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Associate Psychological Practitioners (APPs) in Primary Care: Modelling the Impact
Get PDFBackground: The ‘Associate Psychological Practitioner’ (APP) is an innovative new role that expands the psychological workforce and addresses the rising demand for mental health services in England, yet the impact of this role on NHS workforce capacity has yet to be modelled.
Aim: We modelled the impact of the APP role in Primary Care in terms of additional capacity to provide mental health care and the impact on General Practitioner (GP) capacity within the sector.
Method: Workforce experts of the NHS Workforce Repository and Planning Tool (WRaPT) team used a modelling tool to determine future state scenarios of APPs working across all Primary Care Networks (PCNs) within a region, and the associated change on the baseline workforce. Modelling was based on Lancashire and South Cumbria, a large geographical area in North-West England that includes 41 PCNs. Assumptions used in the modelling included identifying the patient population and workforce in scope, documenting the activity undertaken by APPs, and considering the future state scenarios for modelling.
Findings: With regards to generating additional capacity, having 1 APP in each of the 41 PCNs in Lancashire and South Cumbria could provide 53,000 brief intervention appointments of 45 minutes each, thereby diverting these appointments away from the GP; and up to 48 people could benefit from attending Group and Wellbeing sessions over a year with 1 APP working with another Primary Care colleague, that is, 384 group intervention sessions delivered. In relation to GP capacity, 1 APP (if placed across a PCN, or within multiple practices) could free up at least 1,665 General Practitioner appointments within one year, which could lead to potential cost savings. These findings can be used to underpin decision making in respect of training future cohorts of APPs and contribute to wider workforce planning in primary care
Temporal trend and regional disparity in the investigations for stable chest pain in Europe: An insight from the PIONEER IV trial
No full textOverview of statistics teaching within undergraduate programmes in UK and Ireland Dental Schools
Get PDFAbstract: Introduction The UK General Dental Council (GDC)’s learning outcomes for undergraduate dental students briefly mention critical appraisal, but not statistics. Hence wide variation in statistics teaching across the Dental Schools is likely but has not yet been well-documented.
Methods A survey was conducted to capture the main features of each of the dental degrees in the 18 UK and Ireland Dental Schools in terms of statistics-related (stand-alone or as part of other courses/modules) teaching.
Results Representatives from all 18 Dental Schools completed the survey. There were some similarities, such as most using teaching materials specifically developed for their School, and aiming to teach students to understand/interpret but not generate statistics. However the number/type of staff delivering the teaching, student contact hours, number of statistical concepts taught, whether statistical theory/formulae/packages were used and inclusion in summative assessments varied extensively. Most reported that this teaching was negatively perceived by the students, and many felt that changes were needed.
Discussion and conclusion This comprehensive review of undergraduate dental statistics related provision allows Dental Schools to compare and contrast their own teaching, which is which is very timely given the imminent need to implement a new GDC framework. Guidelines to encourage more standardised teaching should be developed to improve the ability of newly qualified dentists to practise evidence-based dentistr
Wrapping of the Gastroduodenal Artery Stump to Reduce Haemorrhage After Pancreaticoduodenectomy
No full textPancreaticoduodenectomy (PD) is a complex and high-risk surgical procedure associated with significant morbidity and mortality, particularly due to post-pancreatectomy haemorrhage (PPH). Wrapping the gastroduodenal artery stump (GDAS) intraoperatively has been proposed as a preventive measure, utilizing various materials such as the falciform ligament (FL), ligamentum teres hepatis (LTH), omentum, and polyglycolic acid (PGA) sheets. A comprehensive meta-analysis was conducted, including 10 studies involving 3,398 participants. Comparative studies were selected to evaluate the risk of PPH with GDAS wrapping versus control groups. Odds ratios (ORs) were used to assess efficacy. GDAS wrapping significantly reduced PPH incidence (OR = 0.23, 95% CI: 0.11-0.51), despite high heterogeneity among studies (I² = 64%). Subgroup analysis showed significant reductions with FL/LTH (OR = 0.20, p = 0.003) and PGA (OR = 0.18, p = 0.007) but not with omental (OR = 0.37, p = 0.07). The analysis of 30-day mortality did not reach significance (OR = 0.76, p = 0.44). GDAS wrapping may reduce PPH risk; however, further randomised studies are needed to confirm these findings and assess the superiority of specific wrapping techniques
A Qualitative Study of Acculturation and Intimate Relationships Among Refugee Women in Switzerland
No full textIn mid-2024, there were approximately 122.6 million forcibly displaced individuals worldwide (UNHCR, 2024). Of these, 192,507 reside in Switzerland, half of whom are women (Macrotrends, 2023). While extant literature has explored the challenges faced by refugee women, understanding of post-migration experiences related to intimate relationships and acculturation remains limited. This study addresses this gap using interpretative phenomenological analysis (IPA) to capture the emotional, social and psychological aspects of participants’ post-migration experiences. Semi-structured interviews were conducted with 12 refugee women, all in intimate relationships, aged 25-45 years, who migrated to Switzerland from Pakistan, Iraq, Cuba, Colombia, Kurdistan and Turkey. Berry’s (1997) acculturation framework and Bornstein’s (2017) specificity principle guided the data analysis, identifying four experiential themes: ‘Pathways of Acculturation,’ ‘Shadow of Bias,’ ‘Loss in a New Land,’ and ‘Metamorphosis of