Immersive Technologies - The future for tracheostomy education?

Introduction: The need for standardised education on tracheostomy care is well recognised.1 Staff frequently report a lack of confidence in caring for those with tracheostomies, as well as the management of adverse events as they occur.2 Over the past decade, healthcare providers have developed strategies to educate staff, however, the covid-19 pandemic has severely hampered the ability to provide this necessary training due to restrictions on access to training rooms, the need for social distancing and the significant clinical demands placed on both trainers and trainees.3 The potential for immersive technologies to augment healthcare training is gaining interest exponentially.4 However, its effectiveness is yet to be clearly understood and as such it is not yet common within healthcare education.5 Based on the above, we aimed to explore the potential of these immersive technologies to overcome the current challenges of tracheostomy education, and to develop future strategies to use immersive technology in healthcare education. Method(s): We received a 400,000 grant from Cardiff Capital Region (CCR) to undertake a rapid innovation project overseen by the SBRI centre of excellence. The project consisted of 3 main phases: 1) feasibility;2) development;and 3) testing. The project was officially launched in April 2021 and lasted 12 months. Project governance was provided via the SBRI for clinical excellence, a project board with representation from Welsh Government, Cardiff University and Cardiff and Vale UHB, and a project team with clinical expertise in both the delivery of tracheostomy education and the provision of simulation training in healthcare. Result(s): Phase 1: During phase one 4 industries were successful and received up to 30,000 to explore the feasibility of immersive technology to support tracheostomy education. The industries were Rescape, TruCorp, Aspire2Be and Nudge Reality. During the feasibility phase all industries focused on the emergency management process utilising existing NHS Wales tracheostomy education resources and the national tracheostomy safety programme. Phase 2: For phase 2, Rescape and Nudge Reality were chosen to develop the technology. These industries continued to work in conjunction with the project team to capture the core elements of tracheostomy care, including multi-user emergency management scenarios. Additional content was also added for bronchoscopy and insertion of intercostal drains. Phase 3: Testing of both solutions was undertaken over an 8-week period, across 6 Health Boards in NHS Wales. The results of the testing will be analysed and available for presentation in due course. Provision findings demonstrate good face and content validity with high levels of user satisfaction. Discussion / Conclusion(s): The provision of essential tracheostomy education has been severely affected by the covid-19 pandemic. Evolving immersive technologies have the potential to overcome these challenges and improve the effectiveness and efficiency of education packages in tracheostomy care and wider. Through this CCR grant, in conjunction with industry, we have developed two solutions with the potential for widescale procurement and future research on the use of immersive technologies within healthcare.

Developing an aid for virtual clinics for education and identification of lipohypertrophy during the Covid-19 pandemic: Diabetesclinic@ home

Aims/objectives: To develop an app to support virtual diabetes clinics to help people with diabetes to check themselves for lipos and to discuss what they found during the virtual consultation. Method(s): Collaborative project between clinical teams and medical illustrators in Swansea Bay University Health Board, academics in Swansea University and Eli Lilly under a Collaborative Working Agreement. The teams worked together to develop the content, animations, and a learning technologist developed progressive web app (PWA). The app was tested by diabetes patient groups in Wales, as well as HCP groups, Welsh Academy for Nurses in Diabetes (WAND) and Diabetes Specialist Nurses (DSN) forum prior to launch in June 2021. Result(s): Between 28th June 2021 and 11th November 2022 the app had 827 unique users and 124 returning users. Users came from 15 different countries including UK, Australia, USA, Germany, Brazil and Saudi Arabia. The proportion of UK users were 480 (60%) England, 265 (34%) Wales, and 19 (2%) Scotland. A total of 41 users completed the feedback form;of those 11 (27%) did not know about lipos prior to using the app, 11 (27%) found a lipo using the app, 14 (34%) said they made changes to injection technique after using the app and 37 (90%) said their knowledge of lipos increased following using the app. Conclusion(s): A PWA can help to aid virtual clinics an provide education for people with diabetes. The diabetesclinic@ home app improved knowledge and detection of lipos and improved injection technique.

