents increased risks, which is consistent with the current evidence base. However, results should be treated with caution due to several limitations. Data analysed is for successful vaginal breech births and does not include those who aimed for a vaginal birth, but birth outcome was a caesarean section. A bigger study with more robust data is needed to compare birth outcomes (vaginal birth or caesarean section) for babies presenting breech immediately before birth, considering patient choice and maternal satisfaction.
References
• Impey LWM, Murphy DJ, Griffiths M, Penna LK on behalf of the Royal College of Obstetricians and Gynaecologists. Management of Breech Presentation. BJOG 2017; 124: e151–e177.
• Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Hannah, Mary E et al. The Lancet, Volume 356, Issue 9239, 1375-1383
• Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol. 2006 Jan;194(1):20-5. doi: 10.1016/j.ajog.2005.08.039. PMID: 16389006.
• NHS England Digital. (2025). NHS Maternity Statistics, England [2023-2024].
• Fawke, J., Wyllie, J., Madar, J., Ainsworth, S., Tinnion, R., Chittick, R., Wenlock, N., Cusack, J., Monnelly, V., Lockey, A., Hampshire, S., (2021), Newborn resuscitation and support of transition of infants at birth Guidelines. Resuscitation Council UK. https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
• Reitter A, Halliday A, Walker S. Practical insight into upright breech birth from birth videos: A structured analysis. Birth. 2020 Jun;47(2):211-219. doi: 10.1111/birt.12480. Epub 2020 Jan 20. PMID: 31960492; PMCID: PMC7318698.
• Louwen, F., Daviss, B.-A., Johnson, K.C. and Reitter, A. (2017), Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?†. Int J Gynecol Obstet, 136: 151-161. https://doi.org/10.1002/ijgo.12033
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24 | Non-pharmacological interventions for managing chronic pain in patients affected by venous leg ulcers | Aims and Objectives: This study aims to explore the non-pharmacological interventions available in the literature to manage chronic pain in patients affected by venous leg ulcers, with a specific focus on Advanced Clinical Practice.
Background: Venous Leg Ulcers are frequently accompanied by chronic wound pain, which has traditionally been managed primarily through pharmacological treatments, including the use of potent opioids. However, these medications are often associated with undesirable side effects and complications. Recent evidence challenges this conventional approach, advocating for the integration of non-pharmacological therapies to enhance pain management and improve patient outcomes.
Methods: An integrative literature review was employed, and 16 studies were selected, including quantitative, qualitative, and mixed-methods research. These studies were critically appraised for quality and relevance. The review considered international studies conducted in both primary and secondary healthcare settings. The outcome measures examined included reductions in pain scores, relevant indicators, and/or improvements in patient experience.
Results/Findings: The results indicated that electrical stimulation therapy was effective in reducing wound pain. Compression therapy also alleviated pain, particularly when combined with other interventions such as exercise and lymphotherapy. Social support did not show a significant correlation with pain reduction, although peer support groups were found to reduce pain and improve self-esteem and patients' quality of life. Virtual reality was effective in reducing wound pain during dressing changes, while light therapy resulted in a significant reduction in pain and higher wound closure rates. Aromatherapy and music therapy helped reduce pain during or immediately after dressing changes, and traditional Chinese medicine contributed to pain reduction, although it initially worsened pain in the first two hours after application.
Conclusion: This review suggests that effective non-pharmacological therapies are available for managing chronic wound pain in patients with venous leg ulcers. The findings from this study can pave the way for the implementation of new interventions in the current practice, responding to the evolving needs and innovations in the healthcare system. Future research should focus on integrating these therapies into clinical practice, exploring their long-term effects, and addressing potential barriers to their implementation.
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25 | A seminal poetic meta-ethnography on child and adolescent pain | Aims and Objectives: We aimed to systematically search for qualitative research that explored the pain experiences of children and adolescents, and present findings as poems for empathetic understanding.
Background: The World Health Organisation recognise that young people’s pain can unnoticed and unreported and a Lancet Commission highlights uncertainties about the child and adolescent pain management.
Methods: This systematic review was registered on the PROSPERO database (CRD42023429027). Ethical permissions are not required for an evidence synthesis. We searched four electronic bibliographic databases (Medline, PsycINFO, CINAHL, and Embase) from inception to August 2023. Two reviewers screened all full texts, discussed the relevance of each study, and excluded any irrelevant or ‘fatally flawed’ studies. We used the methods of meta-ethnography to synthesise findings and co-created verbatim poems from the original research narrative.
Findings: We screened 7471 titles and included 177 unique studies of 5875 young people from around the world. Our final findings comprise an anthology of poems that describe the emotional impact, transition to adulthood, and challenges that young people face when deciding whether to show their pain to others (or to hide it), for example:
I feel like I am in tall grass,
enemies around me
I don't know where they are,
Or when they're going to attack.
It scares me to my bones.
like a ripple effect.
Petrified.
It is worse than the actual pain.
Imagine that I live to be 90
That grand age!
Another 70 years of pain
The prospect fills me with dread.
It is like a thorn in the side.
Will I get a job, get married, have children,
take care of myself,
live? (Toye et al. 2025)
Conclusions: Poetic meta-ethnography is a fusion of evidence synthesis and arts that can make a valuable contribution to empathetic and compassionate healthcare.
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26 | Post-Traumatic Elbow Stiffness: A Survey of Current UK Physiotherapy Practice | Aims and objectives: To establish the current trends in physiotherapy management of traumatic elbow injuries and post-traumatic elbow stiffness.
Background: Elbow stiffness is a major cause of functional impairment, with an incidence of up to 56% following traumatic injury. Loss of 50% of elbow range-of-movement represents a total loss of 80% of upper limb function. Understanding the best rehabilitation programme for prevention of stiffness following elbow trauma/surgery is in the Top 10 James Lind Alliance Priorities for Elbow Conditions. Establishing the current management of patients with traumatic elbow injuries is important to evaluate and refine practices, reducing variation in care and ensuring continuous improvement.
Methods: UK‐based physiotherapists were invited to complete on online survey, including 25 closed and open questions regarding patient characteristics, the treatment and assessment of traumatic elbow injuries and management of stiffness. University of Oxford ethical approval was sought and deemed not required. Results were analysed and narratively reported.
Results: Of the 71 participants respondents, 70/71; 99% of respondents work for the NHS. Most physiotherapists (68/71; 98%) use active range of motion exercises to manage patients during the acute phase (immediately post-injury to 6 weeks). The greatest challenge reported included reduced elbow extension range-of-movement (64/71; 90%) and pain (59/71; 83%). 9/71 (13%) of respondents had been qualified for less than 5 years, 20/71 (28%) and 19/71 (27%) for >20 years. There was variation in self-reported confidence when treating this patient group.
Conclusion: There are some similarities and some disparities to the way in which traumatic elbow injuries are managed by physiotherapists. Developing standards for physiotherapists are needed to address disparity between treatment, including management and prevention of post-traumatic elbow stiffness. This would help improve patient outcomes. Larger scale investigations are required and the components of current treatment highlighted may lead to intervention development and a feasibility trial. |
27 | A service evaluation to assess and explore the East Timorese community and key stakeholders’ experiences of a local TB service. | Background: According to The World Health Organisation (WHO), Tuberculosis (TB) is a leading infectious disease killer worldwide. Forty-five percent of the global burden of TB disease is found in the Southeast Asia Region. Twenty percent of users of our service have migrated from this region and we needed to understand if their needs were met.
Aim: This service evaluation was to explore the experiences of the tuberculosis (TB) nursing service from the perspective of people within the East Timorese community and relevant stakeholders to the service.
Methods: A service evaluation of the TB Nursing service was undertaken. Community leaders (n=3), Service users (n=13) and HCP (n=5) were asked to comment on the service.
Results and Conclusion: The results show that in the main we are meeting their needs, however key areas for improvement suggested by participants included an increase in TB awareness, focused education and overcoming language barriers.
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28 | What are the experiences of women and midwives of non-severe perineal trauma assessment? A meta-synthesis | Aim: To explore the experiences of women and midwives of non-severe perineal trauma assessment.
Background: In the UK, most women giving birth vaginally experience perineal trauma, predominantly non-severe, yet there is no validated assessment tool to evaluate wound healing postnatally. Current NICE guidelines provide only generic advice on how to complete this assessment, exposing the potential for a variety of non-standardised practices. Criticism of UK postnatal care is widespread, and inadequate perineal trauma assessment might contribute to this.
Methods: Systematic literature review with meta-synthesis using three online databases: CINAHL, PubMed, and Web of Science. Data was synthesised using constant comparative analysis.
Findings: Nine studies exploring the experiences of women (8/9) and midwives (1/9) on non-severe perineal trauma were included. Three themes emerged: ‘How society and healthcare professionals are silencing women’s experiences’, ‘The inadequate provision of perineal care’, and ‘A glimmer of hope, examples of positive experiences’.
Discussion: Women report being underprepared about the extent of their perineal trauma, the potential impact on their lives and the services available if concerned. Some women are not offered perineal assessment and feel their concerns are trivialised by clinicians. These issues are not unique to the UK, as similar challenges exist globally. Improving postnatal care requires better communication, a therapeutic woman-midwife relationship, and societal change to reduce the stigma around perineal trauma, which impacts women's psychophysical health.
Conclusion: Improving postnatal perineal trauma care is crucial, with research needed on assessment practices and tools. Therapeutic relationships and women-centred clinical pathways can enhance experiences.
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29 | A reflection on my transition from ICU Research Nurse to Clinical Research Co-Ordinator | A reflection on my transition from ICU Research Nurse to Clinical Research Co-Ordinator
Using The ERA Cycle (Jasper, 2013) I will be reflecting on my time transitioning from and ICU Research Nurse to Clinical Research Co-Ordinator for GAINs II: Sepsis Immunomics.
Experience
The role that I hold is currently unique within my organisation. I am a Registered Nurse with over a decade of experience, spanning different specialities from Neurosurgery to Palliative Care through to ICU nursing.
It is a culmination of all these experiences that have led me to the role that I am in now. I currently work as a Clinical Research Co-Ordinator for GAINs II: Sepsis Immunomics. This role means that I am co-ordinating a multi-site study whilst recruiting to the same study.
Reflection
Through out this experience I have learnt where my strengths and weaknesses lie in more depth. The skills I have acquired as a clinical nurse across different departments require an acknowledgement in my role today. This can be expanded by starting with communication. As a clinical nurse, I am required to communicate with many people in the Multidisciplinary Team, however now that I am working as Clinical Co-Ordinator, I work with multiple sites and different specialities. I believe I have strong communication skills, this can be demonstrated in the fact that I have successfully facilitated and sustained a multi-site study.
Action
I continue to strengthen my communication skills by asking for feedback from line managers, colleagues and my patients. Jug et al (2019) demonstrates that giving and receiving feedback can improve patient care. I am being proactive in my approach to improving patient care.
References
Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.
Jug, R., Jiang, X.S. and Bean, S.M., 2019. Giving and receiving effective feedback: A review article and how-to guide. Archives of pathology & laboratory medicine, 143(2), pp.244-250.
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30 | Understanding the impact of health inequalities on healthcare outcomes for South Asian patients with Inflammatory Bowel Disease in the UK | Aim:
Capture the impact of the relationship between health inequalities and healthcare outcomes for South Asians with Inflammatory Bowel Disease in the UK
Background:
South Asians (SA) are consistently subject to a reduced level of care through socioeconomic factors and other determinants of health. Alongside the phenotypical and physiological differences across diverse groups, it is also recognised that there are more obvious cultural and religious differences, impacting how people from minoritised backgrounds respond to illness and diseases, including Inflammatory Bowel Disease (IBD). Treatment decisions can be compromised if a patient's cultural belief systems are not accommodated and systematic neglect of these issues throughout healthcare contributes to further disparities and poorer healthcare outcomes. The proposed doctoral research plans to examine the impact of health inequalities (HI) and utilise the results to inform the development of a culturally competent intervention.
Methods:
The project seeks to examine the impact of health inequalities (HI) for SA patients with IBD in the UK through mixed methods including statistical analysis of the Community Practice Research Datalink (CPRD) database to inform qualitative interviews with patients and healthcare professionals. The results will be analysed through thematic analysis techniques. From this a scoping review to explore current intervention practices in other conditions around HI will help develop the intervention.
Results:
The findings of the project have the potential to improve our current understanding of the lived experiences of SA patients with IBD in the UK and how HI impact on their healthcare outcomes. Conducting such research will in turn help inform tangible interventions to build an equitable and culturally competent healthcare service for IBD patients in the UK.
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31 | An evaluation of community-based treadmill training in Parkinson’s Disease to improve gait speed | Aims and Objectives,
To evaluate community-based treadmill training in Parkinson’s Disease (PD) to improve gait speed.
Background,
Treadmill training in PD has been shown to improve overland gait velocity, balance and quality of life in excess of usual over ground walking practise. However these studies use intensive lab based interventions, unattainable for the majority of patients and NHS services. The Physical Disability Physiotherapy Service (PDPS) has therefore been undertaking a service evaluation of treadmill training in community gyms, utilising the proven treadmill methodology but pragmatically applied to community care.
Methods
Patients with idiopathic PD, who were independently mobile indoors and able to follow verbal instructions were eligible to participate alongside their usual care. Patients were screened for cardiovascular suitability using the physical activity readiness questionnaire (PAR-Q). Gait speed was measured using the 10m walk, with balance and quality of life also measured (single leg stand, PDQ-39). The 2-minute step test was later introduced to evaluate changes in fitness. Patients attended a local gym for up to six, once weekly sessions, and completed 25mins of treadmill walking with 5 min intervals at varying speeds (85%, 100% & 115% of average walking speed). Measures were then repeated after the six weeks, with additional follow up at six months.
Results/Findings
To date, results show the treadmill training programme (n=34) improves median gait speed from baseline (1.14m/s(0.99-1.30)), at six weeks (1.28m/s(1.06-1.52)) and six months (1.36m/s(1.26-1.43)), in excess of the MCID for walking speed in PD (0.08m/s). Balance scores have also shown improvement to a smaller extent (Affected leg +3 secs, Unaffected leg + 2secs).
Conclusion
To date, results support use of community-based treadmill training with improvements in gait speed which are maintained in the longer-term. The programme has been positively received by patients providing an accessible, achievable and sustainable tool to facilitate self-management.
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32 | Exploring the use of health technology in community-based midwifery care – an interview study | Aims and Objectives
To explore the use of health technology in UK community midwifery.
Background
New portable health technologies may help address challenges in maternity care, but little is known about their current use, limitations, or areas of unmet need.
Methods
Midwives with current or recent community experience were recruited via social media. Semi-structured interviews were conducted, transcribed, and thematically analysed.
Findings
Thirteen midwives were interviewed between October 2021 and March 2022. Three main themes emerged:
1. Problems with current equipment:
a) Challenges using equipment while working remotely.
b) Concerns about accuracy.
c) Midwives’ perceptions of service user experiences.