Relationships’. Findings revealed participants' experienced racism, systemic barriers, loss, resilience, gendered and cultural challenges, and changes in intimate relationships, which shaped the participants process of acculturation. Acculturation strategies were grouped by pre-migration culture, and intimate relationships were often intertwined with acculturation, as some couples adapted together while others experienced tension due to changing gender and cultural norms. Racism contributed to mistrust, anxiety and social withdrawal, leading to isolation and cultural preservation. This research introduces transformative acculturation (TA) as a novel addition to existing acculturation frameworks, based on the post-migration changes of participants affected by gender-based violence (GBV). TA offers a comprehensive understanding of acculturation, addressing the limitations of existing frameworks by positing TA as a process of cultural, identity, gender and relationship transformation, driven by the pursuit of safety and agency for refugee women impacted by GBV. Furthermore, the importance of interventions and policies guided by transformative acculturation is emphasised, highlighting culturally responsive support that prioritises safety post-migration. Additionally, targeted interventions to support refugee women's intimate relationships post-migration is addressed
AI-Powered Sign Language Translation: Enhancing Communication with MediaPipe and Machine Learning
No full textThe rapid advancement of artificial intelligence (AI) and machine learning has transformed communication accessibility for deaf and hard-of-hearing individuals. This research investigates using Media Pipe and Long Short-Term Memory (LSTM) networks for real-time sign language translation, focusing on overcoming barriers in Arabic Sign Language (ArSL). The study employs a landmark-driven approach, extracting hand and pose features, achieving 99.46% accuracy on a 10,000-sample dataset. Despite its success, challenges include handling diverse signing styles and environmental variations, with limitations in low-light conditions and subtle gesture recognition. TensorFlow Lite enables efficient mobile deployment, though technical details like data storage formats are omitted for brevity. Future work will explore dataset expansion, enhanced temporal modeling, and multimodal integration to boost accuracy and accessibility. Ethical considerations underscore the need for responsible AI development in assistive technologies
Winning hearts and minds: How can post-stroke activity be increased to implement the national clinical guidelines?
No full textIntroduction: Post-stroke inactivity is associated with physical, neuropsychological, and psychosocial complications. Clinical guidelines recommend people be supported to remain active for up to 6-hours per day. This GIRFT Stroke Leadership Academy Quality Improvement Project (QIP) sought to understand current practice, including challenges/opportunities, to inform new ways of working.
Method: Utilising Kaizen principles, the project took place across three hospital trusts, including HASU(H), ASU(A) and Rehabilitation(R) settings, in England. QIP activities included: Cross-sectional survey of patients views/preferences (A); Behavioural mapping observations of physical, social and cognitive activity (15-min intervals; 7am-7pm; 7-days) (H,A,R); and MDT focus groups to ascertain perceptions and attitudes regarding activity provision (A). Quantitative data were analysed using descriptive statistics, qualitative with thematic analysis.
Results or details of the case: Of 19 surveyed patients, 68% (N=13) did not feel they undertook enough activity outside therapy. Preferred increased provision included: balance; strengthening; stroke education; and self-care. Behaviour mapping (N=75 patients) resulted in 25,200 observation time points. Time spent in activity differed across settings, averaging at 5.6 hours. The MDT felt increased education, training, resources and a collaborative long-term approach were required to effectively implement guidelines. Staff beliefs and fear of doing harm were significant barriers, nevertheless a variety of interventions were suggested for future implementation and evaluation.
Conclusion: Patients and staff support an increase in post-stroke activity provision. Work is required to overcome existing beliefs and effect culture change. The project findings will inform further implementation and evaluation activities, with a view to influencing wider spread, adoption and scale-up, to meet the recommended 6-hours
Horizon-scale variability of from 2017--2021 EHT observations
No full textWe report three epochs of polarized images of at 230,GHz using data from the Event Horizon Telescope (EHT) taken in 2017, 2018, and 2021. The baseline coverage of the 2021 observations is significantly improved through the addition of two new EHT stations: the 12,m Kitt Peak Telescope and the Northern Extended Millimetre Array (NOEMA). All observations result in images dominated by a bright, asymmetric ring with a persistent diameter of $43.9± 0.6 consistent with expectations for lensed synchrotron emission encircling the apparent shadow of a supermassive black hole. We find that the total intensity and linear polarization of vary significantly across the three epochs. Specifically, the azimuthal brightness distribution of the total intensity images varies from year to year, as expected for a stochastic accretion flow. However, despite a gamma-ray flare erupting in M87 quasi-contemporaneously to the 2018 observations, the 2018 and 2021 images look remarkably similar. The resolved linear polarization fractions in 2018 and 2021 peak at ∼5%, compared to ∼15% in 2017. The spiral polarization pattern on the ring also varies from year to year, including a change in the electric vector position angle helicity in 2021 that could reflect changes in the magnetized accretion flow or an external Faraday screen. The improved 2021 coverage also provides the first EHT constraints on jet emission outside the ring, on scales of łesssim 1,mas. Overall, these observations provide strong proof of the reliability of the EHT images and probe the dynamic properties of the horizon-scale accretion flow surroundin