Reviewing in a pandemic? A commentary on COVID-19 and domestic homicide review

PurposeThis paper is a commentary on COVID-19's impact on Domestic Homicide Reviews (DHRs), the system in England and Wales that enables learning from domestic abuse-related deaths.Design/methodology/approachDrawing on a practitioner–researcher perspective, this paper reflects on how COVID-19 affected the delivery and experience of DHRs, the place of victims at the heart of this process and what the pandemic's impact might mean moving forward.FindingsThis paper explicates some of the challenges of undertaking DHRs in a pandemic. Critically, however, it argues that these challenges illuminate broader questions about the practice of DHR.Originality/valueThis paper's originality comes from the author's practitioner–researcher perspective and its use of COVID-19 as a lens to consider DHRs.

Vaccination status of the adult sickle cell anaemia population: The South Wales experience

The Sickle Cell Society have issued standards for additional immunisations that adults with sickle cell disease (SCD) require. These include annual influenza, 5-yearly pneumococcal conjugate vaccine (PPV23) and Hepatitis B vaccination. Patients who have not received their primary vaccination as part of the national schedule in the UK should also receive further additional vaccines. We reviewed whether adults with SCD in South Wales currently receive these. 49 adult patients were identified as having SCD under the care of the Hereditary Anaemia Service based in the University Hospital of Wales, Cardiff. GP records were not available for 5 patients leaving a final cohort of 44 patients to analyse. Average age was 33 years (range 17-67). Median age was 27 with the cohort predominantly lying in the 17-29 year category (52%). Results showed good compliance with the annual influenza vaccine in those over 40 (>80%). However, compliance for the 17-29 category and 30-39 categories were 37.5% and 42.8%, respectively. The improved compliance in those >40 was not seen with the 5-yearly pneumococcal vaccine. Compliance was worse in all age groups compared to the annual flu vaccine with only 23% compliance overall. However, when looking at those who had received a single dose of PPV23, the numbers improved to nearly 60%. Compliance with the SARS-CoV2 vaccination was highest at 61.3%. However, rates were lower in the 17-29 and 30-39 age groups in keeping with previous trends. Only 34.1% of patients had full hepatitis B cover. Again, trends in compliance mirrored previous with poorer rates in those under 40. Assessing compliance for the remainder of the standards was more challenging given that we could not confirm retrospectively how many of our cohort had received their primary vaccinations in other parts of the UK, thought to be around half. However, most of the cohort had not received any additional vaccines suggesting high non-compliance regardless. This review looked at data from 2020 and likely reflects the impact of the SARS-CoV2, whether positive or negative. The reduced compliance in 5-yearly pneumococcal compared to flu suggest better health-professional education is needed;if patients are attending for their annual flu vaccine, there is ample opportunity to administer other vaccines. The vaccination rate for our patient group is comparable to national rates by ethnicity although lower than the national average for age. Vaccination rates for the SCD population of South Wales are not adequate. Better education and engagement is needed.

Tracheostomy care and outcomes during the COVID-19 pandemic- an observational cohort perspective from Cardiff

