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Protocol for a randomised trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory In

Por: Dennis · C.-L. · Marini · F. · Dick · J. A. · Atkinson · S. · Barrett · J. · Bell · R. · Berard · A. · Berger · H. · Brown · H. K. · Constantin · E. · Da Costa · D. · Feller · A. · Guttmann · A. · Janus · M. · Joseph · K. S. · Jüni · P. · Kimmins · S. · Letourneau · N. · Li · P. · Lye · S.
Introduction

The ‘Developmental Origins of Health and Disease’ hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase ‘preconception to early childhood’ lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years.

Method and analysis

A randomised controlled multicentre trial will be conducted in two of Canada’s highly populous provinces—Alberta and Ontario—with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first ‘sibling child.’ The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An ‘index child’ conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed.

Ethics and dissemination

The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities.

Trial registration number

ISRCTN13308752; Pre-results.

False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital

Por: Gupta-Wright · A. · Macleod · C. K. · Barrett · J. · Filson · S. A. · Corrah · T. · Parris · V. · Sandhu · G. · Harris · M. · Tennant · R. · Vaid · N. · Takata · J. · Duraisingham · S. · Gandy · N. · Chana · H. · Whittington · A. · McGregor · A. · Papineni · P.
Objective

To describe the characteristics and outcomes of patients with a clinical diagnosis of COVID-19 and false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR), and develop and internally validate a diagnostic risk score to predict risk of COVID-19 (including RT-PCR-negative COVID-19) among medical admissions.

Design

Retrospective cohort study.

Setting

Two hospitals within an acute NHS Trust in London, UK.

Participants

All patients admitted to medical wards between 2 March and 3 May 2020.

Outcomes

Main outcomes were diagnosis of COVID-19, SARS-CoV-2 RT-PCR results, sensitivity of SARS-CoV-2 RT-PCR and mortality during hospital admission. For the diagnostic risk score, we report discrimination, calibration and diagnostic accuracy of the model and simplified risk score and internal validation.

Results

4008 patients were admitted between 2 March and 3 May 2020. 1792 patients (44.8%) were diagnosed with COVID-19, of whom 1391 were SARS-CoV-2 RT-PCR positive and 283 had only negative RT-PCRs. Compared with a clinical reference standard, sensitivity of RT-PCR in hospital patients was 83.1% (95% CI 81.2%–84.8%). Broadly, patients with false-negative RT-PCR COVID-19 and those confirmed by positive PCR had similar demographic and clinical characteristics but lower risk of intensive care unit admission and lower in-hospital mortality (adjusted OR 0.41, 95% CI 0.27–0.61). A simple diagnostic risk score comprising of age, sex, ethnicity, cough, fever or shortness of breath, National Early Warning Score 2, C reactive protein and chest radiograph appearance had moderate discrimination (area under the receiver–operator curve 0.83, 95% CI 0.82 to 0.85), good calibration and was internally validated.

Conclusion

RT-PCR-negative COVID-19 is common and is associated with lower mortality despite similar presentation. Diagnostic risk scores could potentially help triage patients requiring admission but need external validation.

Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database

Abstract

Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital‐acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital‐acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score‐adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in‐hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30‐, 60‐, and 90‐day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital‐acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.

Producing a successful PhD thesis

Por: Barrett · D. · Rodriguez · A. · Smith · J.

All doctoral students strive for the day—after years of often all-consuming study—that their thesis is ready to submit. For both doctoral students and supervisors there is often trepidation about whether the thesis will meet the criteria to merit the award of a Doctor of Philosophy (PhD). As anxieties increase, doctoral students often ask what makes a good PhD, something we explored in a recent ‘Research Made Simple’ article,1 but perhaps the more important question is ‘what makes a PhD student successful?’ In this article we outline the core criteria on which PhD theses are judged and offer suggestions for achieving success.

How are PhDs assessed

Traditionally, a PhD involves 3 to 4 years of full-time study (or a longer part-time programme), which is assessed by the student submitting the work they have undertaken as a thesis or—less commonly—a portfolio of published papers and an associated narrative (sometimes...

A nationwide initiative to increase nursing and midwifery research leadership: overview of year one programme development, implementation and evaluation

Abstract

Aims and objectives

To report on the development, implementation and evaluation of the first year of the National Institute for Health Research 70@70 Senior Nurse Research Leader Programme.

Background

Internationally, there is a lack of nursing and midwifery research and policy contribution to healthcare sectors. To address this, funding was obtained for a Senior Nurse and Midwife Research Leader Programme in England. The programme aimed to increase nursing and midwifery research capacity and capability and support the development of future research leaders.

