Trauma-informed prevention programmes for depression, anxiety, and substance use among young people: protocol for a mixed-methods systematic review.

BACKGROUND: Mental ill-health and substance use bear a substantial burden and harm on young people and often arise from co-occurring and compounding risk factors, such as traumatic stress. Trauma-informed prevention of mental ill-health and substance use demonstrates significant promise in reducing this burden. A systematic literature review is required to identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental ill-health and/or substance use prevention programmes for young people aged 12-24 years. METHODS: MEDLINE, Embase, CINAHL, PsychINFO, and Cochrane Library will be searched from 2012 through September 2022. Reference lists of included articles will be citation-chained. Title and abstracts will be screened and two reviewers will review articles full-text. One reviewer will extract data from eligible articles using a piloted data extraction form, and 20% of the data will be verified by a second reviewer. Risk of bias will be assessed using the Cochrane risk-of-bias tool for randomised trials (RoB 2), Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I), and The Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (CASP), depending on the study type. Characteristics of existing trauma-informed mental ill-health and/or substance use prevention programmes for young people will be summarised narratively. Effectiveness, feasibility, and acceptability will be qualitatively described and summarised, with proportions and effect sizes quantitatively synthesised, where possible. DISCUSSION: Trauma-informed approaches to prevention demonstrate significant promise, yet to date, no study has systematically summarised and synthesised the available literature. To fill this gap, the present review will systematically identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental health and/or substance use prevention programmes for young people aged 12-24. This review will inform the development, adaptation, evaluation, and implementation of future trauma-informed mental ill-health and substance use prevention programmes for young people. Findings will inform critical efforts to interrupt and prevent already elevated trajectories of mental ill-health, substance use, and related harms among those young people exposed to adversity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022353883.

Future Research by the Australian Chiropractic Profession: Analysis of Comments and Suggestions From a Nationwide Survey of Academics and Practitioners.

OBJECTIVE: The purpose of this study was to identify and compare the research priorities of Australian practicing chiropractors and academics across listed research domains and to seek their views on existing chiropractic research strategies. Concurrent objectives were to gain insight into the perspectives on characteristics of research and solicit ideas and suggestions for future research from both groups. METHODS: This study used a mixed-method research design to collect data using an online survey portal. Australian chiropractic academics (n = 220) and practicing chiropractors who were also members of a nationally representative, practice-based research network database (n = 1680) were invited to participate. Data were collected (February 19, 2019, to May 24, 2019). The free-text data were analyzed primarily via semantic coding and verbatim referential units in cases where the category was an exact match for the textual data. Content analyses of the qualitative data were presented in a tabulated and narrative manner as identified domains. Selected representative examples were provided verbatim. RESULTS: The response rate for the survey was 44% for full-time equivalent academics, 8% for casuals and part-time chiropractic academics, and 21.5% for Australian Chiropractic Research Network database chiropractic practitioners. Open-text data comprised a narrower focus on musculoskeletal (MSK) conditions and opposition or reservations by academics and some practitioners toward the research agenda of those espousing traditional concepts and terminology. Comments from both groups illustrate the strongly held views that characterize divergent factions of the chiropractic profession. Some practitioners were highly critical of the narrow focus and epistemological paradigm of Australian university-based research, while others were strongly supportive of the traditional focus of the Australian Spinal Research Foundation. Australian academics at the 4 university-based programs held the view that MSK and spinal pain, for which some evidence already exists, should be the priority of future research, building on what is known. Practitioners believed that future research should be directed toward expanded areas such as basic science, younger populations, and non-MSK conditions. Respondents were sharply divided on attitudes toward traditional chiropractic terminology, concepts, and philosophy and the utility of future research on these topics. CONCLUSION: Our qualitative findings suggest there is a division in the Australian chiropractic profession regarding research direction and priorities. This divide exists between academics and researchers and within field practitioners. This study highlights the attitudes, opinions, and perceptions of important stakeholder groups, which should be considered by decision-makers when formulating research policy, strategy, and prioritization of funding.

IL-15 Superagonist NAI in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer.