Introduction: Prior to the COVID-19 pandemic an estimated 5000 surgical and 12000 percutaneous tracheostomies were completed in the UK each year.1 A UK study looking at COVID-19 tracheostomy outcomes found 1605 tracheostomy cases from 126 hospital, median time from intubation to tracheostomy was 15 days while 285 (18%) patients died following the procedure.2 COVID-19 patients also typically spend longer in critical care with prolonged time receiving organ support when compared to patients diagnosed with other viral pneumonias.3 Incidence of laryngeal pathologies are also higher in COVID-19 patients post tracheostomy.4 Objectives: The aim of this observational study was to review the outcomes of patients post tracheostomy insertion during the COVID-19 pandemic compared to non-COVID patients. Method(s): A service evaluation was completed including all patients requiring a tracheostomy since the beginning of the COVID-19 pandemic in March 2020 within University Hospital Wales, Cardiff. Data was captured from local tracheostomy databases. Patients were grouped into either COVID or non-COVID based on their clinical history. The key outcomes evaluated were number of tracheostomies, average time to cuff deflation and decannulation, critical care and hospital length of stay, occurrence of adverse events and time from critical care admission to tracheostomy insertion. Data was evaluated using descriptive statistics using Microsoft ExcelTM. Result(s): During the review period 58 patients with COVID-19 and 158 without required a tracheostomy. In the COVID-19 group cuff deflation occurred at a median of 10 days post insertion compared to 7 days. Decannulation occurred at a median of 16 days in patients with COVID-19 compared to 18 days. The rate of decannulation was also higher in the COVID-19 group at 74.1% compared to 67.1%. Critical care length of stay was 37 days in the COVID-19 compared to 25 days. Time from intubation to tracheostomy was comparable between groups at a median of 16 days for our COVID-19 cohort compared to 15 days. The incidence of clinical incidents was higher in the non-COVID-19 group at 10.1% compared to 5.2%. Conclusion(s): This internal service evaluation has shown that COVID-19 patients typically spend longer in critical care but their time to decannulation was shorter and their rate of decannulation was higher in our cohort then in the comparison group. This could be due to the tertiary neuroscience and major trauma specialities within our Health Board. Both with groups of patients that, due to the nature of their injuries may require prolonged periods of tracheostomy insertion even after critical care discharge.

The "epidemic within the pandemic”: meeting the needs of racially minoritised women experiencing domestic abuse during the Covid-19 pandemic

PurposeIn March 2020, the UK entered its first lockdown responding to the Covid-19 pandemic. In the same month, the Domestic Abuse Bill had its first reading in Parliament. Charities and non-governmental organisations critiqued the Bill for failing to protect migrants from domestic abuse, and not complying with the Istanbul Convention. Drawing on interviews with staff from Southall Black Sisters, this paper aims to foreground the experiences of practitioners within the women's sector to explore the unique experiences and challenges migrant and racially minoritised women encountered when seeking support from domestic abuse during the Covid-19 pandemic. It highlights how the pandemic-related lockdowns created barriers to accessing support services and housing, creating an epidemic within the pandemic, and how minoritised women and the organisations that supported them had to overcome structural barriers and racism.Design/methodology/approachIn-depth semi-structured interviews were conducted with staff from a leading women's organisation that supports migrant and racially minoritised women. Four participants were asked questions within four themes: domestic abuse before and during the pandemic;accessing support from and reporting domestic abuse;accessibility of resources;and post-pandemic challenges. A phenomenological approach was used to analyse the transcribed interviews.FindingsParticipants consistently highlighted the unique threats and barriers migrant and racially minoritised women faced when seeking support. Barriers included racism, language barriers, cultural constraints, the triple threat of destitution, detention, deportation, and political resistance to protect migrant women from destitution/homelessness.Originality/valueThis paper provides a unique insight into the experiences of staff members within a specialist by and for women's support organisation in England and their perspectives on the barriers racially minoritised and migrant women experienced during the Covid-19 pandemic. It offers rare insights into how service users' needs changed during the lockdowns and how the pandemic affected their ability to operate.

Rehabilitation needs after critical illness: Referral outcomes from a ICU follow up clinic in Northern Ireland

Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.

Performing the City: Space, Movement, and Memory in O Ben'Groes at Droed Amser

In considering some of the aspects that are brought to the site-specific process, this article explores how theatre renegotiates patterns of intraurban movement, enacting complex approaches to space and memory. The focus is on O Ben'Groes at Droed Amser, a Theatr Genedlaethol Cymru and National Theatre Wales production, created in collaboration with BBC Cymru Wales and BBC Arts in 2020 as part of Theatr Genedlaethol Cymru's new programme in response to the COVID-19 emergency and the challenge of creating original dramatic work during lockdown. By allowing virtual audiences to join author and poet Karen Owen on a bus journey from her home and the street where she grew up to Bangor city centre, the production articulated the experience of the city in terms of individual and collective memory, bringing together issues of performance, representation, history, and heritage to reveal alternative layers to the reality of the urban landscape. Memory, I argue, emerged from this production as a performative construct open to renegotiation through a range of present relationships to landscape. In addition to this, the production also offered an alternative to the privileged figure of the walker, performing a subversion of codified patterns of movement.