Design

The programme had three phases: development, implementation and evaluation. The cohort study's evaluation phase consisted of a survey and qualitative written feedback.

Methods

An online survey was sent to cohort members (n = 66). Quantitative survey data was analysed in Survey Monkey. Written feedback asked cohort members to summarise their activities and any challenges. Data were thematically analysed. The “Strengthening the Reporting of Observational Studies in Epidemiology” reporting checklist was used.

Results

Thirty‐nine (59%) cohort members responded to the survey. Responders valued being part of a network (46%), having protected time (22%) and having workplace autonomy (13%). Challenges reported included difficulties accessing online resources (32%), lack of collaborative opportunities (17%) and organisational barriers (10%). Fifty‐six (85%) cohort members submitted the written report. The main themes were “relationship and profile building”, “developing capability and capacity”, “developing the workforce”, “patient and public involvement and engagement” and “quality improvement.”

Conclusions

The 70@70 programme has increased the research profile of the nursing and midwifery professions at a local and national level. International healthcare systems can learn from this, by considering optimal ways to provide nurses and midwives with the tools, resources and confidence to actively contribute to research policy and practice.

Relevance to Clinical Practice

The initiatives undertaken through year 1 of the programme have created a platform through which research can be incorporated into clinical practice, education and teaching.

Randomised controlled trial of integrated trauma-focused psychotherapy for traumatic stress and substance use among adolescents: trial protocol

Por: Mills · K. L. · Barrett · E. · Back · S. E. · Cobham · V. E. · Bendall · S. · Perrin · S. · Brady · K. T. · Ross · J. · Peach · N. · Kihas · I. · Cassar · J. · Schollar-Root · O. · Teesson · M.
Introduction

Post-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive–behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)).

Methods and analysis

A two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12–18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60–90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5.

Ethics and dissemination

Ethical approval has been obtained from the human research ethics committees of the Sydney Children’s Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences.

Trial registration number

ACTRN12618000785202; Pre-reults.

Protocol version

Version 1, 31 July 2017.

What are the foundations of a good PhD?

Por: Rodriguez · A. · Smith · J. · Barrett · D.

A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research. The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.

Foundations of a ‘good’ PhD studySupervision and support

Central to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity...

Survey of nurses’ knowledge and practice regarding medication administration using enteral tubes

Abstract

Aim and objectives

To identify the practice variation of the individual practitioners in medications’ formulation modification for patients using enteral feeding tubing and to support health practitioners involved in this process.

Background

Blockage of enteral tubes is a common problem that can sometimes be resolved but may require replacement of the tube. Medications are a common culprit.

Design

A survey of 73 registered nurses’ practices around medication administration via enteral feeding tubes.

Methods

A questionnaire study was undertaken within a district general hospital across a broad variety of wards to explore nurses’ experiences of medication administration via enteral tubes. The study is reported in accordance with the squire 2.0 guidelines from the EQUATOR network.

Results

Seventy‐three nurses responded. Twenty‐six per cent reported never checking about drug modification for administration via a tube, 12% check every time and 61% when unsure about a new drug. The volume of fluid flushes administered after medication ranged from 7.5–150 ml. Seventy‐one per cent of participants reported stopping feed when medications are required, varying from 1–60 min. Sixty per cent had experienced a blocked tube and 52% the tube being removed for these reasons. The clinical nurse specialist was the commonest first point of call to help. Staff named 15 medications as the most problematic to administer, lactulose and omeprazole were the top two.

Conclusions

Practice varies significantly amongst nurses around medication administration. Theoretically, this may contribute to blocked tubes and excessive fluid administration to some patients. Barriers to medication administration were thematically grouped into: time, difficulty modifying medication, medication interactions and knowledge. Areas identified to support staff include training, devices to crush medications, medication suitability, multidisciplinary approach to streamline care and quick reference guides.

Relevance to clinical practice

Health professionals may use these results to reduce and ultimately avoid problems with administering medications through feeding tubes. Organisations may use these results to develop their local practice pathways for prescribing, dispensing and training around administration of medications through enteral tubes. In a community setting, this paper may improve the awareness of patients, caregivers and prescribers of the possible implications of tubing blockages.

Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database

Abstract

Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital‐acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital‐acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score‐adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in‐hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30‐, 60‐, and 90‐day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital‐acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.