2. Working within the NHS:
a) Limited availability of suitable equipment.
b) Restricted autonomy in its use.
3. Unmet needs:
Midwives identified areas where better or additional tools could support their work.
Conclusion
The study identified significant unmet needs in community midwifery, but also highlighted more urgent concerns about the availability and quality of existing health technologies. Midwives expressed interest in tools that support clinical decision-making, reduce unnecessary hospital visits, ease workloads, and avoid over-medicalisation. However, some voiced concerns about technology undermining their clinical judgement and relationship-based care. Where new tools are introduced, appropriate support and training will be vital to address concerns and ensure successful adoption.
Ethics
This study was reviewed and received ethics clearance through the University of Oxford Central University Research Ethics Committee (Reference number: R66855/RE001). The investigators ensured that the study was conducted in accordance with the principles of the Declaration of Helsinki.
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33 | Large Language Models in Clinical Advice: Evaluating Direct Generation, Retrieval Augmented Generation and Human Reference Answers | Aims and Objectives
The NHS faces increasing pressures due to workforce attrition and rising care backlogs. Pharmacy services, essential for ensuring medication safety and effectiveness, are often overlooked in digital innovation. This study evaluates the potential of Large Language Models (LLMs) to support pharmacy services by answering clinical pharmaceutical queries. It compares the effectiveness of different retrieval methods and assesses their accuracy, relevance, and safety.
Background
LLMs are being increasingly explored for healthcare applications, but their role in pharmacy remains under-researched. This study examines two retrieval techniques: Vanilla Retrieval-Augmented Generation (RAG) and Graph RAG, both supported by an external knowledge source. A direct generation control (ChatGPT 4o without retrieval) was also included. While RAG models leverage retrieval to enhance factual accuracy, challenges such as retrieval errors and hallucinations persist, necessitating a robust evaluation framework for safe clinical deployment.
Methods
Quantitative and qualitative evaluations were conducted. Embedding-based metrics (cosine similarity, CBERT F1, QNLI) were used to measure semantic alignment, while expert pharmacists assessed response accuracy, relevance, and patient safety. A Kruskal-Wallis test with post-hoc Dunn’s test identified statistical differences between models.
Results/Findings
Vanilla RAG outperformed Graph RAG and human reference answers for accuracy and patient safety. Graph RAG struggled with retrieval accuracy, leading to incorrect formulations being retrieved. Despite strong performance, hallucinations persisted, particularly in ChatGPT 4o responses. Expert evaluations revealed inconsistencies in human reference answers
Conclusion
LLMs demonstrate promise in answering pharmaceutical queries, but challenges remain regarding retrieval accuracy and hallucinations. Regulatory frameworks have yet to catch up with LLM advancements, necessitating clearer guidelines on transparency, explainability, and validation. Future work should explore continuous validation methodologies and refinement of retrieval mechanisms to ensure safe clinical deployment.
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34 | The impact of a tissue viability service in critical care unit | Background
Patients in the Intensive Care Unit (ICU) are four times more likely to develop hospital-acquired pressure injuries (HAPIs) compared to those in non-ICU settings (Labeau 2021) due to the combination of severe acute illnesses and pre-existing conditions which contribute to skin deterioration (EPUAP,2019). Despite pressure ulcer prevention polices being in place in a regional Critical Care Unit (CCU) high cases of HAPI are occurring, thus a tissue viability nurse was employed to be part of the critical care team to see if they could reduce the occurrences of HAPIs.
Aim: To evaluate if having a tissue viability nurse as part of critical care team in a regional CCU could decrease the occurrence of HAPIs.
Methodology & Methods
A pre/post retrospective evaluation of the incidence of HAPI between August 2024 and February 2025. Methods used included controlled medical record analysis of all patients who developed a HAPI, completed questionnaire from registered healthcare professional who work in the CCU and reflective diary notes from tissue viability nurse.
Results/findings
1129 patients were admitted to CCU during the study period, 58 (4.90%) developed a HAPI. Pre-implementation reported HAPIs were 37 (6.15%) and post-implementation reported HAPIs were 21 (3.65%).
Analysis of the questionnaires and reflective diary notes found that all of HCP staff were aware of the tissue viability role and initial thoughts of the role was that it was very helpful. It was felt that HCP are being supported through education and management of complex patients.
Discussion & Conclusions
This service evaluation shows some early promise that the presence of a tissue viability nurse could help reduce incidence of HAPIs, compliance with unit protocols and increased staff engagement and knowledge.
Ongoing evaluation of the role is needed to ascertain if the reduction in HAPIs is maintained.
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35 | “An exploration of the interventions and/ or training materials used in the healthcare curriculum to improve confidence and competence amongst healthcare professionals when caring for patients with skin of colour” | Aims: The aim of this review is to explore the interventions that have been utilised within the healthcare curriculum to improve confidence and
competence amongst healthcare professionals when caring for patients with skin of colour.
Background: Healthcare professionals demonstrate reduced competence and/ or confidence in assessing and identifying disease in patients with skin of colour. Light skin tone bias within medical literature is an established issue and this lack of representation of patients with skin of colour contributes to the delays in and inaccurate diagnoses. It is paramount that the content and teaching delivered as part of the healthcare curriculum is fit for purpose and addresses this identified knowledge gap.
Methodology and methods: This research adopted the form of a quasi-systematic literature review and was undertaken using the qualities of a
systematic review, maintaining a comprehensive approach throughout. The ontological position of this review was guided by constructionism and the epistemological paradigm of interpretivism was used. The data analysis was undertaken using a narrative synthesis approach and the structure guided by Popay et al. (2006). Each of the articles were critically appraised and assessed for any ethical concerns.
Results: 10 studies met the inclusion criteria. There was an overarching theme of ‘the importance of exposure to educational materials that represent
patients with skin of colour’.
Conclusions: This review found that increased representation of patients with skin of colour in the healthcare curriculum is a key strategy to address
this knowledge and confidence deficit. |
36 | Impairment vs Occupation Focus: Examining Experiences of Patients with Neurological Conditions Requiring Occupational Therapy Cognitive Assessment | Background
Patient assessment is crucial in occupational therapy practices, highlighting the tension between deductive data collection and inductive functional observation (Stigen et al., 2019). Previous studies have identified this tension but lacked patient perspectives, which are essential for evaluating different assessment types.
Introduction
This study aims to provide patient perspectives on cognitive assessment and the focus on impairments versus functional, occupation-based tasks following brain injury. Initial themes from participant interviews will be introduced.
Objective
The research will examine patient experience of cognitive assessments to understand their perceptions of the assessment types; the impact of these assessments in both inpatient and outpatient settings; and suggest how this might influence practice. Central to this study is placing the patient voice at the forefront, ensuring assessments consider patient experiences and needs.
Methods
Eight participants will be purposively sampled from inpatient and outpatient settings. Semi-structured interviews will explore patient experiences of cognitive assessment. Interview transcriptions will be analysed using Interpretative Phenomenological Analysis (IPA). A reflexivity journal will support self-awareness during analysis.
Results
Results will be presented as themes developed from IPA and will inform ongoing practice within cognitive assessment and intervention processes.
Conclusion
The findings are expected to provide insights into the experiences of adults with cognitive changes requiring occupational therapy assessments. These insights will be shared locally for direct impact on practice and will also be disseminated more widely, with recommendations for practice, education and further research.
References
Stigen, L., Bjørk, E., & Lund, A. (2019). The conflicted practice: municipal occupational therapists’ experiences with assessment of clients with cognitive impairments. Scandinavian Journal of Occupational Therapy, 26, 261-272.
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37 | Optimising PDOC Care: An Interdisciplinary Approach to Excellence at OCE |
Aim
To optimise the care of patients with Prolonged Disorders of Consciousness (PDOC) at the Oxford Centre for Enablement (OCE) by aligning the PDOC pathway with the updated Royal College of Physicians (RCP) national clinical guidelines (2020), utilising resources from leading institutions, and ensuring all staff are trained and competent in the use of assessment tools and best practices.
Objectives
• Align the OCE PDOC pathway with the Royal College of Physicians (RCP) PDOC national clinical guidelines (2020).
• Review resources from leading institutions treating PDOC patients.
• Disseminate the revised PDOC pathway to OCE staff and deliver competency training for assessment tools.
Background
An interdisciplinary team (IDT) was established to focus on PDOC patients. The publication of the RCP guidelines in 2020 initiated a review process to map the existing patient journey, from admission to discharge, ensuring standards are met for patients who lack capacity.
Methods
Regular meetings were held to assign tasks, adhere to project timelines, and plan priority actions. Changes to the PDOC pathway were made, identifying training and support needs, particularly focusing on the assessment phase. Improvements were made ensuring consistency and documentation of the best interest’s process.
Results
The PDOC pathway was updated to align with clinical guidelines. An Integrated Care Plan was created to ensure consistent care for PDOC patients, with clear task outlines for each discipline from admission to discharge. Preconfigured Electronic Patient Record (EPR) documentation was developed for meetings and record-keeping. Recommended assessment tools were adopted, and training was disseminated by advanced PDOC assessors. A competency framework for assessment was launched to ensure adequate training before clinicians interpret results.
Conclusion
Patients admitted to the OCE with a PDOC diagnosis will receive consistent, evidence-based care. The pathway ensures all staff are trained and have access to high-quality resources, with advanced assessors involved in every patient's care.
Word count: 300
References:
Royal College of Physicians. Prolonged disorders of consciousness following sudden onset brain injury: National clinical guidelines. London: RCP, 2020.
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38 | Exploring student paramedics’ experiences of sexual harassment from colleagues whilst on practice placement in UK ambulance services | Aims and objectives
This primary research study is aimed at gaining an understanding of student paramedics experiences of sexual harassment from paramedics or other ambulance colleagues while on practice placement in UK ambulances services.
Background
Inappropriate sexualised behaviour towards colleagues has been highlighted as a significant embedded cultural problem within UK ambulance services (NHSE 2024). Colleagues may be exposed to incidents ranging from suggestive looks, receiving unsolicited pictures of intimate parts, to sexual assault (HSJ 2022). However, there is a paucity of research looking at the placement experiences of student paramedics who are exposed to this culture. This study, which is currently in progress, aims to understand more about the experiences of sexual harassment of student paramedics during practice placement in UK ambulance services.
Methods
A social constructionism underpinning was used to plan and conduct semi-structured interviews. Participants were a self-selected sample of second- and third-year students from two higher education institutions in the UK. Ten participants were interviewed in total. Interviews were transcribed verbatim and will be analysed using Braun and Clarke’s thematic analysis framework (Braun and Clarke 2006). Ethics approval was granted by Oxford Brookes university.
Results/findings
Students interviewed so far have experienced and witnessed a wide range of inappropriate sexual behaviour from paramedics and other ambulance service staff members. Early results highlight significant themes around identifying inappropriate sexualised behaviour, barriers to reporting and the actions of bystanders. As thematic analysis progresses, we expect to understand this construct more deeply and the effect that these experiences have on student paramedics.
Conclusion
This is one of the very first studies to explore sexual harassment experiences from colleagues amongst student paramedics. We expect the results to inform a larger scale intervention study, and to support embedding issues around sexual harassment into pre-registration curricula.
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39 | Exploring Learning Experiences, Career Intentions, and Motivational Factors Among Apprentice Radiographers: A Survey-Based Study | Aims and objectives: The purpose of the study is to explore the learning experiences, career intentions, and motivational factors influencing apprentice radiographers during their apprenticeship in one NHS trust.
Background: The demand for the apprenticeship programme has been increasing steadily since the launch of the first-degree apprenticeship programme in diagnostic radiography five years ago.
Methods: Following necessary approvals, an online survey was conducted anonymously among both recent graduates and current apprentice radiographers using Likert-scale and open-ended questions. Data analysis was based on descriptive statistics and a thematic analysis using of the text based responses.
Results: Eight respondents provided insight into their learning experiences, career aspirations, and challenges faced in clinical practice. Among them, two were recently qualified from the programme. Quantitative analysis of Likert-scale responses revealed that 77.4% of participants found academic staff supportive and 72.4% of participants believed that theory-practice integration was effective. Career satisfaction was notably high (80%), with many expressing clear career pathways and aspirations for advanced roles within next three years. Although, family factors or previous experience did not correlate with learning experiences or career intentions, qualified radiographers reported greater overall satisfaction with the course compared to current student radiographers.
Key motivational factors included workplace mentorship and team support, while major challenges included heavy assessment loads, work-life balance struggles, and frequent changes of placement site. Most recommended the course for its strong clinical training but highlight the need for better placement support, structured teaching, and clinical mentorship.
Conclusion: Though the majority of apprentice radiographers express satisfaction and positive experience with their apprenticeship, these findings highlight the importance of structured mentorship and targeted academic support in enhancing the apprenticeship experience and fostering career development in radiography.
(As part of the FoRRM (Formal Radiography Research Mentoring) scheme supported by College of Radiographers, this research received prior approval from OUH Radiology Clinical Governance Team, Lead Radiographer-Practice Education and line manager) |
40 | Weight loss intervention with specialist dietitian behavioural support for people with cystic fibrosis who have excess weight: the EASE-CF randomised controlled feasibility trial. | Background: Cystic fibrosis (CF) is a genetic, life limiting condition affecting over 11,000 people in the UK. It is characterised by progressive lung function decline and requires complex treatment. Due to improved treatments, 40% of adults living with CF are now also living with overweight and obesity. As this is an emerging issue, there have been no weight loss intervention trials conducted. The safety and acceptability of weight loss programmes in people with CF is unknown.
Aims and Objectives: The primary objective for this trial is to assess whether progression to a definitive RCT is justified. This includes assessment of recruitment, engagement, adherence and retention rates. Exploratory objectives will report between group differences in body weight, body composition, healthy related quality of life, lung function, blood pressure, glycaemic control and blood lipids measured at baseline and 24 weeks. Adverse events will be reported to assess safety of the intervention.
Methods: This is a 24-week multi-centre unblinded parallel randomised controlled feasibility trial with an embedded qualitative study. We plan to recruit n=30 adults with BMI ≥ 27kg/m2 and randomise them to either the intervention (a structured weight loss programme with behavioural support from a specialist dietitian) or usual care groups at a 2:1 ratio. Randomisation will be stratified by age ≥ 40 years and presence of CF diabetes. The trial will be delivered fully remotely with assessments and intervention support provided by video consultation. The prescriptive intervention will include a meal replacement product and a portioned fresh ready meal provided free of charge to participants. Interviews will be carried out with health care professionals and patients.
Conclusion :EASE-CF will be the first randomised controlled trial investigating the feasibility of adults living with CF taking part in an intentional weight loss programme. Approvals are ongoing with recruitment due to start this year.
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41 | Prehabilitation service provision and preoperative clinical pathways for major oesophagogastric cancer surgery patients: A service evaluation. | Background: Prehabilitation is a multidisciplinary intervention aimed at optimising patients prior to surgery. Locally, integration of prehabilitation within the major oesophagogastric (OG) cancer preoperative clinical pathway is unclear.