Culture dose for kids: Impact of arts engagement on 9- 12 year-olds with anxiety

There is growing momentum to understand the value of the arts in mental health and wellbeing. Engagement with the arts can promote wellbeing by helping to build resilience, aid recovery and foster social connections. Aim(s): To co-develop, implement and evaluate the impact of Culture Dose for Kids (CDK), an arts engagement program, on young people's anxiety. Method(s): Mixed methods [surveys and interviews] were used to research an 8-week series of face-to-face arts engagement sessions conducted at the Art Gallery of New South Wales with anxious youth (9-12 years) and their parents/carers. Result(s): Findings indicate that the children's anxiety scores decreased over the eight-week program. Sustained high attendance rates throughout were another marker of its effectiveness and engagement, although a COVID outbreak affected several sessions. Qualitative data, from parent and children's interviews, offered greater insight and meaning into CDK's impact on the child and family. Not only did parents find CDK calming and stress-relieving for themselves ('a little gift of time'), but they said that they are using some strategies and topics from the sessions to connect more closely with their child and their child's issues. By engaging both parent and child in this inclusive, non-stigmatizing arts-based mental health intervention, a more holistic, family-centred, community approach to supporting wellbeing occurred. Conclusion(s): This study responds to the recent call to move beyond the formal mental health system to facilitate community-led initiatives and infrastructure to strengthen young people's overall mental health and well-being and their social connections and involvement with their community.

The Unintended Consequences of COVID-19 Economic Responses on First Home Buyers? Evidence from New South Wales, Australia

As in many other nations, the Australian Government implemented monetary and fiscal policies in response to the COVID-19 pandemic to aid economic recovery. Among these policies were specific measures to assist first home buyers (FHBs) in entering the housing market. However, these unprecedented economic policies might have other direct and indirect implications on FHBs, which have yet to be thoroughly explored in the literature. To fill this gap, through a survey, we collected information via public and online mortgage broker platforms from 61 FHBs who successfully entered the housing market or were actively searching during the pandemic. The results found COVID-19 economic responses counterproductive for FHBs, pushing them to a more disadvantaged position due to an overheated property market. In addition, since the onset of the pandemic, property prices have risen significantly, exacerbating housing inequality as FHBs increasingly rely on intergenerational family support, take on more financial risk, and relocate to regional areas due to fear of missing out. The study highlights the need for macroeconomists and housing policymakers to consider these unintended consequences in formulating policies that minimise the adverse effects of economic stimulus measures.

England's health policy response to covid-19

Government prioritised the NHS but was slow to protect social care

Type 1 diabetes and environment . . . and other stories

A linked ecological analysis of environmental and demographic variables identified several factors, including poor air quality, outdoor light at night, and higher population density that were negatively associated with the incidence of diabetes (Diabetologia doi:10.1007/s00125-020-05087-7). A case-control study using a database of people known to have autoimmune disease raises anxiety about central nervous system inflammatory events (JAMA Neurol doi:10.1001/jamaneurol.2020.1162). A history of exposure to TNF inhibitors carried a threefold increase in risk both of demyelinating diseases, such as multiple sclerosis and optic neuritis, and of non-demyelinating conditions, such as encephalitis, neurosarcoidosis, and vasculitis.