Childrens unscheduled primary and emergency care in Ireland: a multimethod approach to understanding decision making, trends, outcomes and parental perspectives (CUPID): project protocol

Por: McAuliffe · E. · Hamza · M. · McDonnell · T. · Nicholson · E. · De Brun · A. · Barrett · M. · Brunsdon · C. · Bury · G. · Collins · C. · Deasy · C. · Fitzsimons · J. · Galligan · M. · Hensey · C.
Introduction

The aim of this project is to determine the patterns, decision-making processes and parental preferences associated with unscheduled paediatric healthcare utilisation in Ireland. Unscheduled paediatric healthcare is outpatient care provided within primary care settings by general practitioners (GPs), emergency departments (EDs) located in paediatric and general hospitals, and out-of-hours services provided by cooperatives of GPs operating on a regional basis. This project will take a multimethod approach to analysing the utilisation of unscheduled paediatric healthcare nationally within the context of a significant change to the provision of healthcare for young children in Ireland—the introduction of free at the point of delivery GP care for all children aged under 6.

Methods and analysis

A multimethod approach consisting of three work packages will be employed. Using patient-level data, work package 1 will describe patterns of attendance at primary care, out-of-hours medical services and at EDs. Applying a difference-in-difference methodology, the impact of the introduction of free GP care for children under 6 on attendance will be assessed. Work package 2 will explore geospatial trends of attendance at EDs, identifying disparities in ED attendance by local area and demographic characteristics. Work package 3 will employ two discrete choice experiments to examine parental preferences for unscheduled paediatric healthcare and GP decision making when referring a child to the ED. The insights gained by each of the work packages individually and collectively will inform evidence-based health policy for the organisation of paediatric care and resource allocation.

Ethics and dissemination

Ethical approval for this research has been granted by University College Dublin, The Irish College of General Practitioners and the five participating hospitals. Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups.

COVID-19 emergency response assessment study: a prospective longitudinal survey of frontline doctors in the UK and Ireland: study protocol

Por: Roberts · T. · Daniels · J. · Hulme · W. · Horner · D. · Lyttle · M. D. · Samuel · K. · Graham · B. · Hirst · R. · Reynard · C. · Barrett · M. · Carlton · E.
Introduction

The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic.

Methods and analysis

This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.

The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point.

Ethics and dissemination

Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children’s Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).

This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact.

Trial registration number

ISRCTN10666798.

What are Delphi studies?

Por: Barrett · D. · Heale · R.
Introduction

Whenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach. By working to identify a consensus position, researchers can report findings on a specific question (or set of questions) that are based on the knowledge and experience of experts in their field.

However, there are challenges to this approach. For example, what should be done when consensus cannot be reached? How can experts be engaged in a way that allows them to consider objectively the views of others and—where appropriate—change their own opinions in response? One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique.

The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus. Specifically, they developed an approach—named after the...

A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors

Abstract

Aims

To explore available health behaviour change interventions in improving key health behaviours in colorectal cancer survivors and patient perspectives about these interventions.

Design

A systematic mixed studies review was conducted.

Data Sources

Databases searched included Ovid Medline, Ovid Embase, EBSCO PsychoInfo and EBSCO CINAHL. A grey literature search was also completed using Google Scholar and the TRIP database. Identified studies were published between 2003 – 2018.

Review methods

A parallel‐results convergent synthesis design using narrative syntheses was used. Data analysis was conducted following a process of constant comparison. Quality appraisal was conducted using recognized tools appropriate to different study designs.

Results

Sixteen unique studies were identified from an initial search of 354 records. There was a pattern of successful physical activity and dietary change associated with behaviour change interventions of varying intensity, modality and length, but sparse description of intervention content was common. Participants preferred clear explanations of health behaviour importance and for interventions to be administered in sessions either with, or led by, other patients.

Conclusion

The available evidence tentatively suggests that behaviour change interventions can improve the health behaviours of colorectal cancer survivors. However, more research focused on identifying key intervention elements is needed. Patients indicated clear preferences for specific intervention content and delivery, but further research is needed to allow for the appropriate incorporation of patient preferences into the design of such interventions.

Impact

This review highlights the potential for interventions to improve health behaviours evidenced to influence short and long‐term health outcomes in colorectal cancer survivors. However, the examination of the impact of these interventions and patient perspectives indicated a paucity of research. This is an important finding in demonstrating additional research is necessary to improve the support available to a growing group of patients with complex health needs.

Research made simple: developing complex interventions

Por: Rodriguez · A. · Smith · J. · Barrett · D.

In common with many other countries, population ageing, advancements in medical technology, changing disease profiles, the influence of lifestyle choices on health and increased patient expectations are driving health and social care provision in the UK. As the number of people living with one or more long-term conditions rises, interventions to support their health and well-being become increasingly complex. Nurses will not only be expected to deliver complex interventions but are in an ideal position to contribute to priority setting and the development and evaluation of interventions that meet patient needs. It is essential that complex interventions are based on the best available evidence and evaluated if they are to improve health outcomes. In this article we will provide an overview of complex interventions, using dignity therapy as an example, and outline the principles of developing a complex intervention.