Aim: To evaluate the prehabilitation service provision and preoperative clinical pathways for OG patients at a regional cancer centre.
Methods: A retrospective service evaluation of electronic patient records and staff survey was undertaken. Adults undergoing elective OG cancer resection surgery between October 2022 to October 2023 were included. Patient characteristics and details of preoperative interventions were collected, and a survey sent out to staff involved in the preoperative pathway. The findings were evaluated against the Macmillan prehabilitation guidance.
Results: Ninety-five patients were evaluated, of which 70 (73.7%) received physiotherapy as part of prehabilitation. Reasons for non-receipt included: no referral (n=12, 48%), clerical errors (n=5, 20%), and missed appointments (n=8, 32%). Patients not receiving physiotherapy were older (median 70 years, IQR 58-77 vs. 66, IQR 61-73), had a higher proportion of open surgeries (53% vs. 47%), heart disease (28% vs. 8.5%) and obesity (72% vs. 2.8%) compared to those who did. Only 29/95 (30%) received dietetics input and none received psychological support. The staff survey identified that there is no funded prehabilitation service for dietetics or psychological medicine. Potential areas of improvement to align with the Macmillan guidance included: starting interventions promptly, and to develop dietetics and psychological medicine services as part of the prehabilitation service.
Conclusions: These findings will contribute to the development of the current prehabilitation service and inform future research. |
42 | Developing a pathway to support student nurses first choice career posts in community settings. | Aim: To present an initiative to work alongside students and practice partners to dispel the myth that all registered nurses should have exposure to acute experience before venturing into community nursing roles.
Background: Community nurses form a pivotal part of both the National Health Service (NHS) and Private, Voluntary, and Independent (PVI) workforces in the United Kingdom. The projected increase in demand for care in the community as a result of an ageing and growing population with major health needs depends on recruiting and retaining more nurses in primary, community and mental health settings. However, despite the invaluable care provided by community nurses, very few nurses currently choose a community or older person nursing as a first destination job on qualification. Student nurses often perceive nursing in the community environment to be of lower status and complexity compared to nursing in more acute environments.
Method: The Oxford Brookes community pathway in Swindon was developed as a research-informed education and practice development initiative. It seeks to raise the profile of community and older adult nursing while challenging ageist and discriminatory practices. The pathway offers three dedicated action learning sets where students in different community placements can come together to share their experiences, increase awareness, and gain confidence in advancing directly into community roles upon qualification.
Results: Through inclusive education and practice, the opportunity to have all final-year placements in community settings has supported students' choice to enter community nursing as a first-choice career post. Preliminary evaluations of the pathway demonstrate that students are transitioning into practice areas they otherwise wouldn't have thought possible.
Conclusion: The community pathway is an effective tool to support the needs of students and healthcare providers. Ethical approval is currently being sought to evaluate the pathway and disseminate the findings through peer-reviewed journals.
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43 | Developing the future workforce: academic nurse educators' experiences and perceptions of preparing and supporting student nurses for clinical placements in nursing homes. | AIM AND BACKGROUND: This paper explores nurse educators’ experiences and perceptions of supporting nursing home placements. The global population is ageing and requires the provision of skilled registered nurses to meet their needs. However, students do not view nursing homes favourably compared to acute hospital placements (Garbrah et al, 2017). Nurse educators should accept the challenge to facilitate a change in perceptions towards nursing homes as valued learning environments.
DESIGN: Interpretative Phenomenological Analysis (IPA) was undertaken to develop divergent and convergent experiences of nurse educators supporting clinical placements in nursing homes. Each interview was transcribed verbatim and analysed descriptively, conceptually and linguistically which is consistent with the IPA approach. The cross-group analysis elicited individual and shared experiences.
METHODS: Semi-structured interviews with eight nurse educators were conducted online between December 2020 and March 2021. Smith et al's, (2009) six-step iterative process was followed alongside researcher reflexivity, to extract divergent Personal Experiential Themes and convergent Group Experiential Themes.
RESULTS: Participants highlighted how the clinical expertise of the faculty affects role modelling and potentially student perceptions of the value of nursing in care homes. Participants found supporting nursing homes more challenging compared to student placements in other care settings as communication is not streamlined between the university and nursing homes. They expressed how it takes more time and effort to build trusting relationships and support nursing home staff to recognise their own value and roles within the sphere of nurse education.
CONCLUSION: Participants highlighted that employing diverse faculty will support positive role modelling and curricula to enable a deeper understanding of minority placement settings such as nursing homes. Nursing curricula should encourage educators and student nurses to recognise their own stereotypical beliefs, to begin eradicating misconceptions to increase the value of clinical placements in nursing homes within nurse education.
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44 | Working together: embedding research into clinical practice | Aim. To share our experience of Orthopaedic Trauma and Major Trauma research over the last 20 years and discuss how we successfully embed research into clinical practice.
Background. There is organisational support to embed research delivery in daily clinical practice, giving patients and carers the opportunity to participate in and contribute to research, ensuring evidence-based care. This support extends to clinical staff with a strategy to engage nursing, midwifery and allied health professionals in research activity.
Methods. A literature review and personal experience of recruiting to over 70 research studies.
Results. The evidence and our experience support three key themes.
Firstly, creating a research culture requires integration of research and clinical teams; research teams being pivotal in the provision of education specific to studies and the conduit to the trial support teams locally and centrally.
Secondly, equipoise within a clinical team suggests an absence of consensus and evidence to inform practice. This highlights the need for research activity when there is no clear answer to a clinical question. Integrated researchers can promote the development of equipoise by facilitating conversations in daily practice, promoting confidence in admitting equipoise and supporting a research culture.
Lastly, overcoming research reticence. There is a time burden associated with clinical research, making it difficult for clinical staff to actively engage. Researchers can support the clinical team, identifying achievable goals to enable involvement. Education sessions provide an opportunity to enable research with patient groups often difficult to engage in research activity: the frail, cognitively impaired and those who are easily fatigued.
Conclusion
Research cultures take time and energy to grow but create a vibrant clinical learning environment in which staff can thrive, expand knowledge and patients receive effective, more efficient, evidence-based health care. Our model for developing and supporting a research culture is transferable to other clinical areas.
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45 | What factors influence approach and participation in research. | Aims and Objectives:
- What operational factors influence patients participating in research?
- How is the decision to approach patients for research made?
Background:
The Suspected Cancer (SCAN) Pathway is a Non-Specific Symptom (NSS) pathway established in 2017. Alongside the clinical service patients are invited to join the Oxford Radcliffe Biobank. This involves consenting for additional blood samples to be taken alongside routine blood tests and gives permission for data to be collected from consented patients medical records. An analysis of the first 6 years of the SCAN patient cohort demonstrated that 34% of patients consented to participate in research. We wanted to further understand the profile of patients and what factors led to them either not being approached or declining participation in the study.
Methods:
A clinical audit application was submitted to the Oxford University Hospital Foundations Trust. The clinical audit looked at patients seen via the SCAN pathway from 1st April 2024 until the 31st March 2025. Data would be collected via a password protected Excel spreadsheet, including age, gender, GP postcode, ethnicity as described, consent status of patients, reasons for decline, and reasons for not approaching. This audit was approved No: 9778.
Results/Findings:
1362 patients were seen via SCAN pathway between 1st April 2024 and 31st March 2025. 38% of patients were biobanked. The largest barrier appeared to be operational readiness with gaps in staff training, not all sites being prepared to approach patients being most commonly reported. 8% of patients approached declined citing as lack of understanding and concern about data and sample use. 17% of patients were not approached this was most commonly as the people gaining consent were unsure of the appropriateness of asking.
Conclusion:
Operational readiness and staff training regarding consenting more vulnerable patients is essential in improving the participation of research.
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46 | Exploration on transition from children to adult care | Aims
Evaluate current use of RSGH within Oncology and Haematology and explore future ways to improve its use in transition.
Background
Transition of paediatric patients to adult care requires a planned, purposeful process to prepare young people with long term health conditions in a holistic manner, to move into adult healthcare.
Many policies have addressed transition, one commonly identified issue being when young people disengage with their healthcare their condition deteriorates. Recommendations include minimising stress, empowerment and shared decision making.
A nationally recognised tool in structuring transition discussions and documentation is Ready Steady Go Hello (RSGH). RSGH is a series of age-appropriate questionnaires, that equip young people, with necessary skills and knowledge, to manage their health confidentially supporting transition.
Methods
4 data streams collected:
• Stakeholder engagement through informal discussions.
• Observations and informal discussions of areas of excellence within the trust.
• Survey of stakeholders.
• Patient notes data collection (10/2023-04/2024).
Results
• Onus of RSGH solely on consultants.
• Areas of excellence have a Multi-disciplinary approach to RSGH with adequate time and staff engagement.
• Method of completing RSGH forms varies across trust.
• EPR system confusing.
• RSGH have option for separate platform to replace EPR.
• Familiarity of RSGH was greater within Haematology than Oncology. When used RSGH helps with sign posting and guiding clinic discussions.
• 5% of patients completed part of RSGH.
Conclusions
Within Oncology and Haematology, implementing RSGH requires further education, clear pathways and adequate appointment times. A multi-disciplinary approach would be useful to ensure the onus is not solely on the consultants.
The trust would benefit from improved system of completing RSGH forms. Currently there is a lack of continuity and it can be difficult to understand and complete using EPR.
Recommendations
1. More information about RSGH platform.
2. Transition in job descriptions
3. Education and embedding
5. Departments to create a clear RSGH pathway.
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47 | RCT of Physiotherapy exercise rehabilitation with exercise adherence support for people with vertebral fragility fractures. | Purpose: To investigate the clinical effectiveness of an exercise rehabilitation programme with integrated support for adherence compared to exercise rehabilitation only.
Number of subjects: 126, 63 each arm at baseline, with 112 at final timepoint.
Material and Methods: a two-arm, individually randomised controlled trial (RCT) with blinded outcome assessments at baseline, 4, 8 and 12 months. Eligible participants were 55 years or older with ≥1 Vertebral Fragility Fracture (VFF) associated with osteoporosis and back pain. Both arms received progressive exercise rehabilitation including strength, posture, balance, and weight-bearing exercises prescribed by a physiotherapist. Additionally, the intervention arm received an integrated exercise adherence intervention that used ≥ 3 behaviour change techniques from a toolkit of 9 techniques to support exercise behaviour.
The primary outcome was lower extremity function, dynamic balance and fall risk, measured via the Timed-Up and Go (TUG) at 12-months. Secondary outcomes included quality of life (QUALEFFO-41), Thoracic kyphosis, standing balance (Functional reach: FR), muscle strength (timed loaded standing: TLS) and walking exercise capacity (6-minute walk: 6MW).
Results: Participants were aged a mean 72.7 (SD 8.0) years with a mean 2.3 (SD 1.7) VFF. 83 % (n=104) were female, 22 (17%) male, 117 (93%) reported back pain in past 2 weeks and 58 (46%) had fallen in previous year. Intervention participants received a median 5, IQR 3-6 physiotherapy sessions, control participants a median 5, IQR 2-6 sessions. At 12-months, clinically relevant, statistically significant gains were seen favouring the intervention group in the TUG intervention mean 10.1 (SE 0.38) seconds versus mean12.9s, effect size: 2.1s, 95% CI: -3.1 to -1.0s, p=0.000) and 6MW intervention mean 354.6 (SE 6.6) metres versus control 325.7(SE 6.9) m, effect size 24.5m, 95% CI: 5.7 to 43.4m, p=0.011). Differences in QoL, FR, Thoracic Kyphosis and TLS between arms at 12-months were not significant. There were 23 adverse events (8 intervention, 15 control), none related to physiotherapy exercise rehabilitation.
Conclusions: This RCT found integrated, additional support for exercise behaviour within a programme of physiotherapy exercise rehabilitation for people with VFF provided greater benefits to lower extremity function, balance and walking at 12-months as measured by the TUG and 6MW tests.
Ethics: REC 21/WS/0071; ISTRCN: 14465704 |
48 | Entering and adjusting to a different and uncertain world: experiences and support needs of informal carers of adults at risk of suicide | Aims & Objectives
This exploratory mixed methods research aimed to develop an understanding of the experiences and support needs of adult informal caregivers of adults at risk of suicide.
Background
Mental health services in England are dependent on family and friends to support patients who may be at risk of suicide. However, support for these informal carers is lacking despite evidence of caregiver burden, adverse health outcomes, and poor relationships with services. Stigmatising experiences have been unearthed in qualitative studies although perceived stigma relating to suicidal behaviour has not been formally assessed in carers. To date, limited research specifically investigating carers of adults at risk of suicide has been conducted in England.
Methods
An online survey of 101 self-selecting adult carers of an adult at risk of suicide assessed perceived stigma of suicide attempt, carer quality of life and helpfulness of support services, as well as obtaining qualitative data on experiences and support needs. Semi structured interviews were carried out with 15 of the survey participants. Statistical analyses were conducted with quantitative data, summative content analysis was used for qualitative survey data and reflexive thematic analysis for interview data. The three data sets were integrated, and, through a process of abduction, mixed methods interpretations were achieved.
Results
Caring for an adult at risk of suicide was experienced as a transition into a different and uncertain world. Uncertainty manifested emotionally, psychologically, interpersonally and behaviourally, and had detrimental effects on mental and physical wellbeing. Perceived stigma was inversely associated with carer quality of life. Balancing uncertainty with hope helped carers tolerate uncertainty and sustain their caring role. Identified support needs included recognition, information and education, authentic collaboration, peer support, and therapy.
Conclusion
Carers experience considerable psychosocial stress, which can be mitigated by tailored psychosocial interventions focusing on support, connection, education and skills.
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49 | Diagnosing cancer in the ED : Revolutionising the pathway for patients presenting via ED | Aims and objectives : To improve the pathway for patients with new cancers diagnosed in emergency care.
Background : Patients diagnosed with cancer or suspected cancer during an emergency department (ED) presentation are often signposted back to their GP for urgent referral to cancer services.
However, this can result in long delays in patients receiving specialist support, confirmation of
diagnosis and, vitally, starting treatment.
Methods: A quality improvement initiative that aimed to address these issues through the introduction of an ED suspected cancer diagnosis pathway was implemented by the acute oncology service in two EDs in Oxford University Hospitals NHS Foundation Trust in April 2023.
Findings : Data collected during the first 18 months of implementation of the pathway show there has been a significant increase in the numbers of this patient group meeting the NHS England 62-day referral to treatment standard and in the numbers of patients receiving support from an acute oncology named cancer clinical nurse specialist from the point of discharge from the ED.
