1 An evaluation of burnout amongst defence medical services anaesthesia trainees

IntroductionMultiple studies have found burnout to be the highest amongst Anaesthetists and Intensivists. A recent report by the Royal College of Anaesthetists (RCoA) in 2017 reported a burnout rate of 85% amongst anaesthetic trainees. This project aimed to evaluate following questions:What are the levels of burnout among defence anaesthetic trainees?What are the main causes of burnout among defence anaesthetic trainees?MethodsWe conducted an on-line anonymous survey across all trainees within the military anaesthesia cadre which consisted of the following sections:DemographicsOldenburg Burnout InventoryBaseline Mental Health (PHQ 9 & GAD 7)Stressors (Severity and Frequency)ResultsWhilst the burnout rate appears relatively high at 57.9%, it was comparatively lower against the RCoA report. Army (53%) and RAF (46%) trainees had similar rates of burnout whilst the Navy (76.9%) had notably a higher rate. Gender and seniority did not seem to have an effect on burnout. The findings of this study are more in line with other baseline burnout studies than the RCoA welfare report.ConclusionsThe effect of work on personal/family life and administrative burdens seem to be consistent regardless of burnout status. The perceived degree of workload and staff/resource availability appears to be discriminatory to those labelled low risk potentially mirroring the differences seen between services and highlights potential areas to modify our risk of burnout within our cadre.

PEDAGOGICAL SUPPORT OF COMPULSORY MEASURES OF EDUCATIONAL INFLUENCE ON JUVENILE DELINQUENTS

The article presents the results of an empirical study. The aim of the study is to increase the effectiveness of compulsory measures for juvenile delinquents through the development and implementation of the pedagogical support system of these measures.The urgency of the research is determined by the lack of the scientific and methodological support for the practical implementation of compulsory measures of educational influence on juvenile delinquents; by the low level of the psychological and pedagogical readiness of the subjects of the pedagogical interaction; insufficiency of the pedagogical support as the most important condition of these measures effectiveness. Research methods are pedagogical analysis and synthesis, induction and deduction, comparison and generalization of research results, questionnaires, interviews, individual and group conversations, observation, generalization of independent characteristics, statistical methods of information processing.According to the research aim the system of the pedagogical support of compulsory measures of educational influence on juvenile offenders was developed and tested. It includes organizational and substantial, technological and staff resource components and their interaction, the main directions and ways for increasing of the pedagogical training level of the subjects of the pedagogical interaction. The results of the investigation proved the effectiveness of the pedagogical support system of compulsory measures for juvenile delinquents.

COVID-19 testing in English care homes and implications for staff and residents

Introduction Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. Results Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.

Monitoring Advances Including Consent; Learning from COVID-19 Trials and Other Trials Running in UKCRC Registered Clinical Trials Units During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has affected how clinical trials are managed, both within existing portfolios and for the rapidly developed COVID-19 trials. Sponsors or delegated organisations responsible for monitoring trials have needed to consider and implement alternative ways of working due to the national infection risk necessitating restricted movement of staff and public, reduced clinical staff resource as research staff moved to clinical areas, and amended working arrangements for sponsor and sponsor delegates as staff moved to working from home. Organisations have often worked in isolation to fast track mitigations required for the conduct of clinical trials during the pandemic; this paper describes many of the learnings from a group of monitoring leads based in UKCRC Clinical Trials Unit (CTUs) within the UK.MethodsThe UKCRC Monitoring Task and Finish Group comprising monitoring leads from 9 CTUs, met repeatedly to identify how COVID-19 had affected clinical trial monitoring. Informed consent is included as a specific issue within this paper, as review of completed consent documentation is often required within trial monitoring plans (TMPs). Monitoring is defined as involving on-site monitoring, central monitoring or/and remote monitoring. ResultsMonitoring, required to protect the safety of the patients, the integrity of the trial and ensure the protocol is followed, is often best done by a combination of central, remote and on-site monitoring. However, if on-site monitoring is not possible, workable solutions can be found using only central or central and remote monitoring. eConsent, consent by a third person, or via remote means is plausible. Minimising datasets to the critical data reduces workload for sites and CTU staff. Home working caused by COVID-19 has made electronic trial master files (TMF’s) more inviting. Allowing sites to book and attend protocol training at a time convenient to them has been successful and worth pursuing for trials with many sites in the future.ConclusionsThe arrival of COVID-19 in the UK has forced consideration of and changes to how clinical trials are conducted in relation to monitoring. Some developed practices will be useful in other pandemics and others should be incorporated into regular use.