What is a complex intervention?

The UK Medical Research...

Student mental health and well-being: are universities doing enough?

Por: Barrett · D. · Twycross · A.

There is increasing recognition that students in higher education are a population group at high risk of facing mental health challenges. Indeed, the Institute for Public Policy Research recently acknowledged that the level of mental illness and mental distress among UK university students is increasing, and is greater than other sections of the population.1 The prevalence of mental health issues among university students was highlighted by the results of a 2015 survey by the National Union of Students that found that in a sample of 1093 students:

  • Seventy-eight per cent reported facing mental health problems in the previous year.

  • Two-thirds of respondents reported having felt depressed in the last year.

  • The prevalence of suicidal thoughts in the previous 12 months (33%) was double that reported in the general population2 (although the rate of suicide among students has fallen substantially in the past...

  • Nurse educators must demonstrate care, competence and integrity to enhance students trust in them

    Por: Barrett · D. · Harris · M.

    Commentary on: Varagona LM, Hold JL. Nursing students' perceptions of faculty trustworthiness: thematic analysis of a longitudinal study. Nurse Educ Today 2019;72:27–31. doi: 10.1016/j.nedt.2018.10.008.

    Implications for practice

  • Student nurses’ trust of nurse educators is dependent on faculty demonstration of care, commitment, competence and professionalism.

  • Larger-scale studies of factors influencing student nurses’ trust in faculty members—and the impact of trust on outcomes—are required, with utilisation of both qualitative and quantitative approaches.

  • Context

    The professional relationship between nurse educators and nursing students is an important factor in enhancing the academic and clinical development of learners. As a result, researchers have sought to understand the relationship more fully, including factors such as power dynamics1 and the importance of effective relationships in promoting a sense of ‘belonging’ among students.2 The study by Varagona and Hold3 extends this evidence base by focusing on...

    Protocol for a longitudinal, prospective cohort study investigating the biology of uterine fibroids and endometriosis, and patients quality of life: the FENOX study

    Por: Tapmeier · T. T. · Nazri · H. M. · Subramaniam · K. S. · Manek · S. · Garbutt · K. · Flint · E. J. · Cheuk · C. · Hubbard · C. · Barrett · K. · Shepherd · E. · Zondervan · K. T. · Becker · C. M.
    Introduction

    Millions of women suffer from the consequences of endometriosis and uterine fibroids, with fibroids the cause for over 50% of hysterectomies in the USA, and direct costs for their treatment estimated at between US$4 and US$9 billion. Endometriosis commonly affects millions of women worldwide predominantly during reproductive age, with severe menstrual and non-menstrual pain and subfertility the main symptoms. Due to the ‘unhappy triad’ of endometriosis—lack of awareness, lack of clinically relevant biomarkers and the unspecific nature of symptoms—women wait on average for 8–12 years before the definitive endometriosis diagnosis is made. Treatment options for both conditions are not satisfactory at the moment, especially with a view to preserving fertility for the women and families affected. In the Fibroids and Endometriosis Oxford (FENOX) study, we combine the investigation of fibroids and endometriosis, and plan to collect high-quality tissue samples and medical data of participants over a time frame of 5 years after surgical intervention.

    Methods and analysis

    Biological samples such as blood, saliva, urine, fat, peritoneal fluid and—if found—endometrial tissue or fibroids as well as detailed clinical and intraoperative data will be collected from women undergoing surgery and participating in the study after informed consent. We plan to recruit up to 1200 participants per disease arm (ie, endometriosis and uterine fibroids) over 5 years. Participants will fill in detailed and validated questionnaires on their medical history and quality of life, with follow-ups for 5 years. Enrolment started on 2 April 2018, and FENOX will close on 31 March 2028. We will analyse the biological samples using state-of-the-art molecular biology methods and correlate the findings with the medical records and questionnaire data.

    Ethics and dissemination

    The findings will be published in high-ranking journals in the field and presented at national and international conferences.

    Trial registration number

    ISRCTN13560263.

    Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

    Por: McNicholas · F. · Sharma · S. · Oconnor · C. · Barrett · E.

    Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists’ well-being.

    Objectives

    To report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.

    Setting

    Community CAMHS in Ireland.

    Participants

    An online questionnaire was sent to all consultant child psychiatrists registered with the Irish Medical Council (n=112). Fifty-two consultants replied (46% response rate).

    Primary outcome measures

    Questions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.

    Results

    The prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p0.001) and patient-related burnout (r=0.476, n=52, p0.001). Lack of confidence in government commitment to investment in CAMHS (p0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).

    Conclusion

    The high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists’ well-being is required.

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