Conclusion : The project is ongoing and has been embedded in the acute oncology service. Anecdotally, there is evidence that patients have an improved experience, owing to the level of CNS support, the speed of investigations and treatment and the ability of the pathway to 'rule out' a cancer diagnosis (where possible) in a timely fashion. Future plans include a formal evaluation of the service using Programme Theory / Theory of Change. |
50 | Factors Influencing Return to Work Among Nigerian Soldiers Injured on Duty: Perspectives of Service Users and Providers | Background: Soldiers, particularly in low- and middle-income countries like Nigeria, face heightened vulnerability to injuries that can significantly impact their quality of life and ability to return to work. This study explores the factors influencing the return to work among Nigerian Army soldiers injured on duty (IoD).
Methods: Using an exploratory qualitative approach, data were collected through four focus group discussions (FGDs) and two individual interviews. Participants were selected through purposive sampling and included consenting healthcare workers (n=12) and IoD soldiers (n=13) in the FGDs, as well as medical specialists responsible for managing these soldiers in the interviews (n=2). Thematic analysis revealed two main factors affecting the return to work for IoD soldiers: internal and external.
Result/Findings: Internal factors included limited rehabilitation resources, such as a shortage of occupational therapists, psychological and personal challenges, injury severity, and the absence of clear return-to-work policies and legislation. External factors involved the adequacy of benefits and remuneration, public recognition, post-injury welfare support, and demographic considerations. Findings suggest that barriers to returning to work outweigh the facilitators for injured Nigerian soldiers. A major challenge is the lack of awareness regarding the role of occupational therapy within the Nigerian Army Medical Corps, alongside systemic gaps that hinder effective rehabilitation and reintegration.
Conclusion: This study underscores the urgent need for systemic reforms, improved rehabilitation resources, and increased awareness of occupational therapy to enhance support for injured soldiers.
Keywords: Barriers, Enablers, Nigerian Army, Return to Work, Occupational Therapy, Injured Soldiers. |
51 | 4 Treatment vs 3 Treatment High Dose Rate Cervical Brachytherapy | Aims and Objectives: To investigate the deliverability of cervical brachytherapy in 3 treatments vs current clinical practice of 4 treatments, the biological effect to organs and whether treatment characteristics correlate with these effects.
Background: Brachytherapy is a type of radiotherapy that delivers radiation dose via a high dose rate (HDR) radioactive source inserted into cavities and through the skin. OUH clinical practice delivers the radiation dose (28 Gy) in 4 treatments across 3 days. Recent research and guidance outline 3 treatments can meet clinical practice (from the EMBRACE II trial) biological effect aims for small tumours. The department could deliver this across 2 days, thereby resulting in fewer days in hospital for the patient and a reduction in departmental resources to deliver the service.
Methods: 46 cervical cancer patients (treated January 2023 – July 2024) were audited. The total tumour biological effect for each patient was reverse engineered to find the equivalent delivered dose required for 3 treatments. The patients’ first 3 clinical treatment plans were scaled to the calculated 3-treatment delivered dose, doses received by organs extracted, and the resultant biological effect calculated for the rectum, sigmoid, bladder and bowel.
Results/Findings: The delivered dose per treatment calculated for 100% of patients was 8.5Gy±0.05Gy, so 8.5 Gy per treatment was used for scaling. For all organs, ≥94% of the biological effect remained comparable to 4-treatment values, 100% of the patients’ rectum and bowel biological effect. There was no correlation in biological effect changes in small vs large tumour patients.
Conclusion: Three-treatment HDR brachytherapy appears comparable to four-treatment practice. There was no significant link between tumour size and biological effect changes. EMBRACE II aims are achievable in three treatments with OUH's current clinical techniques. Three-treatment practice is being piloted.
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52 | Supporting student self-regulation in the classroom: Perspectives from mainstream UK primary school teachers | BACKGROUND
Self-regulation is a foundational skill that helps children to access education, achieve academic success and positive long-term outcomes. Schools are an important environment where children can develop these skills. Despite there being many self-regulation support strategies available to teachers, a recent scoping review has identified a gap regarding which of these strategies teachers are using day to day.
RESEARCH QUESTION
What types of strategies do UK mainstream primary school teachers use to support students' self-regulation in the classroom?
METHODS
After ethical approval (UREC No:241794), qualified teachers in mainstream UK primary schools (n=214) completed an online questionnaire. Participants listed their top three strategies for supporting dysregulated students and indicated how frequently they use specific strategies with different student groups. Quantitative data were analysed using descriptive and inferential statistics (inferential statistics not reported here), while text data were analysed using content analysis.
RESULTS
Teachers reported using breaks, physical space changes, breathing techniques, movement, fidgets, and other sensory tools to support students with self-regulation. When asked about specific strategies, teaching and communication strategies were most commonly used with whole classes (68.3% always use), while sensory diets were least used (7.9% always use). Less than half of teachers consistently used environmental setup (43.9%) and visuals (38.1%) to support whole-class self-regulation. Visual and sensory strategies were used more frequently with Special Education Needs (SEN) students.
CONCLUSIONS
This study has identified the types of strategies used by mainstream primary school teachers to support children to develop and use self-regulation skills in the classroom. Opportunities exist for teachers to integrate environmental adjustments and visuals more consistently as universal classroom provision. Future research could explore preventative strategies, how teachers adjust communication for SEN students and interventions to help teachers integrate universal supports more consistently. |
53 | What Has Been Missed? The Key Role of Routine Follow-Ups in Traumatic Brain Injury Recovery |
Background:
Adults with traumatic brain injury (TBI) in the UK are typically managed by neurosurgeons in major trauma centres. TBI-related sequelae can be debilitating. Early intervention by a specialist significantly reduces social morbidity and symptom severity. National guidelines recommend specialist referrals for persistent problems, yet most patients are not routinely followed up. TBI sequelae are often missed during admission, and patients lack clear instructions for follow-up care.
Aims:
Analyse common issues in TBI patients post-discharge
Methods:
Retrospective data collection from 30 patients with moderate-to-severe TBI discharged from a major trauma centre and attended a telemedicine clinic with a TBI Advanced Clinical Practitioner over a 6-month period. We reviewed the number of issues identified, referrals made, and interventions provided.
Results:
The median number of issues identified per patient was 2.33. Common issues included fatigue (16.22%), vertigo/balance (13.51%), and ENT problems (hearing/tinnitus) (12.16%). Twenty-two referrals were made post-consultation, including vestibular physiotherapy (n=6), ENT (n=4), occupational therapy (n=3), neurology (n=2), and rehabilitation medicine (n=2). Interventions/advice included TBI education (n=30), return to work (n=15), driving/DVLA advice (n=15), seizure safety (n=14), fatigue management (n=12), medication advice (n=7), travel advice (n=6), vestibular exercises (n=4), anosmia management (n=3), and alcohol advice (n=3). Only 4 patients required further follow-ups.
Conclusions:
All patients received some intervention or advice. Routine TBI follow-ups demonstrate clear benefits and are typically needed only once post-discharge and, therefore, should be considered for all patients with moderate-to-severe TBI.
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54 | Robust PET/CT radiomic models for sarcoma in a large retrospective clinical cohort | Background: Cancer patients are regularly assessed through medical imaging, including positron emission tomography (PET) which provides information on tumour metabolism. PET imaging data contains a wealth of quantitative information that could provide valuable contributions to characterising tumours when combined with other ‘omic data. This work looks at radiomics for a rare type of cancer called sarcoma where tumours form in bones and soft tissue. Initial work has focused on how image acquisition and reconstruction methods limit the generalisability of radiomic models.
Methods: Radiomic feature stability to variations in image noise was assessed in phantom and tumour datasets by varying reconstruction methods, using a dual approach in a retrospective sarcoma clinical dataset (N=20) (ethical approval 24/HRA/1339) and a modular heterogeneous imaging trst-object [1]. The next phase will identify reliable and useful features for heterogeneity assessment in a 10-year retrospective sarcoma cohort from Oxford University Hospitals (N=1,052).
Results: A high proportion of features (phantom: 77%, tumour: 88%) showed high variability (>15%). Strong correlation was observed between feature variability in phantom and tumour data. Initial cohort exploration reveals a large longitudinal dataset with 526 patients having multiple PET/CT scans, enabling delta-radiomic assessment.
Conclusion: The dependence of PET radiomic features on image noise characteristics was assessed. Future work will focus on how to incorporate this information in radiomic models. The PPI group formed for this project will contribute to the production of visual and written lay summaries to aid effective communication of the research. |
55 | Experiences following intensive visual function study – patient perspectives | Introduction
Research studies play a vital role in improving patient care, outcomes and experience. This is linked with improved outcomes in the trusts that are research active, and in devising the healthcare of the future. The study aims to evaluate participant research experience after taking part in a visual function research study running alongside an NHS ophthalmology outpatient clinic.
Methods
Patient participants were invited to take part in a recorded semi-structured interview, following visual function assessments which were part of a study assessing visual outcome measures in inherited retinal degeneration (reference 20/WM/0283). Interviews were transcribed and anonymised. Coding of patient participant experiences and analysis were completed in NVivo V.12 software (QSR International, USA). Patient transcripts were closely read and coded line-by-line using inductive methods to form overarching themes: “Conduct of Examinations”, “Emotions”, “Interactions with staff” and “Practicalities”.
Results
Many mentioned how positive staff interactions positively influenced their decision to participate as well as made the experience far more pleasant. The convenience of combining the appointment with an existing NHS assessment worked well. However, participants described negative emotions associated with previous experiences such as being reminded about the loss of ability to drive. Some participants found the questionnaires (such as the VFQ-25) hard to access and irrelevant to them. Lack of comfort during testing and in the waiting areas was another significant finding. In addition to poor communication and inefficient transition between the research and clinical appointments.
Conclusion
Overall participants reported a positive research experience, the feedback provided evidence that undertaking the study alongside NHS clinical care worked well, but highlighted several areas for improvement, such as improved communication and organisation between clinical and research teams, improved patient quality-of-life instruments, their suitability, accessibility and delivery. Greater consideration of the emotional impacts of testing and research is needed.
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56 | Micronutrient deficiencies are common both pre- and post-intestinal transplantation | Aim
To describe the micronutrient status of adult patients receiving an isolated small bowel transplant pre- and post-transplantation.
Background
Intestinal transplant (ITx) is indicated in the UK for patients on Home Parenteral Nutrition (HPN) that is causing complications or is inadequate or where the transplant of other organs requires an intestine graft (i). There is little data regarding nutrition management in ITx (ii). Post-ITx patients fall within BIFA guidelines for those receiving artificial nutrition (iii) and ESPEN micronutrient guidelines (iv) which are used for intestinal failure patients. Most patients rehabilitate to oral nutritional autonomy (v, vi) post- ITx; there are no guidelines or data for this specific clinical cohort to benchmark their nutrition status. Aim: to describe the micronutrient status of adult patients receiving an isolated small bowel transplant pre- and post-transplantation.
Methods
Retrospective cohort analysis approved as a service evaluation by OUH. Micronutrient results were excluded from analysis where CRP>20mg/L
Results
Copper and zinc levels are significantly lower at 1 year post intestinal transplant for our cohort, but for both nutrients levels remain within reference range pre- and post-transplant.
Serum iron significantly improved post-transplant in our adult cohort and the levels went from low to in range.
As an observational finding, more patients’ results were in range 1 year after transplant for iron, manganese, selenium, vitamin D, vitamin B12 and zinc. Fewer patients had an ‘in range’ copper or ferritin after 1 year.
Most micronutrients are in range pre- and post-transplant except for iron which was low in this cohort pre-transplant.
Conclusion
There are implications from the findings for nutrition management both pre and post transplant. Clinical status pre or post transplantation may influence the nutritional biomarkers. More work is needed to characterize micronutrient status further than 1 year post transplantation and to describe accompanying medical nutritional interventions |
57 | A taste for our own medicine? Drivers of uptake for seasonal vaccination among healthcare workers. | Aims and Objectives:
Following on from initial studies conducted at the height of the pandemic by Manby, Dowrick and Karia et al (2022) exploration of drivers and motivators in those who receive vaccines could aid understanding that can be further explored to move towards improved dissemination of information sharing and messaging in future healthcare workers (HCW’s) vaccine campaigns across the NHS.
Background:
During 4 months of the winter in 2024/25 over 38,000 positive Covid tests were performed in the UKs hospitals (1), from those seeking medical support in secondary care with Covid-19 illness, in addition to high cases of influenza seen in admitted patients over the same period. Adding huge pressure to an already stretched NHS. However, vaccine uptake in HCWs is on the decline in the UK, and during the same winter months only 21% of eligible frontline HCWs in England accepted a Covid Booster (2).
Methodology:
Questionnaires and semi structured interviews were offered to HCWs already enrolled in PITCH-2 (an ethically approved (REC:23/NW/0280) healthcare worker covid immunology study). The anonymous questionnaires addressed social media influence, colleagues’ attitudes, and cultural influences, and were online to allow HCWs to speak freely. The interview follow-up of 22 volunteers were conducted via MS teams and recorded audibly for transcription during Spring 2025.
The Interviews focused on participants’ drivers and motivations and their feelings about advocating and recommending vaccination to the patients they care for and friends and family. Following the coding of transcripts, thematic analysis was utilised.
Results/Findings:
Initial findings suggest emerging themes may be altruistic sentiments; concerns for vulnerable patients; inherited behaviours from culture and older family; and being able to understand the science behind the recommended uptake are all relevant in vaccine acceptance. Full findings following completion of thematic analyses (Expected May 2025) will be presented at the conference.
References
(1) https://assets.publishing.service.gov.uk/media/67c87349d0fba2f1334cf2b2/weekly-influenza-and-COVID-19-report-data-week-10-2025.ods
(2) National flu and COVID-19 surveillance reports: 2024 to 2025 season - GOV.UK https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2024-to-2025-season
Manby L, Dowrick A, Karia A, et al Healthcare workers’ perceptions and attitudes towards the UK’s COVID-19 vaccination programme: a rapid qualitative appraisal BMJ Open 2022 ;12:e051775.
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58 | Optimising Toxicity Monitoring and Dosage Adjustments in Patients on Adjuvant Abemaciclib for Breast Cancer | Background Breast cancer is the most common cancer diagnosed in women in the UK, with new treatment options leading to decreasing mortality rates. One such treatment is Abemaciclib, approved for use in the adjuvant setting in 2022. Adjuvant Abemaciclib is an oral systemic anti-cancer treatment given for two years, generally well-tolerated but often requiring dose reductions due to toxicities.
Research Aim This service evaluation aims to determine if the current pathway for patients on adjuvant Abemaciclib supports toxicity monitoring and dosage adjustments. It involves collecting secondary data on patients' starting doses, dose reductions, completion of the treatment course, early discontinuation, and actionable blood abnormalities in the first eight weeks.
Methods: Secondary data was collected from patients prescribed adjuvant Abemaciclib in 2023 and January to November of 2024. Data was presented in tables and graphs, and descriptive statistics were used for evaluation.
