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Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition
- Jarrod J Homer, Stuart C Winter, Elizabeth C Abbey, Hiba Aga, Reshma Agrawal, Derfel ap Dafydd, Takhar Arunjit, Patrick Axon, Eleanor Aynsley, Izhar N Bagwan, Arun Batra, Donna Begg, Jonathan M Bernstein, Guy Betts, Colin Bicknell, Brian Bisase, Grainne C Brady, Peter Brennan, Aina Brunet, Val Bryant, Linda Cantwell, Ashish Chandra, Preetha Chengot, Melvin L K Chua, Peter Clarke, Gemma Clunie, Margaret Coffey, Clare Conlon, David I Conway, Florence Cook, Matthew R Cooper, Declan Costello, Ben Cosway, Neil J A Cozens, Grant Creaney, Gahir K Daljit, Stephen Damato, Joe Davies, Katharine S Davies, Alina D Dragan, Yong Du, Mark R D Edmond, Stefano Fedele, Harriet Finze, Jason C Fleming, Bernadette H Foran, Beth Fordham, Mohammed M A S Foridi, Lesley Freeman, Katherine E Frew, Pallavi Gaitonde, Victoria Gallyer, Fraser W Gibb, Sinclair M Gore, Mark Gormley, Roganie Govender, J Greedy, Teresa Guerrero Urbano, Dorothy Gujral, David W Hamilton, John C Hardman, Kevin Harrington, Samantha Holmes, Jarrod J Homer, Deborah Howland, Gerald Humphris, Keith D Hunter, Kate Ingarfield, Richard Irving, Kristina Isand, Yatin Jain, Sachin Jauhar, Sarra Jawad, Glyndwr W Jenkins, Anastasios Kanatas, Stephen Keohane, Cyrus J Kerawala, William Keys, Emma V King, Anthony Kong, Fiona Lalloo, Kirsten Laws, Samuel C Leong, Shane Lester, Miles Levy, Ken Lingley, Gitta Madani, Navin Mani, Paolo L Matteucci, Catriona R Mayland, James McCaul, Lorna K McCaul, Pádraig McDonnell, Andrew McPartlin, Valeria Mercadante, Zoe Merchant, Radu Mihai, Mufaddal T Moonim, John Moore, Paul Nankivell, Sonali Natu, A Nelson, Pablo Nenclares, Kate Newbold, Carrie Newland, Ailsa J Nicol, Iain J Nixon, Rupert Obholzer, James T O'Hara, S Orr, Vinidh Paleri, James Palmer, Rachel S Parry, Claire Paterson, Gillian Patterson, Joanne M Patterson, Miranda Payne, L Pearson, David N Poller, Jonathan Pollock, Stephen Ross Porter, Matthew Potter, Robin J D Prestwich, Ruth Price, Mani Ragbir, Meena S Ranka, Max Robinson, Justin W G Roe, Tom Roques, Aleix Rovira, Sajid Sainuddin, I J Salmon, Ann Sandison, Andy Scarsbrook, Andrew G Schache, A Scott, Diane Sellstrom, Cherith J Semple, Jagrit Shah, Praveen Sharma, Richard J Shaw, Somiah Siddiq, Priyamal Silva, Ricard Simo, Rabin P Singh, Maria Smith, Rebekah Smith, Toby Oliver Smith, Sanjai Sood, Francis W Stafford, Neil Steven, Kay Stewart, Lisa Stoner, Steve Sweeney, Andrew Sykes, Carly L Taylor, Selvam Thavaraj, David J Thomson, Jane Thornton, Neil S Tolley, Nancy Turnbull, Sriram Vaidyanathan, Leandros Vassiliou, John Waas, Kelly Wade-McBane, Donna Wakefield, Amy Ward, Laura Warner, Laura-Jayne Watson, H Watts, Christina Wilson, Stuart C Winter, Winson Wong, Chui-Yan Yip, Kent Yip
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- Journal:
- The Journal of Laryngology & Otology / Volume 138 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 14 March 2024, pp. S1-S224
- Print publication:
- April 2024
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Reducing levels of Violence in the Psychiatric Intensive Care Unit (PICU) - a multidisciplinary quality improvement project
- Zoe Moore, Lynne Pritchard, llana Hamilton
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S210-S211
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Aims
Our aim: To reduce the number of Level 1* violent incidents in Ward 4 by 30% by April 2020
*Level 1 is defined as “Behaviour involving force, which causes or is intended to cause physical harm to others; but excludes assault on objects, threats or verbal abuse”
Ward 4 is Belfast Health and Social Care Trust's only PICU, with a total of 6 beds. Our project took place on the background of a recent move to a new purpose-built inpatient unit, as well as a trust-wide initiative to address levels of violence across inpatient psychiatry services.