METHODICAL APPROACHES TO THE FORMATION OF ACCOUNTING AND ANALYTICAL PROVIDING OF ECONOMIC SAFETY OF BUSINESS ENTITIES

Lately there are more and more investigations dedicated to economic safety of business entities, though methodical approaches connected with its accounting and analytical providing are not attended enough. Therefore, the goal was set – to deepen the knowledge about methodical approaches to the forming of accounting and analytical providing of economic security of business entities. To reach this goal the authors clarified the term “accounting and analytical providing of economic security of business entities”, revealed the basic elements, comprising it, functions and methodology of accounting and analytical providing the economic safety of business entities, and developed the conceptual model, where considered the purpose, object, subject and methodology of managing the economic safety of business entity, and also the influence of the surrounding area, different threats of financial, staff, resource and production, informational and other components of economic safety (of outer and inner nature). The term given by the authors and the conceptual model of accounting and analytical providing of economic safety of business entities developed by them, do not pretend on absolute fullness of characteristics of all the aspects and connection between the components of accounting and analytical providing of economic safety of business entities. However, they give the input in further development of theoretical ideas about the essence of the given category and the connection between its components.

THE COMPARATIVE CHARACTERISTICS OF CONTENT OF FUNCTIONS WHICH ARE REALIZED BY UPBRINGING ACTIVITY SUBJECTS IN HIGHER PEDAGOGICAL AND MILITARY EDUCATIONAL ESTABLISHMENTS

The article is devoted to the problem of lack of theoretical, methodological and technological bases of projecting the process of formation servant’s personality who will be working in a state establishment. This process is considered in higher pedagogical and military educational institutions. The list of upbringing members in this institutions is defined (they are the members of a university administration, a dean’s office, the course officers (in military educational establishments), the lecturers, and also students or cadets as persons who are doing self-upbringing). Features of implementation their individual functions are described. Motivation aspects of the object of educational work are discussed in detail. The features of motivational activity in structural units “a university administration – a dean’s office”, “a dean’s office – the course officers”, “the course officers – the cadets” (in military educational establishments), “a dean’s office – the lecturers”, “the lecturers – students or cadets” are particularized. Realization of projecting function on the different levels of the educational system (the creation of provisions for educational work, its concepts, programs, plans and the like that) is investigated. Differences in realization of organizational function of members of upbringing process in the both types of higher education institutions are defined. Distinctive feature regarding staff resource in the two types of educational establishment (the lecturers of pedagogical educational institutions have pedagogical education however the biggest part of their military colleagues does not have it) was emphasized. Attention on the general lines of realization diagnostic (studying conditions of upbringing activity in an institution (a subdivision), readiness to execute it by members of upbringing system, and degree of formation in students (cadets) the personality of a state establishment servicer), prognostic (imagining the expecting result of realization certain upbringing actions, programs, plans, and conception of upbringing work), stimulating (using the encouragement methods to subordinates (who are subjects of upbringing work), students and cadets) and control (realization control actions which are focused on execution the plans and programs of upbringing work) functions is concentrated. The research results will contribute to the construction of educational systems in higher school, which will be oriented to state needs in preparation the pedagogical or military specialist.

Quality and Safety in Anesthesia and Perioperative Care

Quality and Safety in Anesthesia and Perioperative Care offers practical suggestions for improving both quality of care and patient safety in the perioperative setting. The book is divided into two parts: the first on clinical foundations and the second on practical applications, and the chapters emphasize strategies that support reform at all levels, from operating room practices to institutional procedures. Written by leading experts in their fields, chapters are based on accepted safety, human performance, and quality management science, and they illustrate the benefits of collaboration between medical professionals and human factors experts. The book highlights concepts such as situation awareness, staff resource management, threat and error management, checklists, explicit practices for monitoring, and safety culture. Quality and Safety in Anesthesia and Perioperative Care is a must-have resource for those preparing for the quality and safety questions on the American Board of Anesthesiology certification examinations, as well as clinicians and trainees in all practice settings.