Real-World Single-Centre Experience of Jak Inhibitor Use in Ra

Background/Aims The use of Janus Kinase Inhibitors (JAKi) has been gradually increasing overtime in the management of rheumatoid arthritis (RA) and other inflammatory arthritis and these appeal to patients. being oral agents. Nevertheless, rheumatologists have become cautious about their use since recent trials have shown safety concerns about VTEs, MACE and malignancies. Methods We decided to study use of JAKi at our centre in Princess of Wales Hospital Bridgend. The aim was to assess whether appropriate patients were selected (considering cautions about MACE, VTEs and malignancies). We also wanted to see whether all patients had required pretreatment safety testing and post-treatment monitoring performed. Results These were 70 patients;59 were females and 11 were males. All of them were diagnosed as RA. Average age was 61.1 years (20-85), average duration of disease 129.9 months (16-340) and average duration of treatment was 58.1 weeks. The most common JAKi being used was baricitinib (84%) followed by tofacitinib (12%) and upadacitinib (4%). 50% patient were on concomitant csDMARDs among whom two-thirds were on methotrexate. Looking at previous biologic use, 9 patients were biologic naive, 22 had one biologic, 15 had two biologics used in the past. All patients were appropriately selected (severe RA and no significant risk factors for MACE, VTEs and malignancies). All patients had pre-treatment Hepatitis B, Hepatitis C, latent TB, FBC and LFTs checked. All patients had FBC and LFTs monitored post treatment. No patient developed VTE, MACE or cancer on treatment. 84.2% patients had lipids tested before starting JAKi. 22.8% patients had abnormal lipids before Rx initiation and 62.5% of these were on lipid lowering Rx. All patients had lipids tested post treatment, but the timing was quite variable and only 62.5% of patients had lipids tested on the recommended time. There were 2 deaths recorded in this cohort. One of those was an 80-year-old RA patient on baricitinib 2mg OD, who died due to chest infection on the background of ILD. He was not on steroids or csDMARDs. The second patient was 63 years' old (on baricitinib 4mg OD), and died due to respiratory sepsis, and was also on azathioprine. She had RA with advanced ILD. The reasons for discontinuing JAKi were inefficacy (46%), side effects (39%) and both inefficacy and side effects (15%). 41.4%of patient experienced side effects due to JAKi. These included infection 28%, deranged lipids 17%, cytopenia 14%, deranged LFTs 14%, GI side effects 10%, skin rash 7% and varicella zoster 3%. Conclusion There has been steady increase in the use of tsDMARDs for RA and other rheumatic conditions. Due to short half-life, these drugs became a popular choice during COVID-19 pandemic but on the other hand safety monitoring became extremely challenging during this time.

Management of Adults with Systemic Lupus Erythematosus (Sle) in 2021: A Multi-Centre Audit within Wales as Part of an Ongoing Quality Improvement Exercise

Background/Aims Significant changes to working practices within rheumatology have occurred since the beginning of the COVID-19 pandemic: virtual consultations have now become commonplace. This audit was undertaken as part of ongoing quality improvement work to assess the standards of care provided to patients with SLE attending rheumatology departments across Wales. Care was audited against the standards outlined in the 2018 British Society of Rheumatology guideline for the management of adults with SLE. Results were compared with the previous multi-centre audits of SLE care in Wales and the UK. We were interested to see whether changes to working practices had significantly affected the care of patients with SLE across Wales. Methods Rheumatology services in Wales were invited via email to participate. Data collection occurred between June and August 2021. Data was collected via online questionnaire, held securely by the Dudley Group NHSFT. Unit questionnaires were submitted by a lead clinician in each centre. Five centres across Wales submitted data from 62 clinical encounters with patients with SLE. Result(s): Conclusion Results of this multi-centre audit do not demonstrate any widespread significant changes in care for patients with SLE in Wales between 2019 and 2021, despite 48% of consultations audited being undertaken virtually. Blood pressure and urinalysis were not consistently measured in 2021, likely secondary to the increased prevalence of virtual consultations. Group education has been undertaken as to the importance of facilitating observations in the virtual environment and centres have shared their experiences of how they tackle this challenge locally. (Table Presented).