Results: Out of 88 patients, 51 had at least one dose reduction, primarily due to diarrhoea and fatigue. The most common time points for dose reductions were the second and fourth cycles of treatment. Fourteen patients discontinued treatment early, and six had actionable blood abnormalities during the first eight weeks.
Conclusion: Dose reductions due to toxicity are often required, and recognising toxicity and adjusting doses can improve treatment adherence rates.
Implications for Practice: Updating the pathway to include review points with an advanced clinical practitioner at cycles two, four, and six is indicated. The local SACT protocol should reflect different starting doses.
Recommendations: Further research should examine patients' perspectives on the treatment and their experience with the patient pathway. Exploring the experience of being reviewed by an ACP while on SACT would guide further development of ACP-led services.
Ethical Approval: This study has received ethical approval from Oxford Brookes University and has been logged as a quality improvement project via Ulysses at OUHFT.
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59 | Developing a quantitative approach to prioritisation of medical equipment replacement | Aims and objectives:
To formulate a risk stratification approach based on a technical risk score to help objectively inform the prioritisation of assets that require replacement
To generate an objective tool to further determine a risk stratification approach considering clinical, digital, financial and sustainability parameters.
Background: There is increasing cost to medical equipment, an increasing number of capital assets on the Trust inventory and insufficient capital funding available to cover the costs of replacing all required assets. The current methodology for prioritising equipment replacement is relatively subjective and relies on the impartiality and attendance of the equipment representatives to ensure that clinical urgency is fairly weighted against replacement need. Based on a scale of 1-10, could be argued as not sufficiently granular or inclusive of the other factors which influence medical device effectiveness.
Methods: Using the Trust asset inventory we export the data to score against objective factors such as equipment age, maintenance contract and last repair job to assign a risk score. This will be provided to the directorate equipment leads to further stratify according to a defined risk matrix to provide justification as to the equipment most in need of replacement.
Results: In time for the conference we hope to be able to present the outputs of the methodology in terms of any themes or challenges that we have encountered with the process. The engagement we have achieved with stakeholders, and the plan for future work in this area.
Conclusion: It is hoped by having a more robust method for prioritising equipment replacements we can replace the right equipment at the right time and make most effective use of resources across a diverse clinical landscape.
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60 | Supporting women with adherence to adjuvant endocrine therapy (SWEET): feasibility study of the HT&Me intervention | Aims, objectives and background
Women with estrogen receptor-positive (ER+ve) breast cancer are recommended daily oral adjuvant endocrine therapy (AET) for at least 5 years, but up to 50% discontinue early. We assessed an evidence-based, theoretically-informed, patient-centred intervention (HT&Me) to support AET adherence and improve quality-of-life, in terms of patient acceptability and feasibility to deliver within the UK National Health Service (NHS).
Methods
This single arm study aimed to recruit 45 women with stage I-III breast cancer within 14 weeks of first AET prescription. After completing baseline questionnaires, participants received the HT&Me intervention comprising: (i) a short animation; (ii) two personalised nurse/practitioner consultations (in-person or online); (iii) an interactive web-app; and (iv) regular email reminders. Participants completed follow-up questionnaires at 8 weeks. A sub-sample of women (n=20) and health professionals (HPs; n=14) participated in semi-structured interviews.
Results
We recruited 51 women. Participants varied in digital confidence at recruitment (low/moderate, 28% (n=14); high, 61% (n=31)). HT&Me was demonstrated as feasible to deliver. Overall, 69% (n=35) engaged with the web-app; 87% (n=40/46) found HT&Me helpful; and 80% (n=36/45) reported it motivated them to keep taking AET. Both consultation formats were considered acceptable. Completion of outcome measures was high. HPs considered HT&Me addresses an important unmet need.
Conclusions
HT&Me is feasible, acceptable and helpful to women. Findings provided valuable insights for design and delivery of the full-scale randomised controlled trial assessing effectiveness now underway (ISRCTN24852890).
Implications for Cancer Survivors
HT&Me offers potential to improve AET adherence, thereby reducing recurrence risk for women with ER+ve breast cancer.
The study received ethics and governance approval from the South Central - Hampshire A HRA Research Ethics Committee (22/SC/0150). |
61 | Piloting an Immersive Virtual Reality 3D Self-Management Education Experience for Adults with Type 1 and Type 2 Diabetes Mellitus: A Qualitative Study. | Aims
Diabetes is a condition of global concern that can be mitigated through self-management education. Virtual reality technology offers an immersive and interactive approach. It may promote self-care and access to healthcare information. This study aimed to explore the experiences of adult participants with Type 1 or Type 2 diabetes during the piloting of a 3-D Automatic Virtual Reality Environment (VR-CAVE) approach to diabetes education. The study objective was to capture the participants’ ideas for the future development of VR technology as a diabetes educational tool.
Methods: Following university ethical approval, 15 adults with type 1 or 2 diabetes were recruited via local communities and social media. The participants were invited to a short diabetes education module in the VR-CAVE. Subsequently, qualitative focus group interviews were undertaken to elicit and evaluate the participants’ experiences of various design elements and their considerations for future development.
Results: Three categories emerged: ‘Experience of an immersive learning environment for diabetes education,’ ‘Comparison with prior diabetes educational experiences,’ and ‘Imagined development of the VR-CAVE technology.’ The participants reported a novel experience and a better understanding of the physiology of diabetes. The presence of an avatar felt non-judgmental.
Conclusion Participants are open to using a VR-CAVE for diabetes education. This study identifies aspects that could be enhanced through an immersive environment. Further research is needed to realise the benefits for the diabetes community and scale the virtual reality resources and technology for different platforms to enable access for individuals and health service organisations.
Keywords
Diabetes Mellitus, Type 1, Type 2, Virtual Reality, Self-Management education, Avatar, Technology
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62 | Therapies Outcome Measure Evaluation (TOME) Service Evaluation Project | Aims and Objectives: To map current use of Outcome Measures for clinical groups in the Therapies department at OUH. To understand perceived usage, barriers and facilitators to using Outcome Measures from Therapies staff at all levels.
Background: Outcome measures (OMs) – tools to capture change in patient functioning, performance or participation over time – are instrumental in establishing healthcare effectiveness and have been strongly mandated for Allied Health Professions (AHPs). OMs use in AHPs is highly varied, with systematic reviews concluding that clinicians and patients have mixed preferences, limited understanding, OMs vary in relevance and validity, and limited consistency and feedback of findings to patients and staff.
It is currently unknown what OMs are routinely used across the Therapies department and the perceived barriers and facilitators for this. The department spans four Trust divisions, representing diverse staff and patient populations.
Methods: A mixed methods evaluation is being conducted with two phases. Firstly, information about OMs was mapped for each of the clinical groups within the department in terms of measures, timings, WHO ICF domains, staff responsible and data capture and feedback.
Secondly, following a pilot, clinicians at all levels (students, Band 3 – 8) will be invited to complete a questionnaire asking about choice and timing of OMs, perceived importance, barriers and facilitators for OM use, and evaluation practice.
Results/Findings: The mapping activity has indicated a wide variation in OM usage in terms of type, frequency, capture and evaluation activities.
The staff questionnaire phase is ongoing. Initial findings will be available to present at the event.
Conclusion: This service evaluation captures large variations in OM utilisation within Therapies. Understanding the variation and contextual factors for use of OMs in Physio, OT, SLT and Dietetic clinical groups will enable standardisation of important processes to ensure best practice evaluation across the Therapies department. |
63 | Student Paramedic Experiences and Perceptions of Practice-Based Learning | Aims and Objectives
The study research question is, ‘In which ways do student paramedics experience and perceive practice-based learning (PBL) as part of a professional qualification degree programme?’ The project will explore student paramedics' perceptions of PBL experiences, associated learning and development, and perceptions of PBL relevance to their professional qualification.
Background:
Student paramedics must be prepared to undertake autonomous practice at the point of qualification. They will encounter cases ranging from urgent care presentations to life-threatening emergencies, typically without immediate supervision. In preparation for this diversity of practice, student paramedics undertake PBL experiences as part of their degree. PBL provision in their curriculum varies in settings and duration experienced, typically from predominantly within ambulance services to a broader spectrum of experiences in various health and social care settings.
The design of this pilot study, part of a Doctorate in Education, is informed by Biesta’s (2000) three domains of educational purpose.
Methods
The study design uses an arts-based methodology to acquire rich data about participants' experiences with PBL. Arts-based methods enhance traditional forms of qualitative data collection. Participants will be paramedic students from UK universities offering a paramedic science degree. Audio-visual data of student paramedics' experiences will be recorded and collected throughout to record demographic information and the type of practice-based learning undertaken. Participants will then create an arts-based timeline representing their PBL experiences and key events. Participants will then participate in an in-depth interview to explore their timeline and experiences and provide data to answer the research question and aims.
Results/Findings
Data will be analysed using Baruna & Clarke’s (2022) reflexive thematic analysis, building codes into themes through six steps:
Discussion/Conclusion/Implications
Enhancing student learning and development through PBL experiences is important in preparing qualified paramedics. Understanding students' experiences during PBL provides opportunities for educational interventions to ensure optimal experiences.
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64 | Physiotherapy exercise rehabilitation with additional, tailored support for adherence for people with vertebral fragility fractures: The OPTIN randomised controlled trial. | Aim: To investigate the clinical effectiveness of physiotherapy exercise rehabilitation with integrated, tailored support for exercise adherence versus exercise rehabilitation alone for people with vertebral fragility fractures (VFF).
Background: Exercise rehabilitation can benefit people with VFF. Many patients do not fully adhere to physiotherapy exercises, with lower adherence associated with worse outcomes.
Methods: A multi-centre, two arm, RCT with blinded outcome assessments and intention-to-treat analysis. The primary end-point was 12 months. Eligible participants were 55 years or older with ≥1 VFF. All received 4-months (7 sessions) of exercise rehabilitation. Additionally, intervention participants had a 90-minute adherence intervention. Here physiotherapist used a motivational interviewing approach, set goals and utilised ≥ 3 behaviour change techniques (BCTs) from a trial toolkit of 9 established BCTs. The primary outcome was functional mobility, measured via the Timed-Up and Go (TUG) at 12-months. Secondary outcomes included quality of life (QUALEFFO-41, EQ-5D-5L), Thoracic kyphosis, standing balance (Functional reach: FR), muscle strength (timed loaded standing: TLS) and exercise capacity (6-minute walk: 6MW).
Results: 126 adults aged mean 72.7 (SD 8.0) years with mean 2.3 (SD 1.7) VFF participated.; 83 % (n=104) were female, 22 (17%) male. There was no significant difference in average session attendance: intervention group mean 5.5 (SD 2.1) sessions versus control mean 5.1 (SD 2.2) sessions. In the intervention group, physiotherapists used a median 5 (IQR 4 to 6) BCTs per participant. At 12-months, clinically relevant, statistically significant gains were seen favouring the intervention group in the TUG (difference: 2.1s, 95% CI: -3.1 to -1.0s, p<0.01) and 6MW (difference: 24.5m, 95% CI: 5.7 to 43.4m, p=0.01).
Conclusions: This RCT found integrated, additional support for exercise behaviour within physiotherapy exercise rehabilitation for people with VFF provided greater benefits to functional mobility and exercise capacity at 12-months as measured by the TUG and 6MW tests.
Registration: ISRCTN: 14465704
Ethical approval received: REC 21/WS/0071 |
65 | What are the experiences and views of frail older patients with heart failure of end-of-life care conversations: A literature review | Abstract
Aim: To review literature concerning the experiences and views of frail older patients with end stage heart failure regarding end-of-life conversations with the aim to better understand patient perspective of advanced care planning and end of life conversations and practices. The objective is to use this understanding and knowledge to inform care and to facilitate high quality advanced care planning and end of life care conversations on the researcher’s own clinical practice.
Methods: Qualitative systematic literature review and reflexive thematic analysis. Searches of CINHAL, PsycINFO, British Nursing Database and PubMed from January 2014 to January 2024 were conducted, with hand searches of references from the relevant studies of older patients with end stage heart failure and caregivers concerning end of life discussions and advanced care planning. Extracted data was critically appraised using the Johanna Briggs Institute (2017), (JBI) critical appraisal tool for qualitative studies and were analysed using Braun and Clarke’s (2020, 2006) reflexive thematic analysis.
Results: 8 qualitative studies were reviewed and analysed systematically, 4 themes were developed from the studies that captured the views and perceptions of older adults with heart failure regarding end-of-life conversation. The 4 themes identified are: Patient’s priority is managing illness, Patient’s perception is that it is not heart failure it is old age, Patients have limited knowledge and understanding of their illness i.e. heart failure, and End of life conversations are difficult to have.
Discussion: End of life is rarely discussed as patients and care givers focus largely on disease management thus putting value on life today rather than thinking about death. Many prefer not to discuss end of life as it is perceived as inevitable & part of the aging process, many do not realise the seriousness of the disease as they lack information on prognosis and severity. Furthermore, end of life conversations can be complex, and found to be difficult by patients, family and clinicians alike. As a result of this the conversations too often do not take place.
Conclusion: This study has taken a step closer to helping to facilitate high quality end of life conversations for all patients, including those with end stage HF, and will help to inform ongoing work on the authors own unit, and ultimately to improve patient care at a faster rate.
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66 | Evaluation of the prevalence of nausea during and after radiotherapy to the breast +/- locoregional lymph nodes |
Aims and Objectives:
We aimed to assess how many patients having breast radiotherapy experience nausea and whether this should in fact be consented for.
Background:
Patients undergoing radiotherapy to the breast can experience nausea during their treatment. This is not currently consented for on the RCR consent forms for radiotherapy to the breast.
Methods:
202 patients undergoing radiotherapy to the breast +/- locoregional lymph nodes over a 3-month period were included. Data included treatment site, dose, whether the patient experienced nausea, if anti-emetics were prescribed, grade of nausea, and duration. We assessed if patients had chemotherapy or concurrent endocrine therapy, including whether patients were prone to nausea. Patients were contacted 2-4 weeks after radiotherapy to assess whether they experienced nausea and duration.
Results/Findings:
183 patients in total had a complete baseline toxicity questionnaire with a post-treatment follow up call. 40/183 patients we were unable to contact post radiotherapy.
45/183 patients experienced nausea grade 1-3 on treatment (40 Grade 1, 3 Grade 2, 2 Grade 3).
30/45 patients were having right breast treatment, 14/45 were having left breast treatment, and one patient had bilateral breast treatment. 17/45 patients experienced nausea grade 1-3 post radiotherapy for more than 3 days and ongoing at the time of their follow up call. 5/45 patient were unable to be contacted post radiotherapy.
13/45 patients had chemotherapy, 12/45 described themselves as being prone to nausea. 25/45 patients had endocrine therapy prior to radiotherapy; none mentioning nausea as a side effect.
Conclusion:
Patients receiving radiotherapy to the breast experienced nausea during and after radiotherapy. From results this cannot be attributed to other treatments. Results will be discussed with the breast oncology team to determine whether nausea should be consented for. Plans are being evaluated to assess whether dose to stomach and liver can be attributed to nausea.