MethodWe divided our project into 3 main areas:
Patient factors
Staff factors
Environmental factors
We identified and implemented a number of change ideas, using Plan-Do-Study- Act methodology, regularly meeting to review progress and plotting our data on a run chart.
Key patient interventions included a “Mutual Respect” exercise and regular “Community Meetings”.
Staff interventions included use of Safety Crosses, Daily Safety Briefings and the Broset Violence Checklist (BVC).
Environmental factors were continually assessed and escalated as appropriate.
We raised awareness of our project and gained feedback by creating a dedicated notice board, providing a staff information session and including it as an agenda item at ward meetings.
Our project measures were identified as:
Outcome: Number of level 1 violent incidents occurring per week
Balancing: Number of incidents in other categories; Patient satisfaction
Process: Staff safety rating; Engagement with interventions
ResultUnfortunately, we were unable to meet our initial goal and there continued to be considerable variation in the number of weekly incidents.
We believe this was attributable to several factors, including the level of acuity within the ward during the project timeframe. It was noted that a relatively small number of patients contributed to a large proportion of the total incidents. Our results, therefore, did not reflect the success of interventions with other patients on the ward.
Despite this, we noted improvements in terms of patient and staff engagement with the project, including subjective reports of staff safety during shifts.
ConclusionThe unpredictable and complex nature of the PICU setting cannot be under-estimated and this ultimately impacted on achieving our intended outcome.
We do feel, however, that the project has had a positive impact and we hope we can build on this progress over the coming months.
Further interventions are being explored, including personalised daily activity schedules and attempts to reduce levels of continuous observations.
Peer mentoring in psychiatry: a trainee-led initiative
- Zoe Moore, Linda Irwin, Stuart Brown, Julie Anderson, Stephen Moore
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S149
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Aims
Our aim was to establish a Peer Mentoring Network within Psychiatry Training in Northern Ireland.
Recognising that starting a new job can be a stressful time in any junior doctor's career, we wanted to ensure that new Core Trainees (CT1s) joining our Specialty Programme were well supported through this transition.
Although Clinical and Educational Supervision is well established in providing a support structure for trainees, we believed that a peer mentoring relationship, (with allocation of a Higher Psychiatry Trainee as mentor), would be of additional benefit.
It was hoped that the scheme would prove mutually beneficial to both mentee and mentor.
MethodWe delivered a presentation at CT1 induction and sent out follow-up emails to encourage participation. Higher trainees were also sent information via email and asked to complete a basic application form if interested in becoming a mentor. Prospective mentors then attended a one-day training session.
Two lead mentors, (also higher trainees), were allocated to oversee the scheme, with additional supervision from two lead Consultants. Mentor-Mentee matches were made based on information such as location, sub-specialty affiliations and outside interests.
Matched pairs were advised about the intended frequency and nature of contacts. Check-in emails were sent halfway through the year and feedback evaluations completed at the end.
Result95% of trainees who completed the evaluations said they would recommend the scheme to colleagues.
Mentees reported benefits in terms of personal and professional development, whilst mentors reported improved listening, coaching, and supervisory skills.
A small number of trainees highlighted that 6 monthly rotations impacted on ability to maintain face to face contacts.
Recruitment and engagement have improved annually. We are currently running the third year of the scheme and have achieved 100% uptake amongst CT1s and are over-subscribed with mentors, (19 mentors to 13 mentees).
ConclusionThe majority of feedback received has been positive and interest in the scheme continues to grow.
Potential issues relating to location of postings has been overcome, at least in part, by recent changes to ways of working and the use of alternative forms of contact, such as video calling.
Having exceeded demand in terms of mentor recruitment, we hope to extend the scheme to include trainees of other grades, and particularly those who are new to Northern Ireland.
We are excited to see where the next stage of our journey takes us and hope that others will be inspired to embark on similar schemes within their areas of work.
Reducing the use of oral psychotropic PRN medication in acute mental health inpatients
- Zoe Moore, Rachel Morrow, Meta McGee
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S210
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Aims
Project aim:
To reduce the use of oral psychotropic PRN* medication on Ward 3 AMHIC (Acute Mental Health Inpatient Centre) by 20% by May 2020
(*PRN = Pro re nata/As required)
On Ward 3, we identified a number of unintended negative consequences of PRN medication to both patients and staff.