Bridging theory and practice in the humane entrepreneurship domain: insights from small and medium Italian enterprises

PurposeHumane entrepreneurship (HumEnt) has been theoretically proposed as a new model of entrepreneurship supporting the idea of an enlarged entrepreneurial strategic posture. The aim of paper is to frame humane entrepreneurial orientation's (HEO) characteristics by showing how firms apply the HumEnt approach, and to offer suggestions to build an HEO measurement scale.Design/methodology/approachThe study adopts a case study approach, focusing on five Italian small and medium enterprises (SMEs).FindingsThe study (1) identifies which are the characteristics of HEO strategic posture in the enterprises under examination;(2) shows that entrepreneurs' personal values and credos are fundamental to having an HEO strategic posture adopted;(3) provides indications on the development of a measurement scale through a discussion of emerging HEO themes.Originality/valueThe value of the study is that emerging themes of HEO strategic posture was derived from the analysis of five Italian SMEs. Entrepreneur's personal values have been proven to be relevant in the implementation of HEO. Based on the emerging HEO themes, the study contributes to the literature opening the way toward the building of an all-encompassing HEO measurement scale.

FEASIBILITY of LINKING UNIVERSAL WELL-CHILD HEALTHCARE and FINANCIAL COUNSELLING: FINDINGS from the AUSTRALIAN HEALTHIER WEALTHIER FAMILIES (HWF) PILOT RANDOMISED CONTROLLED TRIAL

Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.

Ethnic and gender trends at the annual British Association of Urological Surgeons (BAUS) meeting: A review of BAUS programmes over a 13-year period (2009-2021)

Objective: In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce. Method(s): To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009-2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually. Result(s): A total of 2569 speakers (range: 135-323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001). Conclusion(s): Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias. Level of Evidence: Not applicable.Copyright © British Association of Urological Surgeons 2022.

IMPLEMENTATION INSIGHTS from SITE CHAMPIONS and STATE LEADS POST-ROLLOUT of the SAFER BABY BUNDLE

Background: National rollout of the Safer Baby Bundle (SBB) is recommended by the National Stillbirth Action and Implementation Plan for improving the standard of antenatal care at scale to reduce stillbirth. Progressive implementation over 2.5 years, commenced from mid-2019. This qualitative study aims to understand the process enablers and barriers influencing the effectiveness of SBB implementation. Method(s): Semi-structured interviews with SBB site leads/champions (17 maternity services) and state program leads across Queensland (QLD), Victoria (VIC) and New South Wales (NSW) were conducted post-implementation of SBB to explore local, regional, and state implementation strategies, processes and experiences. Normalization Process Theory was used as an analytic framework for thematic analysis to understand different approaches and contexts for SBB implementation. Result(s): 17 site leads (6 VIC, 5 NSW, 6 QLD) and 6 state program leads were interviewed from Sept to mid-Nov 2022. Findings indicate strong local leadership, shared regional and state-based learning opportunities, consistency of information and endorsement by clinical networks were key implementation supports. Barriers included limitations and inconsistencies across data and information systems, and constraints with protected time for training and improvement activities. High turnover and re-deployment of leads due to external factors (e.g., COVID, extreme weather events) disrupted timelines, impacting commitment and engagement with the initiative. Conclusion(s): Despite differences in resources, approaches, and timelines between sites and states for SBB implementation, similar key barriers and enablers were identified. An in-depth understanding of the factors underpinning successful implementation of the SBB will guide future activities to support sustainable change.

Proceedings of the 6th National Patient Reported Outcome Measures (PROMs) Annual Conference

The proceedings contain 47 papers. The topics discussed include: long COVID rehabilitation services, Cardiff and Vale and Cwm Taf Morgannwg University health boards: social return on investment;the clinical meaning of family reported outcome measure (FROM-16) scores: translational research to support holistic clinical practice;patient-centered outcome measure design: the perspectives and preferences of children and young people with life-limiting or life-threatening conditions;co-creation of a patient reported outcome measure for older people with frailty and acute care needs (PROM-OPAC);PROMs: coming of age in lymphoedema services in Wales;ForMi-person-centered planning and outcomes recording app;true colors online mood monitoring in the bipolar disorder research network (BDRN) research program: challenges, benefits and importance of personalization;patient reported outcome measures for rheumatoid arthritis disease activity: using Rasch measurement theory to achieve more meaningful measurement;developing a roadmap towards national collection of electronic patient-reported outcomes for people with chronic kidney disease in the UK;and measuring bereavement support needs in people bereaved during Covid-19;the adaptation and development of a bereavement support needs scale.