BACKGROUND: Patients with Bacillus Calmette­Guérin (BCG)­unresponsive non­muscle-invasive bladder cancer (NMIBC) have limited treatment options. The immune cell­activating interleukin-15 (IL-15) superagonist Nogapendekin alfa inbakicept (NAI), also known as N-803, may act synergistically with BCG to elicit durable complete responses (CRs) in this patient population. METHODS: In this open-label, multicenter study, patients with BCG-unresponsive bladder carcinoma in situ (CIS) with or without Ta/T1 papillary disease were treated with intravesical NAI plus BCG (cohort A) or NAI alone (cohort C). Patients with BCG-unresponsive high-grade Ta/T1 papillary NMIBC also received NAI plus BCG (cohort B). The primary end point was the incidence of CR at the 3- or 6-month assessment visit for cohorts A and C, and the disease-free survival (DFS) rate at 12 months for cohort B. Durability, cystectomy avoidance, progression-free survival, disease-specific survival (DSS), and overall survival were secondary end points for cohort A. RESULTS: In cohort A, CR was achieved in 58 (71%) of 82 patients (95% confidence interval [CI]=59.6 to 80.3; median follow-up, 23.9 months), with a median duration of 26.6 months (95% CI=9.9 months to [upper bound not reached]). At 24 months in patients with CR, the Kaplan­Meier estimated probability of avoiding cystectomy and of DSS was 89.2% and 100%, respectively. In cohort B (n=72), the Kaplan­Meier estimated DFS rate was 55.4% (95% CI=42.0% to 66.8%) at 12 months, with median DFS of 19.3 months (95% CI=7.4 months to [upper bound not reached]). Most treatment-emergent adverse events for patients receiving BCG plus NAI were grade 1 to 2 (86%); three grade 3 immune-related treatment-emergent adverse events occurred. CONCLUSIONS: In patients with BCG-unresponsive bladder carcinoma in situ and papillary NMIBC treated with BCG and the novel agent NAI, CRs were achieved with a persistence of effect, cystectomy avoidance, and 100% bladder cancer­specific survival at 24 months. The study is ongoing, with an estimated target enrollment of 200 participants (Funded by ImmunityBio.)

Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic.

Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.

Trends in repeat general anaesthesia for treatment of dental caries at a children's hospital in Toronto, Canada: a 10-year retrospective investigation.

BACKGROUND: Treatment of early childhood caries (ECC) under general anaesthesia (GA) was the most common day surgical procedure performed for preschool children in Canada. Evidence with regard to the rate of repeat GA for dental care for Canadian Children is limited. AIM: To determine the rate of repeat dental caries treatment performed under GA over a 10-year period and to assess the relationship between the frequency of repeat dental treatment under GA and medical comorbidities. DESIGN: This was a retrospective assessment of the dental records of 973 children who required repeat dental treatment under GA over a 10-year period. The rate of repeat dental treatment under GA was calculated. A Chi-square analysis was performed to determine associations between medical comorbidities and the frequency of repeat dental treatment under GA. RESULTS: The rate of repeat dental treatment under GA over a 10-year period was 10.8%. The yearly repeat rate and simple moving 5-year rate of repeat dental treatment under GA increased. Having a medical comorbidity was not associated with repeat dental treatment under GA. CONCLUSIONS: The rate of repeat dental treatment under GA was consistent with the rates reported in the dental literature and increased over the 10-year period.

Risk factors for complications and implant loss after prepectoral implant-based immediate breast reconstruction: medium-term outcomes in a prospective cohort.

BACKGROUND: Prepectoral implant-based breast reconstruction with acellular dermal matrix has become an increasingly popular option for selected patients. There are no randomized data to demonstrate short- or long-term outcomes. Cohort studies to date have demonstrated safety, but risk factors for complications are unknown. METHODS: A prospective cohort study of all patients undergoing prepectoral implant-based breast reconstruction between 2013 and 2019. Clinical factors and those related to reconstruction were analysed in relation to complications and implant loss using univariable and multivariable logistic regression. RESULTS: A total of 469 reconstructions were undertaken in 289 women; the majority of reconstructions were performed using a one-stage direct-to-implant technique with acellular dermal matrix. Median follow-up was 21 (range 2-71) months. Minor complications were seen after 11·2 per cent of reconstructions, major complications after 5·9 per cent, and the rate of implant loss by 3 months was 3·1 per cent. In the final multivariable model, sentinel node biopsy (odds ratio (OR) 5·06, 95 per cent c.i. 2·00 to 12·80), axillary clearance (OR 6·67, 1·17 to 37·94) and adjuvant radiotherapy (OR 7·11, 1·60 to 31·61) were independent risk factors for development of a major complication, and sentinel node biopsy (OR 4·32, 1·23 to 15·22) for implant loss. CONCLUSION: Prepectoral implant-based breast reconstruction has acceptable medium-term results but careful patient selection is advised.

Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

PURPOSE: We present final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor therapy (Rezum™) for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 197 subjects >50 years of age with International Prostate Symptom Score ≥13, maximum flow rate ≤15 ml/second and prostate volume 30 to 80 cc were randomized and followed for 5 years. From the control arm of 61 subjects, a subset of 53 subjects requalified and after 3 months received treatment as part of the crossover group and were also followed for 5 years. The total number of vapor treatments to each lobe of the prostate was determined by length of prostatic urethra and included middle lobe treatment per physician discretion. RESULTS: Significant improvement of lower urinary tract symptoms was observed at <3 months post-thermal therapy, remaining durable through 5 years in the treatment group (International Prostate Symptom Score reduced 48%, quality of life increased 45%, maximum flow rate improved 44%, Benign Prostatic Hyperplasia Impact Index decreased 48%). Surgical re-treatment rate was 4.4% with no reports of device or procedure related sexual dysfunction or sustained de novo erectile dysfunction. Results within the crossover group were similar through 5 years. CONCLUSIONS: Minimally invasive treatment with water vapor thermal therapy provides significant and durable symptom relief as well as flow rate improvements through 5 years, with low surgical re-treatment rates and without impacting sexual function. It is a versatile therapy, providing successful treatment to obstructive lateral and middle lobes.

Neutrophil-Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer.

AIMS: The neutrophil-lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. MATERIALS AND METHODS: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. RESULTS: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06-2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49-3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5-3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76-4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). CONCLUSION: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

The Benefits Experience by Families Participating in the Watersports Inclusion Games.

Aims The Watersports Inclusion Games (Inclusion Games) is a free event for children and families with disability to participate in water-based activities. Family participation in physical activity can improve mental health and confidence in children with disability. This study aims to gain an insight into the benefits and barriers of participation, perceived by parents and carers. Methods After an initial literature review, an online pre-event and post-event survey was constructed via SurveyMonkey. Both surveys were circulated three times to attendees. Statistical and thematic analysis was carried out to compare changes in responses both before and after the event. Results 49% of participants were primarily hoping to experience a new sport in a controlled environment and meet others with similar challenges. The surveys also highlighted an increase in reported family bonding [P=0.14] due to the event. A thematic analysis revealed event organisation and planning is vital for effective participation of children with disability. Conclusion Creating an equal opportunity for young people with disabilities and their families to partake in watersports led to increased confidence and a higher likelihood of future participation. Effective organisation and extra help were key enabling factors facilitating these benefits.

Predicting the Risk of Disease Recurrence and Death Following Curative-intent Radiotherapy for Non-small Cell Lung Cancer: The Development and Validation of Two Scoring Systems From a Large Multicentre UK Cohort.

AIMS: There is a paucity of evidence on which to produce recommendations on neither the clinical nor the imaging follow-up of lung cancer patients after curative-intent radiotherapy. In the 2019 National Institute for Health and Care Excellence lung cancer guidelines, further research into risk-stratification models to inform follow-up protocols was recommended. MATERIALS AND METHODS: A retrospective study of consecutive patients undergoing curative-intent radiotherapy for non-small cell lung cancer from 1 October 2014 to 1 October 2016 across nine UK trusts was carried out. Twenty-two demographic, clinical and treatment-related variables were collected and multivariable logistic regression was used to develop and validate two risk-stratification models to determine the risk of disease recurrence and death. RESULTS: In total, 898 patients were included in the study. The mean age was 72 years, 63% (562/898) had a good performance status (0-1) and 43% (388/898), 15% (134/898) and 42% (376/898) were clinical stage I, II and III, respectively. Thirty-six per cent (322/898) suffered disease recurrence and 41% (369/898) died in the first 2 years after radiotherapy. The ASSENT score (age, performance status, smoking status, staging endobronchial ultrasound, N-stage, T-stage) was developed, which stratifies the risk for disease recurrence within 2 years, with an area under the receiver operating characteristic curve (AUROC) for the total score of 0.712 (0.671-0.753) and 0.72 (0.65-0.789) in the derivation and validation sets, respectively. The STEPS score (sex, performance status, staging endobronchial ultrasound, T-stage, N-stage) was developed, which stratifies the risk of death within 2 years, with an AUROC for the total score of 0.625 (0.581-0.669) and 0.607 (0.53-0.684) in the derivation and validation sets, respectively. CONCLUSIONS: These validated risk-stratification models could be used to inform follow-up protocols after curative-intent radiotherapy for lung cancer. The modest performance highlights the need for more advanced risk prediction tools.

