Ulster Medical Journal最新文献

Background: Evidence of initiatives to support General Practitioners (GPs) during the Covid-19 pandemic is scant.

Aim: To understand the impact of a novel method of providing support in the early stages of the pandemic.

Design and setting: A mixed-methods study of GPs working in a socially deprived area of Belfast.

Method: A survey was distributed to GPs who had attended a series of educational meetings at the beginning of the COVID-19 pandemic. The survey incorporated the Warwick Edinburgh Mental Wellbeing Scale and questions about the virtual meetings. Follow-up interviews were undertaken with five GPs to further explore their lived experiences and their perceptions of the virtual support forum.

Results: The Covid-19 pandemic resulted in a measurable diminution of emotional well-being in GPs in North and West Belfast. Attendees rated a series of virtual meetings highly and described the following themes (and subthemes): a sudden traumatic change (emotional response, fight or flight, painful reminders of the status of general practice in the NHS); a coming together (stepping up to take responsibility, sharing of information, feeling of affirmation); reflections on what worked (calming facilitation, careful selection of speakers, creating the right atmosphere, ownership and autonomy) and building future direction (defining future direction, capitalising on lesson learned).

Conclusion: The virtual meetings harnessed the instinct to come together witnessed at the beginning of the pandemic, and as well as sharing valuable information, also provided emotional support along with a sense of comradeship, ownership and autonomy.

How this fits in: GPs did not feel included or supported at the outset of the pandemic. Coming together with fellow professionals was a welcome source of support. Professional support can be delivered using a virtual platform. Continued professional development is more acceptable than explicit emotional support, but when done well can bolster resilience and emotional well-being.

Background: Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC).

Methods: Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed).

Results: 47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate.

Conclusion: The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.

Introduction: During the COVID-19 pandemic, there have been suggestions that there will be a reduction in cancer diagnoses, causing a detrimental effect on patients1. We therefore conducted an analysis to assess if there has been a reduction in new haematological malignancy diagnoses within the Belfast Health and Social Care Trust (BHSCT).

Methods: We observed a significant decline in diagnostic tests used in the diagnosis of haematological malignancies. We therefore decided to analyse the impact of COVID-19 on the volume of tests performed to see if this impacted the number of new cases of haematological malignancies diagnosed. To ascertain the number of new diagnoses referred to Clinical Haematology we decided to analyse the number of new diagnoses discussed at the local Multidisciplinary Team Meetings (MDM) between March and June 2020 and compare this with the same period in 2019. In line with NICE guidelines2 there has been no change to the referral pathway for patients with new haematological malignancy.

Results: Results show that there is no significant difference between the number of new malignant haematological diagnoses discussed during March to June 2020 and the same period in 2019. This confirms that the number of new diagnoses remains the same within the two time periods.

Conclusion: This analysis highlights that despite a reduction in primary and secondary care diagnostic blood tests, there is no difference in the number of new cases of haematological malignancies discussed at Haematology MDM throughout the first surge of the COVID-19 pandemic locally.

Many of us are involved in the education and training of junior doctors. Maintaining and improving the quality of such training is the common goal of all medical educators, including those working in the Northern Ireland Medical and Dental Training Agency (NIMDTA) and within our hospitals - the Local Education Providers (LEPs). The development of NIMDTA's Placement Quality Initiative (PQI) aims to create a more collaborative working relationship between NIMDTA and the LEPs, working together, to achieve a shared goal and develop and implement strategies to improve current practice. We review the PQI process, from both a trainee and trainer's perspective, and ascertain if this approach has facilitated positive, reproducible changes in training programmes that are felt at ground level.

Introduction: The general medical council (GMC) conducts the National Training Survey (NTS) annually. Part of the survey illustrates the statistics of United Kingdom medical school graduates in core and speciality application. We aimed to review the speciality training application and performance of graduates of Queen's University Belfast (QUB), and compared with graduates of medical schools in England, Scotland, and Wales.

Method: The progression reports from the GMC NTS 2016-2019 were accessed on the GMC website. All data available were extracted in April 2020. The mean results for all graduates of 33 UK medical schools in Northern Ireland, England, Scotland, and Wales were collated from the NTS. Applications to the seven specialities with the greatest number of posts available across the UK were analysed.

Results: No differences were noted in the majority of the application stages when comparing graduates from QUB with other UK medical school graduates. However, QUB graduates were less likely to be invited for an interview when applying for core surgical training AND receive an offer for Core Anaesthetic and ACCS Training. QUB graduates were less likely to apply for General Practice training.

Conclusion: Our study evaluates the performance of QUB graduates compared to other UK medical graduates in core/speciality application. Based on our findings, QUB and postgraduate deaneries may consider focussing on strengthening applications for aspiring surgeons, improving interview performance for anaesthetics and ACCS applicants, and attracting trainees to pursue a career in General Practice.