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67 | Barriers and strategies for the MDT to facilitate early mobilisation of older people on the emergency assessment unit: A QI project | Aims
- To understand current levels of patient mobilisation and the barriers and facilitators to enabling early mobility on Emergency Assessment Unit (EAU) at Oxford University Hospitals (OUH).
- To provide appropriate interventions based on findings for therapy amenable issues.
Objectives
-Determine baseline level of patient activity on the EAU. Understand MDT-perceived barriers and facilitators to mobilising older persons on the ward
Background
Older patients (>65 yrs) spend most of the time in bed during a hospital admission, which is associated with negative effects such as functional decline, institutionalisation, increased LOS, pressure areas, and mortality. In the EAU ward at OUH most patients are older and frail (83%). To reduce risk of these effects, maintenance of physical activity should be encouraged, especially for frail patients.
Methods
A mixed methods evaluation as part of a Quality Improvement initiative. A quantitative evaluation of the EAU ward was undertaken to determine patient baseline activity levels. Proportions of patients mobilised out of bed and reasons for their status were combined with routinely collected patient demographic and clinical characteristics.
Additionally, an online survey was sent to members of the ward MDT to understand barriers and facilitators to mobilising older persons. Quantitative and qualitative data from 15 questions will be descriptively analysed.
Results/Findings
Ward evaluation data for 96 patients across 8 timeframes were recorded. An average of 46% of patients were not mobilised, with 21% of patients were not given the opportunity to mobilise. 24 members of the MDT responded to the questionnaire. Analysis is underway and will be presented at the event.
Conclusion
A substantial proportion of older patients are not mobilised in the EAU, and half of these patients are not offered the opportunity to mobilise. Once MDT-perceived factors for mobilisation are better understood, an intervention will be implemented in the EAU and impact evaluated. |
68 | Patient-centred decision making in the use of thickened fluids: A comparative case study | Aims and Objectives: To compare the management of two patients with dysphagia both exploring the introduction of IDDSI Level 3 thickened fluids after videofluoroscopy.
Background: Dysphagia (swallowing disorder) is common after acquired brain injury. One compensatory management approach is to modify the texture of patients’ food and fluids. Recent literature reviews have revealed a mixed picture of risks and benefits associated with thickening fluids which requires a patient-centred approach.
Methods: This is a comparative case study.
Results/Findings: There were similarities between the two patients’ impairment profiles; on their initial Videofluoroscopic Swallow Study (VFSS), both patients were overtly aspirating IDDSI Level 0 and silently aspirating large amounts of IDDSI Level 1 and 2 fluids but did not show aspiration on IDDSI Level 3 fluids. Despite presenting with very similar swallow profiles, they made different capacitous decisions initially, and then both changed their minds after having lived with the reality of their choices. One patient decided to stop thickened fluids and start drinking thin fluids with acknowledged risk and the other decided to stop thin fluids at risk and resume thickened fluids. Both patients showed improvements in their swallow function during their hospital stay and their decisions took place at different points in their rehab journey.
Conclusion: These case studies show the importance of patient-centred decision making and the need for SLT follow-up after decisions are made. It highlights the importance of instrumental assessment and the need for caution when prescribing thickener from bedside assessments.
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69 | Characterisation of musculoskeletal health problems encountered by intensive care survivors: a prospective observational study | Aims and objectives: To characterise the specific musculoskeletal (MSK) complications experienced by patients following a period of critical illness.
Background: Survivors of critical illness frequently experience new or worsening physical impairments which persist for years after the acute hospitalisation. MSK conditions remain under-investigated as a potential cause of long-term disability in ICU survivors.
Methods: This study received UK ethical approval (21/NS/0143) and represents a sub study of a large multicentre observational study. The primary study was a prospective cohort study undertaken across four UK NHS Trusts. Adult patients admitted to ICU for ³48 hours without neurological injury or MSK trauma were eligible. Participants received a telephone follow-up six months after ICU admission where their MSK health state was assessed using the MSK Health Questionnaire (MSK-HQ). Participants reporting a MSK problem at follow-up underwent a comprehensive in-person assessment. The assessment evaluated pain, joint range of movement, and strength. To incorporate a biopsychosocial approach the Fear-Avoidance Beliefs Questionnaire was included.
Results: Of 254 participants followed up in the primary study, 150 participants reported an MSK health problem. Sixty-one of the 150 participants (41%) with an MSK problem underwent an assessment. All experienced pain as part of their MSK problem, with a median (IQR) Visual Analogue Scale score of 70 (41.5-80). The most reported location for an MSK problem was the shoulder (n= 30, 49.2%), with multisite problems reported by more than half (n= 33, 54.1%). One quarter of participants (n= 15, 24.6%) had high levels of fear-avoidance beliefs related to physical activity
Conclusion: Six months following admission to ICU, 54% of survivors with an MSK health problem present with multisite MSK problems with the shoulder the most frequently and severely affected. High levels of pain and low levels of physical activity are common, with 25% of participants having fear-avoidance beliefs relating to physical activity.
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70 | How does screening and detection of psychological needs, on admission, affect functional outcomes within ischaemic stroke patients? | Background: Stroke is a leading cause of adult disability globally, significantly impacting both physical and psychological well-being. Among the psychological effects, Post-Stroke Depression (PSD) is a prevalent condition, affecting approximately one-third of stroke survivors. PSD is associated with increased mortality rates and poorer functional outcomes, highlighting the critical need for early identification and intervention. Psychological disorders following a stroke frequently manifest as apathy and lethargy, leading to reduced engagement with rehabilitation programs, such as physiotherapy and occupational therapy. This lack of engagement prolongs the recovery process, ultimately affecting long-term functional outcomes and overall quality of life. Aims and Objectives: This literature review aims to investigate the impact of early screening and detection of psychological needs, on admission, on the functional outcomes of ischemic stroke patients. By evaluating existing research, this literature review seeks to determine whether early psychological assessment improves functional outcomes and thus, overall recovery trajectories. Methods: A systematic and comprehensive search strategy was created to identify relevant literature across four major healthcare databases: CINAHL, PubMed, PsycINFO, and the British Nursing Index. Stringent inclusion and exclusion criteria were applied to ensure the selection of high-quality studies relevant to the research question.
Currently I am doing an NIHR research internship, which concludes in June. As I am currently working on this, my findings and conclusions are not available, but will be available by July. Thank you for your consideration.
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71 | Understanding access to evidence-based interventions amongst young people under the care of mental health services in the UK. | Across the UK, Child and Adolescent Mental Health Services (CAMHS) provide assessment and intervention for young people with mental health difficulties and their families. These services are varied in terms of structure, staff background, care pathways and the types of interventions offered. Whilst the barriers to accessing evidence-based interventions have been explored (e.g. Peters-Corbett et al., 2023), the nature of the interventions which are currently offered within CAMHS, and the pathways to accessing these remains somewhat unclear. Enhancing our understanding of this will be key to improving access to evidence-based interventions.
With this in mind, this project will take a mixed-method and multi-stage approach to explore:
• What interventions are currently provided in CAMHS around the UK, and are these interventions evidence-based?
• What is young peoples’ experience of receiving these interventions?
• What informs CAMHS clinicians’ decision making around which interventions should be provided?
• What do key stakeholders perceive to be the barriers and facilitators to accessing evidence-based interventions amongst young people under the care of CAMHS?
The development of the proposal for each stage will be informed by PPI involvement, and will be subject to ethical approval as appropriate. This poster presentation will be an opportunity to discuss the planned project with NMAHPPs, to further shape the proposal
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72 | A service evaluation to identify the learning and development needs of staff working within a Children’s therapies and gait Service: Staff perspectives on their learning and development needs, and barriers and enablers to these being effectively met. | Aims and Objectives: This service evaluation sought to gain an understanding of the educational needs of staff working within the Children’s Therapies and Gait (CT+G) CSU from the perspective of staff working within this team.
Background: Learning and development has been frequently cited as an area requiring development within CT+G (recurrent theme in exit interviews, time to talk sessions, staff survey etc, and from it being raised in meetings across the CSU). To support starting to address this, a fixed term 1 year Practice Education Facilitation AHP (0.6 WTE) post has been created to scope learning and development needs within the CSU. As part of this role, this particular service evaluation will enable a service-wide evaluation of the educational needs of this team from the perspective of the staff working within it. It should support in the identification of specific needs (both met and un-met), what is working well, while also identifying what is not currently working well, and therefore areas for service development. The findings from this service evaluation will also be contributing to a much wider scoping piece that in turn will enable the development of series of recommendations and support future workforce planning to develop the required educational infrastructure within the service.
Methods: Qualitative and quantitative data have been collected via an online questionnaire (using Microsoft forms) sent to all staff working with the CT+G CSU. Data will now be analysed by the project lead with themes identified from this and how they map across the 4 pillars of practice.
Results/Findings: TBC - analysis has just been commenced
Conclusion: TBC
Governance: This service evaluation was added to the ulysees audit platform and was signed off for completion. |
73 | Enhancing Heart Failure Care in Routine Consultations by Clinical Pharmacists in Primary Care – A Programme for Education and Support | Aim:
To introduce and evaluate a programme to support clinical pharmacists in primary care to manage and recognise heart failure (HF).
Objectives:
• To enhance existing consultations for people with HF.
• To highlight when to suspect HF and how to refer to local diagnostic services.
Background:
HF is a chronic condition with increasing prevalence. There are evidence-based treatments which improve mortality, morbidity, and risk of unplanned admission. It is increasingly common for clinical pharmacists to undertake the routine medication reviews for people with HF.
Methods
A 3-month programme comprising formal education sessions, shadowing clinicians, accessing MDT discussions, and virtual support sessions, was provided to a convenience sample of 11 senior clinical primary care pharmacists. Participants consented to evaluation of their data, but formal ethical approval was not required for a service evaluation.
Participants completed a survey on the overall programme, and self-assessments of their knowledge and confidence across 5 domains at 3 time points. The survey comprised open and closed questions, self-assessments used a Likert scale.
Responses were analysed using descriptive statistics for self-assessment and closed questions, and themes identified from open questions.
Results:
Nine of eleven participants provided self-assessments. Knowledge was consistently assessed as greater than confidence, and there was a clear improvement in both by the end of the programme.
Seven of nine felt their practice had changed as a result. The 2 who did not feel practice had changed reported they had not been released from practice to engage in all aspects of the programme.
Conclusion:
In this pilot, a combination of education and support led to improvements in self-assessed knowledge and confidence in HF management and was linked to self-reported positive changes in practice. The findings suggest that delivering education sessions in isolation may not be sufficient to change practice.
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74 | Mobility in the intensive care unit – one size may not fit all: a service evaluation | Aims and Objectives:
This study aims to identify factors associated with achieving a step transfer prior to ICU discharge and explores its relationship with rehabilitation delivery.
Background:
Achieving a step transfer to a chair prior to Intensive Care Unit (ICU) discharge positively impacts post-ICU management and hospital outcomes. Evidence identifying patients less likely to achieve this milestone is limited which may affect therapists’ ability to effectively allocate resource to optimise service delivery.
Methods:
A retrospective analysis of prospectively collected data for all admissions to a single UK general ICU in a tertiary teaching hospital was conducted (Ulysses ID 9235). Data from consecutive admissions between 1st January 2023 and 1st January 2024 of patients who were aged 18 years or over, were admitted for than five days or more and survived to ICU discharge were included.
The level of mobility using the Manchester Mobility Score (MMS) on ICU discharge was dichotomized (≥5 or ≤4). Variables considered to potentially influence the outcome were identified a priori. Logistic regression assessed the demographic and clinical variables for independence of association with achieving an MMS ≥5 on ICU discharge.
Results:
The absence of ICU-Acquired Weakness (ICU-AW) was independently associated with achieving MMS ≥5 on ICU discharge (OR 6.31 95% CI 1.23 to 32.47, p=0.03). Patients achieving MMS ≥5 on their first rehabilitation contact achieved higher mobility levels on ICU discharge (MMS 7 vs 5, p<0.001). This was in a shorter time frame (3 days vs 6, p<0.001), and utilised less rehabilitation resource (4 vs 7 sessions, p<0.001).
Conclusions:
Rehabilitation interventions should be prioritised for patients presenting with ICU-AW. Patients not achieving MMS ≥5 on their first rehabilitation contact should have resources reappropriated to them. Therapy teams should facilitate delivery of patient centred rehabilitation to patients more vulnerable to significant sequelae of critical illness.
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75 | Planning MRI Scans for Stereotactic Radiosurgery: Optimising Immobilisation and Scan Quality | Aim
Stereotactic Radiosurgery (SRS) must be delivered with sub-millimetre accuracy. To this end, patients are immobilised at OUH using the Encompass™ SRS immobilisation system.
Each patient must have pre-treatment imaging to allow accurate delineation of the target for treatment and any organs at risk. CT is used to provide dosimetric information and these images are fused with same-day MRI in order to define target/avoidance structures with the level of accuracy required for SRS.
Current MRI configuration at OUH does not facilitate scanning patients while immobilised in the Encompass™ system as the diagnostic coil options do not fit around the (otherwise MRI-compatible) radiotherapy (RT) immobilisation equipment.
Therefore, non-immobilised MRI images are manually fused by Therapeutic Radiographers and Clinical Scientists to the immobilised CT data for RT planning which can result in discrepancy between the two datasets. Subsequently this may reduce accuracy of target delineation.
Method
GE have recently manufactured a flexible MRI coil which is compatible with RT immobilisation equipment (AIR RT™).
Based on published studies, MRI scanning in SRS immobilisation with the AIR RT™ coil is expected to improve accuracy of target volume delineation, reduce image fusion error and improve signal to noise ratio which may result in improved identification of normal anatomical structures at RT planning.
Results
Implementation of AIR RT™ coil into the SRS planning pathway is expected to improve image quality, patient experience, accuracy of image fusion, target delineation and SRS outcomes.
A bid was developed and Oxford Hospitals Charity funding has been awarded to purchase the AIR RT™ coil at OUH.
Conclusion
AIR RT™ coil was delivered to OUH in December 2024. This is the first in clinical use in the UK. Once commissioned, radiotherapy and radiology staff will work collaboratively on a series of research projects to investigate the impact of the AIR RT™ coil. |
76 | “Investigating whether routinely collected biomarkers could improve the prediction of hospital-acquired pressure injury: a retrospective cohort study” | Aim
To explore the potential of how biomarkers could improve HAPI prediction
Background
Hospital-acquired pressure injuries (HAPI) remain a significant challenge in healthcare, contributing to prolonged hospital stays, increased patient morbidity, and substantial healthcare costs. HAPIs are one of the most frequent and often preventable adverse events. The global prevalence in adults is approximately 12% (Rodgers, Sim et al., 2021). Despite widespread use, traditional risk assessment tools such as the Braden score, lack sufficient predictive accuracy due to limited validity. Furthermore, current methods for early pressure injury identification require visual skin inspection, leading to disparities in detection and treatment. Emerging evidence suggests routinely collected biomarkers may offer an objective and reliable approach to identifying patients at risk of HAPI.