Trends in Mental Health Presentations to a Paediatric Emergency Department.

Aims This study aimed to analyse trends in mental health presentations to the Emergency Department (ED), which anecdotally had increased over the past decade. Methods The ED's electronic 'Symphony' system was used to identify the annual number of presentations categorised as having a mental health complaint from 2006-2017. A detailed analysis was performed on presentations over a one-year period. Results The number of presentations increased from 69 in 2006 to a peak of 432 in 2016 (526% increase). The overall admission rate was 33.3%(n=99), while 52.5%(n=156) of presentations occurred outside of standard working hours. Similar increases were documented by other ED's worldwide, and the WHO estimate that neuropsychiatric disorders will become one of the top five causes of morbidity, mortality and disability among children by 2020. Conclusion With the number of mental health presentations dramatically increasing, carefully designed and integrated strategies are required to pro-actively tackle this growing epidemic.

SMOOT libraries and phage-induced directed evolution of Cas9 to engineer reduced off-target activity.

RNA-guided endonucleases such as Cas9 provide efficient on-target genome editing in cells but may also cleave at off-target loci throughout the genome. Engineered variants of Streptococcus pyogenes Cas9 (SpCas9) have been developed to globally reduce off-target activity, but individual off-targets may remain, or on-target activity may be compromised. In order to evolve against activity at specific off-targets while maintaining strong on-target editing, we developed a novel M13 bacteriophage-mediated selection method. Using this method, sequential rounds of positive and negative selection are used to identify mutations to Cas9 that enhance or diminish editing activity at particular genomic sequences. We also introduce scanning mutagenesis of oligo-directed targets (SMOOT), a comprehensive mutagenesis method to create highly diverse libraries of Cas9 variants that can be challenged with phage-based selection. Our platform identifies novel SpCas9 mutants which mitigate cleavage against off-targets both in biochemical assays and in T-cells while maintaining higher on-target activity than previously described variants. We describe an evolved variant, S. pyogenes Adapted to Reduce Target Ambiguity Cas9 (SpartaCas), composed of the most enriched mutations, each of unknown function. This evolved Cas9 mutant reduces off-target cleavage while preserving efficient editing at multiple therapeutically relevant targets. Directed evolution of Cas9 using our system demonstrates an improved structure-independent methodology to effectively engineer nuclease activity.

Abnormalities detected at pre-purchase examination of National Hunt racehorses presented at sale.

BACKGROUND: Few studies are available concerning prevalences of abnormalities in the Thoroughbred horse population. OBJECTIVES: Determine the prevalence of commonly observed abnormalities in a National Hunt Thoroughbred population using results of pre-purchase examinations conducted at Thoroughbred sales venues. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Veterinary pre-purchase examination certificates for 13,603 3- and 4-year-old Thoroughbred National Hunt horses from Tattersalls Ireland, Goffs Ireland and Doncaster Bloodstock Sales Ltd. (DBS) Sales were analysed. All conditions noted by the veterinarians were recorded to determine the prevalence of abnormalities. RESULTS: Abnormalities were recorded in 73.6% of horses; 12.0% had abnormalities likely to prejudice their use for racing. Metacarpal/metatarsal exostoses and tarsal-plantar desmitis affected 17.1 and 19.4% of the sample respectively, while 9.9% were found to make abnormal respiratory noises and 5.3% had recurrent laryngeal neuropathy. Age, year of birth and sex significantly affected the prevalence of many abnormalities (P<0.001). The proportions of horses sold differed significantly between horses with and without some abnormalities, with unaffected horses significantly more likely to be sold (e.g., prejudicial findings present vs. non-prejudicial/none, 38.1% vs. 77.6% respectively, P<0.001). A range of abnormalities significantly negatively affected the price at sale (P<0.001). Significantly higher proportions of horses in the lower price categories had multiple abnormalities (P<0.001). MAIN LIMITATIONS: The study consisted only of horses entered into store horse sales and presented for sale. Horses kept for racing or breeding purposes or horses withdrawn prior to the panel veterinary pre-purchase examination were not included. The upper respiratory tract was only examined endoscopically in horses found to have an abnormal respiratory noise. CONCLUSIONS: A large proportion of 3- and 4-year-old Thoroughbred National Hunt horses intended for sale are affected by abnormalities. The prevalence of many abnormalities increases with age and certain abnormalities are viewed negatively by purchasers, affecting sale of the horse and achieved sale price.