These included issues with over-use, dependence and side effects; as well as loss of staff ownership and challenging interactions with patients, (including escalation to aggression).
Following the success of our Child and Adolescent Mental Health Inpatient colleagues in this area, we decided to embark on a project to change practice within our ward.
MethodIn order to quantify the problem, we first collected baseline data on current use of psychotropic PRN medication.
As a multidisciplinary project team, we then brainstormed potential contributory factors and displayed these visually as a driver diagram.
This divided our project into 3 main areas:
1) Safe prescribing
2) Safe administration,
3) Safety culture.
Outcome: Number of doses of oral psychotropic PRN medication administered per week
Balancing: Violent incidents; IM administrations of psychotropic medication
Process: Time taken to complete interventions; Patient and staff satisfaction. Change ideas were selected and implemented sequentially, using Plan-Do-Study- Act methodology.
These included:
1) Weekly review of PRN prescribing
2) Nursing administration sheet
ResultBy the end of May 2020, we had exceeded our initial goal, reducing the weekly median number of doses of oral psychotropic PRN medication administered by over 30%.
Our balancing measures remained stable and we gained useful insights and development ideas from a staff survey.
Further change ideas were planned for implementation over the months that followed, however, the impact of the COVID-19 pandemic meant that the project lost some momentum.
ConclusionDespite running into some difficulty over recent months, the team remain motivated to maintain and build upon our previous success.
In the past few weeks, “Calm Cards”, (a patient-centred intervention promoting use of individualised alternative coping strategies), have been introduced.
We hope that the outcomes of this intervention will be positive, both in terms of further reducing use of PRN medication and encouraging development of skills which can be utilised beyond the hospital environment.
We also intend to share our learning with colleagues and explore the possibility of introducing the project to other wards within the hospital.
Contributors
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- By Saleh H. Alwasel, Susan P. Bagby, David J. P Barker, Richard Boyd, Robert Boyd, Graham Burdge, Graham J Burton, Anthony M Carter, Irene Cetin, Zoe Cole, Cyrus Cooper, Hilary Critchley, Elaine Dennison, Susie Earl, Johan G Eriksson, Caroline H. D Fall, Anne C. Ferguson-Smith, Tom P. Fleming, Alison J. Forhead, Abigail L. Fowden, Dino Giussani, Laura Goodfellow, Nicholas Harvey, Christopher Holroyd, Joan Hunt, Alan A. Jackson, Thomas Jansson, Eric Jauniaux, Rosalind John, Eero Kajantie, Michelle Lampl, Karen Lillycrop, Charlie Loke, Samantha Louey, Per Magnus, Ashley Moffett, Lorna G. Moore, Terry Morgan, Clive Osmond, Perrie F. O'Tierney, Robert Pijnenborg, Lucilla Poston, Theresa L. Powell, Elizabeth J. Radford, Tessa J. Roseboom, Amanda Sferruzzi-Perri, Colin P. Sibley, Gordon C. S. Smith, Emanuela Taricco, Kent Thornburg, Benjamin Tycko, Owen R. Vaughan, Lisbeth Vercruysse
- Edited by Graham J. Burton, David J. P. Barker, Ashley Moffett, Kent Thornburg
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- Book:
- The Placenta and Human Developmental Programming
- Published online:
- 04 February 2011
- Print publication:
- 16 December 2010, pp vii-x
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The effect of tea on iron and aluminium metabolism in the rat
- Susan J. Fairweather-Tait, Zoe Piper, S. Jemil A. Fatemi, Geoffrey R. Moore
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- Journal:
- British Journal of Nutrition / Volume 65 / Issue 1 / January 1991
- Published online by Cambridge University Press:
- 09 March 2007, pp. 61-68
- Print publication:
- January 1991
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Weanling male Wistar rats were fed for 28 d on a semi-synthetic diet containing normal (38 μg/g) or low (9 μg/g) levels of iron. They were given water or tea infusion (20 g leaves/I water) to drink. Two further groups were given a normal- or low-Fe diet containing added tea leaves (20 g/kg diet). At the end of the study period, all rats given the low-Fe diet were severely anaemic, as assessed by haemoglobin, packed cell volume and liver Fe. Those given tea or the diet with added tea leaves showed a greater degree of Fe depletion. The blood and liver aluminium levels were not increased as a result of consuming tea or tea leaves, despite the higher Al intakes. Fe deficiency per se had no effect on Al absorption or retention from tea. It was concluded that the Al in tea was very poorly absorbed but that tea, either in the form of an infusion or as tea leaves, had an adverse effect on Fe status