Methods
Data approval was obtained from the Trust Research and Development department. Participants were admitted between January and December 2024 to acute adult medical wards in a large teaching hospital in England. The population characteristics of those participants with and without HAPI will be reported and compared, for all and based on subgroups such as hospital length of stay and Braden score. Distributions of biomarkers are plotted. Analyses was carried out in Stata v16 and R v4.4.
Results
Data from 13,942 patient admissions (304 hospital acquired pressure injuries) with median hospital stay for patient with HAPIs was 18 (11.5 to 31) days and 5 (2 to 11) days for those without. Braden scores at admission were mean (SD) 14.7 (3.3) and 17.2 (3.6) respectively. Biomarker distributions and their potential predictive value in combination with the Braden score will be presented.
Discussion and Conclusions
This study provides critical insights into the potential role of biomarkers in enhancing HAPI risk prediction. By integrating objective biomarkers with the risk score, clinicians may be better equipped to identify high-risk patients and implement timely prevention strategies.
References
Rodgers, K., et al. (2021). "Systematic review of pressure injury prevalence in Australian and New Zealand hospitals." Collegian 28(3): 310-323.
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77 | A service evaluation into the confidence of midwives’ in assessing Black, Brown and ethnic minority newborns using the Apgar scoring tool. | Aim
The aim of this service evaluation is to assess midwives' confidence in evaluating Black, Brown, and ethnic minority newborns at birth using the Apgar scoring tool. Additionally, it seeks to appraise the relevance and effectiveness of the Apgar tool in the current maternity care context and to provide recommendations for improving newborn care in clinical practice.
Background
The Apgar scoring tool has been used globally for over 50 years to assess newborn health at birth in maternity and neonatal care settings. However, the tool was originally developed based on White newborns, and recent discussions have raised concerns regarding its accuracy and inclusivity for newborns from diverse ethnic backgrounds.
Methods
A service evaluation was conducted using a Microsoft Forms questionnaire, collecting both quantitative and qualitative data from midwives working in a maternity unit in central United Kingdom.
Results
A total of 52 responses were collected and analysed to determine midwives' confidence when assessing Black, Brown, and ethnic minority newborns using the colour component of the Apgar scoring tool. The findings showed that while 98% of midwives felt confident in assessing White newborns, only 38% reported feeling confident in assessing Black, Brown, and ethnic minority newborns. Additionally, participants expressed that the Apgar scoring tool is no longer an appropriate or accurate measure for the increasingly diverse populations they serve and emphasised the need for specific training to enhance their clinical practice and knowledge in this area.
Conclusion
This service evaluation is the first to focus specifically on midwives' confidence in providing essential newborn care across all ethnic groups. The results highlight the urgent need for changes aimed at reducing racial bias and addressing growing concerns related to the care of Black, Brown, and ethnic minority newborns. The evaluation provides future recommendations to improve midwives' confidence, skills, and knowledge, with the aim of positively impacting outcomes for the global majority in maternity care.
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78 | What determines successful leadership – findings from studying the leadership practice of executive nurses in acute provider hospitals in the English NHS. | Executive Nurses hold complex roles pivotal in securing high-quality patient care and are often identified as responsible for failing care standards. Understanding and explaining how executive nurses lead nursing in the boardroom influenced by the cultural context could also shed light on nurse leadership at all levels.
The study aimed to examine the perception of successful executive nurse leadership from the perspectives of executive nurses, chief executive officers, medical directors, and senior health leaders and explain the potential forces that contribute to successful leadership.
A critical realist narrative design was used to understand and explain executive nurse leadership practice; 19 semi-structured interviews were conducted. Snowballing through ‘super recruiters’ formed a sample reflective of the board demographics. Using critical realist and narrative thematic analysis, a narrative was recreated for each participant group. A meta-narrative was created to describe the experience of successful executive nurse leadership and potential explanations of how it’s experienced by both executive nurses and those with whom they share the boardroom.
Executive nurses’ leadership experiences can be characterised as a liminal space in which they transition from being unprepared for the executive role and the risk of being seen as to ’nursey’, to confidently providing nursing advice through securing professional credibility and visibility, knowledge of nursing practice and policy.
Executive nurses lead using a relational approach that under-labours traditional theory-promoted leadership approaches. A model of relational leadership and nursing leadership characteristics has been developed to inform a nursing way of knowing leadership.
Limited evidence exists on executive and nurse leadership to inform nursing leadership practice, which is traditionally informed by managerial theories and policy. Therapeutic relationship skills inform successful relational leadership. They enable the development of complex relationships in challenging contexts, fostering collaboration and partnerships to achieve the common goal of providing safe patient care.
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79 | The existence of ‘Nursism’ as a prejudicial contextual factor in determining successful executive nurse leadership in acute provider hospitals in the English NHS. | Presenting the explanation of the potential of cultural forces that influence the board leadership of Executive Nurses who hold complex roles pivotal in securing high-quality patient care. Understanding the cultural context of nurse leadership sheds light on the leadership for nurses at all levels.
The study aimed to examine the perception of successful executive nurse leadership from the perspectives of executive nurses, chief executive officers, medical directors, and senior health leaders and to explain the potential forces that contribute to successful leadership.
A critical realist narrative design was used to understand and explain executive nurse leadership practice; 19 semi-structured interviews were conducted. Snowballing through ‘super recruiters’ formed a sample reflective of the board demographics. Using critical realism and narrative, thematic analysis, a narrative was recreated for each participant group. A meta-narrative was created to describe the experience of successful executive nurse leadership and potential explanations for how it is perceived by both executive nurses and those with whom they share the boardroom.
Executive nurses’ leadership experience can be characterised by leading relationally, which is necessary to navigate the influences of the cultural context in which they lead. The context and approach are influenced by board member's unconscious bias and prejudiced perceptions of nurses and nursing. A dominant focus on delivering government policy and targets creates an invisible cultural clash between a managerial and a safe, compassionate nursing agenda, which has been framed as the concept of ‘nurs-ism’.
It is pertinent for all nurses to understand how the cultural context can influence the perception of nurse leadership. The existence of nurs-ism suggests that nursing does not speak for itself, in contrast to the more authoritative social status of medics and medicine.
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80 | Retention and completion of a doctoral nursing programme: Sense making through collective reflection. |
Introduction: This discussion paper examines the experiences of eight students participating in Oxford Brookes University's inaugural professional nursing doctorate programme.
Aims: This paper aims to make sense of our experiences and contribute to the existing knowledge about doctoral study by sharing our insights.
Design: Discursive paper drawing on the principles of auto-ethnography
Methods: Through individual and group reflections on our experience, we address the questions “Why did we stay?” and “How do we make sense of the fact that we all, as a group, successfully completed the programme?”
Findings: The main reasons we gave for staying were: i) commitment, which had three strands of ‘proving’, ‘obligation’ and ‘self-determination’; ‘ii) self-identity and common humanity. The two further elements that helped us make sense of our cohort’s completion were i) the joy of learning together, and ii) professional friendship and Socratic inquiry.
Conclusion: As the first programme cohort for the nursing doctorate in our area, we became a close and supportive group which we argue, contributed to our success. We ascribed this to our characteristics as doctoral students and the creation of a sisterhood reminiscent of a community of practice. We also acknowledged the importance of the WhatsApp platform in facilitating group cohesion, and that our process of reflection brought a sense of reflexive closure at the end of our programme.
Implications for doctoral education in nursing: We recommend that doctoral cohorts, supervisors, and teaching teams systematically plan opportunities into programmes for organic relationship development and consider how the literature on communities of practice might support academic development. Academic staff could also encourage students to set up an online communication channel such as WhatsApp or similar at an early stage in their programmes and give particular consideration to closure and transition to post-doctoral practice on completion of professional doctorates.
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81 | A qualitative evidence synthesis to understand the experience of ethnically and racially minoritised physiotherapists | Aims and Objectives: We aimed to systematically search for qualitative research that explored the experience of ethnically and racially minoritised physiotherapists to contribute to a more inclusive NHS workforce.
Background: Physiotherapists from diverse backgrounds bring unique skills and knowledge to the profession that can enhance patient care. Research indicates that ethnically/racially minoritised physiotherapists are underrepresented and can encounter career obstacles.
Methods: We registered the study on PROSPERO (420250644228). We systematically searched four bibliographic databases (MEDLINE, PsycINFO, CINAHL, EMBASE) using a key text and thesaurus terms (syntax available on PROSPERO). We included research that explored the experiences of ethnically/racially minoritised physiotherapists or physiotherapy students around the world. Using Rayyan software, two reviewers screened potential studies and used the CASP Critical Appraisal tool. We undertook a thematic synthesis of qualitative research, as outlined by Thomas and Harden (2008).
Findings: We screened 183 reports and included 13 unique studies. Studies included 123 racially/ethnically minoritised physiotherapists and 106 students from around the world. Our final themes include: physiotherapy is a White profession; people treat me differently; people are not culturally sensitive; people find it awkward to talk about race; people don’t see racism; I must either keep quiet or push back.
Conclusions: Our themes help us to understand the experiences of racially/ethnically minoritised physiotherapists. Future research might utilise these findings to frame qualitative enquiry that can help us to unpick and address barriers to career entry and progression. Our findings have the potential to underpin a richer and more inclusive physiotherapy profession and facilitate improvements in accessibility and quality of care for ethnically/racially minoritised service users. An inclusive and diverse physiotherapy profession can contribute to improvements in patient care and work satisfaction for physiotherapists.
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82 | Older adults’ perception of vulnerability and inequality in recovering from the pandemic in the UK | Abstract
Title: Older adults’ perception of vulnerability and inequality in recovering from the pandemic in the UK
Aims and Objectives
The aims of this pilot study were to explore the vulnerabilities and inequalities experienced by older adults in the UK during their recovery from the COVID-19 pandemic. It focuses on key social determinants of health (SDOH), including access to food, housing, healthcare, essential information, income, social interaction, and technology.
Background
The COVID-19 pandemic has disproportionately affected older adults thus exposing their vulnerabilities and deepening existing inequalities. Understanding their experiences is crucial to informing policies that may enhance their well-being and resilience in a post-pandemic society.
Methods
A qualitative exploratory-descriptive approach was used. Semi-structured interviews were conducted with ten older adults. Data analysis followed a thematic approach to identify key themes. Ethical approval was granted by the Oxford Brookes University ethics committee, UREC Registration No: 231700.
Results/Findings
Participants emphasised dependence on community support, mainly family and faith-based groups, and respect within their communities. However, technological proficiency varied, with some reporting difficulties accessing online services and maintaining social connections due to compromised IT skills. A sense of vulnerability and loss was shared, driven by fears of contracting the virus, grief over disrupted routines and reduced social ties. Adherence to government policies, such as mask-wearing, was respected. Media portrayals emphasising "old age" heightened feelings of vulnerability. Psychological impacts, including anxiety, depression and loneliness, were prevalent, alongside physical effects like reduced exercise. While access to food and healthcare was generally sufficient, some participants preferred online medical consultations to avoid travel. A few reported that the pandemic brought family closer.
Conclusion
The study highlights the significant impact of the pandemic on older adults’ daily lives, their mental health, and social well-being. It underscores the need for inclusive policies to enhance their digital literacy, support their mental health, and strengthen social networks. Addressing these areas can help reduce inequalities and foster resilience in the post-pandemic era.
Keywords: Covid-19, older adults, SDOH
Word count: 295
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83 | Association between quality of life with visual function in inherited retinal diseases | Aims, Objectives and Background: Inherited retinal diseases account for the leading cause of blindness amongst working-age adults in the United Kingdom. The approval of novel therapies for these diseases requires an understanding of how standard clinical measures of retinal function relate to self-perceived visual disability. This study investigated the association between visual function and quality-of-life in patients with inherited retinal disease, to identify meaningful health outcomes.
Methods: A cross-sectional study (ISRCTN24016133) was conducted in patients with monogenic retinal disease. Vision-related and health-related quality-of-life were assessed using validated questionnaires: Visual Function Questionnaire 25 (VFQ-25), Low Luminance Questionnaire (LLQ) and EuroQoL-5D-5L. Visual function measures included best-corrected visual acuity in ETDRS and Moorfields Acuity Chart letters, low luminance visual acuity and microperimetry.
Results: Twenty-five patients were recruited. The median age was 30 years (interquartile range 23–48) and 80% of patients were male. LLQ scores were lower than VFQ-25 and exhibited fewer ceiling and floor effects. Microperimetry was the only significant predictor of VFQ-25 and LLQ scores (p=0.036, R²=37% and p=0.012, R²=54% respectively, with Holm-Bonferroni-adjusted significance). No significant associations were observed between other visual function measures and questionnaire scores. A linear mixed model found no significant difference in the predictive value of the better compared to the worse eye for questionnaire scores (β=2.14, SE=4.88, p>0.05). There was no significant correlation between LLQ and EuroQoL-5D-5L scores (rho=-0.008, p=0.9709).
Conclusion: Microperimetry is a patient relevant measure in inherited retinal diseases. This study demonstrates to stakeholders, such as regulatory bodies, how visual function measures translate to patients’ quality-of-life. |
84 | Challenges of setting up a sample collection service for Musculoskeletal Biobank. | Working towards streamlining a process to recruit participants, collect biological samples as well as health related data for Biobank study. This takes into consideration the priorities of the scientist, as they conduct the research; and the priorities of the surgeon whose primary goal is to care for their patients.
The UK Biobank holds a large health resource database for scientists in the form of biological samples and/ or health data. The aim of this is to develop an understanding of many diseases and eventually develop treatments. The demand to collect as many samples as possible is therefore very high, with many thousands of patients recruited each year. This places a great demand on the sample collection process.
We present our experience with setting up a safe and effective Biobank collection process. We will examine the challenges we face as a Research Delivery Network as we coordinate and liaise with scientists and surgeons, whose priorities differ from one another. Most of all we present a robust model for ensuring that the needs of the patient are met, with particular reference to the consent process prior to sample collection.
We describe our experience in beginning and developing a robust sample collection algorithm at the Nuffield Orthopaedic Centre. Our presentation will include the specific challenges encountered during the start-up process. The need for continuous MDT meetings to encourage information sharing and group-working. A continual feedback process with the Research Delivery Network team playing a central role, networking between patients, scientists and surgeons.
Communication is an integral part in any study and giving feedback, whether that is negative or positive, it is vital to improve the process and further the research. |
85 | Enhancing Research Integration in Endoscopy: Bridging Perceptions and Practice | Background
Research is a cornerstone of high-quality clinical care, particularly in world-leading healthcare institutions like ours. However, in fast-paced environments such as endoscopy departments—where efficiency and positive patient experience are paramount—research is often perceived as an added burden. Clinical staff, acting as gatekeepers, may hesitate to introduce research opportunities due to concerns about delaying procedures or increasing patient stress. This reluctance risks limiting valuable research participation and progress, as well as limiting patients’ rights to autonomy.