Prevalence and presentation patterns of enamel hypomineralisation (MIH and HSPM) among paediatric hospital dental patients in Toronto, Canada: a cross-sectional study.

PURPOSE: The purpose of the study was to determine the prevalence and presentation patterns of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) in the Division of Paediatric Dentistry at The Hospital for Sick Children (SickKids) in Toronto, Canada. METHODS: A cross-sectional study of 429 eligible participants was carried out by nine trained and calibrated examiners. The European Academy of Paediatric Dentists (EAPD) criteria for diagnosis and documentation of MIH and HSPM defects were used. RESULTS: Molar incisor hypomineralisation and HSPM prevalence was 12.4% and 5.2%, respectively. Regarding MIH, the affected molars and incisors attributed to 5.6% of the total prevalence, the remaining having only molars affected. Demarcated white opacities were most common in MIH (60%) and HSPM (67%), followed by yellow/brown opacities (MIH 22%, HSPM 9%), post-eruptive breakdown (MIH 8%, HSPM 24%), atypical caries (MIH 6%, HSPM 0%), and atypical restorations (MIH 4%, HSPM 0%). In both MIH and HSPM, single surface hypomineralised lesions were significantly more common than multi-surface lesions (p < 0.0001). Most lesions affected buccal enamel (MIH 55%, HSPM 47%). Lesion extension was most frequently less than 1/3 of a tooth surface (MIH 58%, HSPM 67%) and this was significantly more common in teeth affected by HSPM than MIH (p = 0.03). Individuals with HSPM were more likely to present with two affected molars than individuals with MIH (p = 0.03). Hypomineralised second primary molars were not predictive for MIH. CONCLUSIONS: The prevalence of MIH and HSPM was within the range of published studies. The most common MIH and HSPM lesions affected single surface of a tooth, mostly on the buccal surface and were less than 1/3 of the surface area size.

Investigating the appropriateness of physician-ordered diagnostic computed tomography for patient management in a rural hospital in New South Wales, Australia.

AIM: To examine the performance of "appropriate" versus "inappropriate" computed tomography (CT) and to examine whether physicians who practise in a rural hospital in NSW Australia, achieved imaging appropriateness in their ordering of diagnostic CT examinations. MATERIALS AND METHODS: An audit of the electronic medical records of medical ward inpatients (during the 2016/2017 financial year) was carried out. De-identified data were extracted for all patients who had undergone diagnostic CT while on admission. Using the SPSS analytical software, chi-square tests for independence were conducted to check for difference between appropriate and inappropriate CT imaging. RESULTS: Of all the CT procedures, 92% were found to be appropriate. Appropriate CT confirmed the provisional diagnosis in more instances than inappropriate CT (132 versus three). This observed difference was significant with a small size effect (chi-squared [1, n=362]=8.58, p=0.003, φ=0.16). Similarly, appropriate CT significantly facilitated a change in the proposed direction of care (140 versus 40) (chi-squared [1, n=362]=7.75, p=0.005, φ=0.16). In addition, appropriate CT which confirmed diagnosis, resulted in a change in the proposed direction of care as opposed to inappropriate CT (115 versus one; chi-squared [1, n=362]=8.11, p=0.004, Cramer's V=0.24). CONCLUSION: Specialist physicians who practise in a rural hospital setting achieved CT appropriateness. Appropriate CT is beneficial to patient care. Adhering to recommended imaging guidelines is essential for achieving imaging appropriateness.

Caring for Caregivers: An Evaluation of Schwartz Rounds in a Paediatric Setting

Aim To evaluate the views of staff on a multidisciplinary intervention for promoting reflective practice called Schwartz Rounds. Methods The data was collected via an anonymous, opt-in standard feedback form filled in by attendees of Schwartz rounds immediately after they had attended a round. The form contained statements that could be rated using a Likert scale. The rounds were open to all staff in Temple Street Children's University Hospital (TSCUH). The data was quantitatively analysed using SPSS software. A thematic analysis of the free text comments from the standard feedback form was also performed. Results In 95% (n=189) of the returned forms, the statements were all rated positively. A Kruskal-Wallis test (p= .466) showed there was no significant difference between clinical and non-clinical staff in terms of how much they agreed to the statements about the rounds. Conclusion The results showed that there was a positive perception of Schwartz rounds in TSCUH.