Aim:
To address this, we explored both patient and staff perceptions regarding research activity within the endoscopy setting. Specifically, we investigated how patients felt about being approached for research participation on the day of their procedure and examined staff attitudes toward collaborating with research teams.
Methods:
Through two structured service evaluations, we collected insights from 20 patients across John Radcliffe and Horton Hospitals and 31 staff members. These were conducted according to governance in place.
Findings:
A majority of 95% of patients reported that being invited to participate in research had little to no impact on their stress levels, and all patients found the research staff to be professional and supportive. Encouragingly, the majority would recommend research participation to their family and friends.
Staff feedback was equally positive—over 80% agreed that research teams worked well within the department. Suggestions for further integration included providing regular updates on active studies and offering research-focused learning opportunities for clinical staff.
Conclusion:
This study demonstrates that research can be seamlessly embedded within endoscopy services without disrupting clinical workflows or patient experiences. Through collaboration and addressing misconceptions, we can strengthen our research culture, ensuring that both staff and patients feel empowered to contribute to health advancements. Embracing research as part of routine care will ultimately enhance both clinical practice and patient outcomes.
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86 | A Retrospective Audit and Analysis of the Oxford University Hospitals (OUH) Carotid Artery Ultrasound Database | Background
In 2017 the VSU Microsoft Access database was created to monitor carotid ultrasound investigations. In 2023 we audited UK and Ireland vascular centres on current practices in grading carotid stenosis, identifying differences that remain in the criteria used to grade disease severity. This study aims to determine the impact on clinical practice if the criteria was changed. As ageing is associated with lower absolute cerebral perfusion, the secondary aim explored the effect of sex and age within the database.
Methods
Between November-2017 and August-2024, the VSU database recorded 8785 investigations. Excel was used to clean and prepare the data, RStudio, SPSS and GraphPad Prism was used for further analysis.
Results
The database contained 7387 unique first assessments in patients with a varied clinical history, 65% were male. Females were on average older (69±12 vs. 71±13 years old) and had less carotid artery disease at a younger age. When scans were normal, males had lower velocities only within the left internal carotid artery (ICA). In the presence of moderate (>50% stenosis) and severe disease (>70% stenosis), there was no difference between the sexes. Older patients (>75 years old) had significantly lower velocities with severe disease (mean difference, 80 cm.s-1). Sensitivity analysis suggested that grading moderate disease with lower velocity thresholds (125 cm/s vs 130 cm/s) and velocity ratios (2-4 vs <3.2) would have impacted 43 and 115 patients respectively, but only 7 patients when grading with both criteria; none had clinical events.
Discussion
Changing the criteria to grade moderate disease would have low impact on clinical practice. However, the difference in blood velocities between the ages could suggest that some older patients might not meet the recommended diagnostic velocity thresholds to grade severe disease.
Conclusions
Further studies are required to investigate the influence of ageing on grading carotid artery disease.
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87 | Escaping to Empathy: An Interactive Escape Room for Teaching Elderly Care | Aims & objectives: This project develops a simulation based escape room to enhance elderly care education for urgent care practitioners.
Background: Traditionally taught as a series of didactic lectures with poor student feedback and knowledge acquisition, an alternative approach was developed. This escape room initiative introduces an interactive, time-sensitive approach tailored for paramedics and nurses undertaking a minor illness course. The scenario replicates real-world challenges, encouraging collaborative decision making and skill application in a controlled, immersive environment with potential to expand scope. Ethical guidelines in the collection of data was followed, with informed consent obtained from each participant.
Methods:
A mixed methods evaluation assessed the impact of this intervention. Quantitative data were collected via pre- and post-questionnaires measuring knowledge acquisition and confidence levels. Qualitative feedback from reflections and questionnaires explored participant experiences, engagement and areas for improvement. AI-driven tools were integrated to personalise puzzles, simulate patient interactions and analyse participant performance.
Results/Findings:
Findings indicate that the escape room approach enhances engagement, knowledge retention and interdisciplinary communication. Participants reported increased confidence in handling complex elderly care scenarios and improved understanding of psychological assessment tools. The gamified format demonstrated potential for broader implementation in national training initiatives, though standardisation would be beneficial.
Conclusions
This innovative escape room aligns with OH's goals of advancing patient safety and education. By integrating gamified learning and AI-enhanced tools, this approach offers an immersive alternative to traditional training methods, with significant potential for workforce development in elderly care education. |
88 | Understanding the educational needs of midwives in relation to physiological birth | Background
Lifelong learning is an essential part of a midwife’s journey. Much education is guided by NHSE's Core Competency Framework (2023), which sets national training standards but leaves little time for subjects beyond its scope. Midwives are experts in physiological birth but challenges can arise due to a less experienced midwifery workforce. Incidents in our unit highlighted the need for enhanced training related to physiological birth.
Aim
To assess midwives' confidence in various aspects of physiological birth and determine training requirements to create a tailored educational workshop.
Methods
An anonymous MS Forms questionnaire was distributed to all midwives at a large maternity unit between 9th January 9 – 3rd March 2025. Sixty-nine respondents completed the survey, which included Likert-type scales and open questions to assess confidence, barriers and learning needs. Quality improvement methodology was used throughout. The QI project was registered with Trust - approval ID 10204.
Results
Literature Findings
Educational interventions can improve confidence levels Enhanced self-efficacy is linked to better motivation and performance. Programs included lectures, audiovisual demos, and hands-on training.
Survey Findings
Survey results showed midwives were less confident in performing episiotomies (6.3/10), determining fetal position via vaginal examination (6.2/10), and administering sterile water injections for back pain (5.8/10). They were more confident in providing continuous support during labor (8.9/10), caring for women using water immersion (8.7/10), and supporting non-supine birthing positions (8.6/10). Participants requested education on fetal positioning, massage and therapeutic touch, fetal position determination, and episiotomy performance.
Design, Delivery, and Evaluation
The physiological birth workshop will be based on the principles of constructivist learning theory and will include multi-modal, evidence-based content, ultising problem-based learning, reflective discussions, case studies, and hands-on skills training.
The CAST Universal Design for Learning framework will be used to maximize inclusivity. Post-intervention surveys will assess confidence levels and training effectiveness. Performance audits will review emerging trends and safety incidents. |
89 | Using evidence-based co-design to develop a virtual based exercise intervention that aims to increase confidence to exercise in persons with haemophilia. | Intro- Due to advances in treatments, people with haemophilia (PWH) are living longer. They are not as active as the general population due to joint damage and lack confidence to be active due to concerns about further bleeds and pain. There is a need to facilitate healthy ageing through promotion of physical activity and exercise. Changing patient beliefs and increasing physical literacy and confidence to move are thought to be key to helping PWH become more active. This paper describes the development of an exercise and behaviour change intervention to improve confidence to exercise in PWH.
Methods- The 4-stage Medical Research Council framework for complex intervention development was used.
1: Identify possible intervention elements from the literature and by engagement with stakeholders. Existing online exercises classes in haemophilia centres were visited to review exercises and gain stakeholder feedback.
2: Produce a draft exercise programme for stakeholder review
3: Develop a theory of change model to guide the behaviour change elements with stakeholders
4: Finalise the intervention.
Stakeholders included 17 PWH and 7 physiotherapists working in haemophilia. 7 online focus group meetings were held.
Results-
The final intervention is a hybrid 12-week physiotherapist led progressive exercise programme. Classes are 45 minutes including Pilates, HIIT and balance elements, together with discussion sessions focusing on physical activity recommendations, the types and benefits of different exercise styles, and the effects of physical activity, together with the effects of aging for PWH. PWH expressed the need for a physiotherapist expert in haemophilia to teach the class and for their individual musculoskeletal abilities to be considered. They were keen to exercise with other PWH and gain confidence/social support from group interaction. The COM-B model of behaviour change was used to develop the intervention.
Discussions/Conclusion-Co-design helps to produce an intervention that understands the stakeholders needs. Through this process the intervention developed to incorporate not only increasing physical activity but also confidence to exercise. The use of behaviour change theory identified the behaviour techniques included in the intervention and aims to increase physical literacy in this population.
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90 | What are nurse educators perceptions of the facilitators and barriers of developing an inclusive curriculum | Ethical approval was sought by the Ethics committee within the Faculty of Education at Oxford Brookes University.
The empirical research is a qualitative study of nurse lecturers' perceptions of inclusive pedagogy in nurse education conducted in a post-’92 university’s adult nursing programme. The research explored the frustrations the lecturers and third-year students identified, addressing the need to develop inclusive pedagogy in higher education and nurse education. Unlike many other studies, this study began with nurse educators' perceptions of inclusion and pedagogy rather than the policies provided by the university.
The literature review identified inclusive pedagogy as having begun in schools and being introduced into higher education with the development of a universal design for learning.
This study used ethnographic qualitative research to explore the perceptions of the nurse lecturers. To identify the nurse educators' perceptions of the barriers and facilitators to the introduction and current use of inclusive pedagogy, it was important to consider the lecturers' lived experience of inclusive pedagogy before considering the university’s role.
The research identified three findings: Nurse educators perceive their understanding of inclusion as a barrier or facilitator in developing inclusive nurse education. They also perceive that the degree to which they understand and practice inclusive pedagogy can facilitate or hinder this development. Finally, they perceive a lack of consistency in inclusive approaches across the department, which can create facilitators or barriers to developing inclusive nurse education for all.
The study's recommendations include a precise definition of inclusive pedagogy, as lecturers and students are currently confused about it. The lecturing team needs to take a team approach to implementing inclusive pedagogy. Three levels of action are required: individual, team, and university. It is important to consider these three dimensions to introduce the inclusive curriculum into the adult nursing programme successfully.
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91 | A Mixed Methods Study to Develop and Assess the Feasibility of a Digital Self-Management Platform for People with Lung Cancer | Background: A novel digital self-management platform, to support individuals with lung cancer was co-designed (Handheld Health Lung Cancer) and its feasibility was tested with lung cancer survivors in the UK- LungFit Study. Digital health interventions have gained prominence in chronic disease management, offering accessible and scalable solutions to enhance patient self-care. However, ensuring usability, feasibility, and clinical effectiveness remains a challenge. Our study employed a structured methodology to design, implement, and assess the intervention, integrating co-design principles and rigorous evaluation techniques.
Aims The primary aim of this study was to develop and evaluate a digital platform that enhances physical functioning and quality of life for lung cancer patients. Specifically, it sought to: (1) Co-develop the platform through an iterative, user-centred approach; (2) Assess usability and user experience; (3) Evaluate the feasibility of implementing the platform in a real-world setting.
Methodological Discussion The study was structured into two key components. Part A focused on the co-development of the platform, employing co-design workshops/interviews with patients, their caregivers, and healthcare professionals and usability testing with people living with lung cancer. Part B examined feasibility through a mixed-methods study. Data collection methods included semi-structured interviews, focus groups, questionnaires, and clinical assessments, ensuring a comprehensive evaluation of user engagement and intervention impact. Qualitative data was analysed thematically, using a framework process, while quantitative data was analysed using descriptive statistics. An agile development methodology and the COM-B behaviour change model were used to optimise the intervention’s effectiveness.
Conclusion: The integration of mixed-methods research provided a comprehensive understanding of the platform’s usability and potential impact. Ethical considerations, including informed consent and data protection, as well as PPI were central to the study’s rigorous design. By adopting a structured and iterative methodology, this research has contributed to the growing evidence supporting digital health interventions in oncology, highlighting their potential to enhance patient self-care and well-being.
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92 | Introducing novel forms of occupational therapy professional reasoning: A practical strategy for embedding planetary health considerations in allied health professional practice | Background: It is undeniable that climate change has direct and severe impacts on human health and wellbeing. Occupational therapists (OTs) are the allied health professionals (AHPs) with the unique remit of supporting human participation through facilitating optimal interactions between people, occupations and environments. Similarly to the professional regulatory bodies of most AHPs, the World Federation of Occupational Therapists (WFOT) has established requirements for OTs to consider planetary health issues within their professional practice. Unfortunately, however, practical means to do so are limited.
Objectives: Two new forms of professional reasoning are proposed, with suggestions for embedding them within OT practice, and consideration of the potential impacts for other AHP groups.
Methods: Professional reasoning refers to thinking processes that are used to guide each stage of the OT process. Various differentiated types of professional reasoning are identified in the literature, with some forms viewed as straightforward, novice-level, and others founded on more complex meta-cognitive skills, thus associated with expert practice. The explicit articulation of the types of professional reasoning being considered in any interaction has the potential to ensure that OTs are accountable for all factors that require consideration within complexity therapeutic situations. The inclusion of ENVIRONMENTAL REASONING (novice) and SUSTAINABILITY REASONING (expert) as new categories of professional reasoning is proposed as a usable strategy for action on this essential issue.
Conclusion: The addition of explicit, new categories of professional reasoning to OT practice may be a straightforward strategy for supporting the professional transition from theoretical acceptance of the need to consider environmental sustainability, to the provision of practical tools for tackling this challenge. In addition to the advancement of OT practice, future empirical research to explore the impacts of this addition has the potential to inform professional practice of other AHP groups. |
93 | Identifying Frail Patients at the Front Door: A Quality Improvement Project on Improving Identifying Frailty and Accuracy of Clinical Frailty Scale in the Emergency Department in an Acute General Hospital | Background: The rise in frail patients seeking care at Emergency departments (ED) globally has led to an increased focus on improving the identification and care of frail patients upon arrival in ED. The clinical frailty scale (CFS) has been used in the ED to identify frail elderly patients to prompt the initiation of a comprehensive geriatric assessment. However, it has been noted that the CFS's accuracy was low, and training needs have been identified.
Methods: To address this, a quality improvement project was carried out using the PDSA (Plan, Do, Study, and Act) cycle to enhance the accuracy of frailty identification at the front door. SQUIRE guideline is followed to report.
Intervention: Based on the fishbone and driver diagram, a training programme was designed and delivered to the ED nurses in November 2023 (PDSA cycle 1) and from September to October 2024 (PDSA cycle 2). A lanyard card was developed to simplify and standardise the CFS scoring. This was disseminated to ED nurses along with 1:1 brief education in conjunction with other training activities.
Results: Following the training intervention, the correct identification of CFS 6 and above improved from a baseline of around 50% to around 60% after the first cycle, and to over 70% after the second cycle. While the accuracy of CFS also improved to 40%, it remains to be seen whether this change is sustainable and not just a normal variation.
Conclusion: This quality improvement project, using a lanyard card, in conjunction with brief teaching and other training methods, effectively increased the rate at which moderate to very severely frail frailty was identified and subsequently referred to frailty teams.
Keywords: Quality improvement, Clinical frailty scale, Frailty, identification of frailty, Emergency department, frailty at front door, front door frailty, same-day emergency care
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