Search

Introduction: Effective utilisation of the unregistered support workforce is essential to counter a well-documented imaging workforce crisis, yet it is unclear how imaging departments deploy their support staff. As part of a wider explanatory mixed methods study, this research explored models of support workforce deployment across England, identifying the factors which may encourage or inhibit implementation of these models., Methods: Imaging support workforce deployment at regional and place (NHS Trust) level was investigated using Framework Analysis to combine interviews with Imaging Network representatives and Radiology Service Managers (RSMs) alongside workforce establishment data. Purposefully selected imaging services represented varying regions, sizes and support workforce proportions., Results: Forty-two interviews represented 18 (81.8 %) Imaging Networks, and 24 imaging services (17.5 % eligible NHS Trusts). Additional workforce data was supplied by 18 RSMs. Three themes (Deployment Rationale and Decision-Making, Innovations in Support Workforce Activities, Stability and Sustainability of the Support Workforce) demonstrated the pivotal role enacted by the imaging support workforce. Extensive variations in role utilisation, deployment, scope of practice and pay rates were recognised, alongside inconsistently implemented Assistant Practitioner roles with a limited scope of deployment., Conclusion: This is the first research to explore support workforce deployment at regional and place levels. The imaging support workforce in England is operationally managed rather than strategically planned, exposing services to local variation with deployment models developing in isolation. This pivotal workforce can support greater service capacity development but requires a more consistent approach to utilisation and deployment., Implications for Practice: National alignment of roles and competencies is urgently required. At regional and place levels, deployment models should be interrogated as a first step towards longer term workforce planning for this essential, yet under-utilised, workforce., Competing Interests: Conflicts of interest statement All authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow., Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them., Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties., Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research., Competing Interests: Z. Hamoodi reports research fellowship funding from Royal College of Surgeons, National Joint Registry, and The John Charnley Trust, related to this study. A. Sayers is senior statistician on the HQIP/NJR Lot 2 contract. M. R. Whitehouse is the principal investigator for the HQIP/NJR Lot 2 contract to provide statistical support, analysis and associated services to the NJR, related to this study, and reports multiple grants or contracts from the NIHR and Ceramtec, royalties or licenses from Taylor & Frances, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Heraeus, all of which are unrelated to this study. A. C. Watts reports royalties or licenses and patents planned, issued or pendingfrom Adler, consulting fees from Medartis, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medartis, Stryker, and Arthrex, all of which are unrelated to this study, and is also a member of the editorial boards of the National Joint Registry and The Bone & Joint Journal., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme., Methods: A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model., Results: Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition., Conclusions: The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration.

Introduction: Employer led apprenticeship trailblazer groups develop the occupational standard and end point assessment associated with a particular job or occupation. All degree apprenticeship programmes within England must align to these and for allied health professions, this is a new concept. Exploring stakeholder motivations for being part of the trailblazer groups is essential to inform subsequent curriculum design and implementation for this new model of education., Methods: Eighteen semi-structured interviews were undertaken across the three radiography related (diagnostic, therapeutic and sonography) trailblazer groups using a pragmatic constructivist approach., Results: Strong themes emerged around professional recognition, and conflicts between being 'educated' or 'trained', and between vocational and academic components of radiography training. Even within these pioneer groups there was a lack of understanding around degree apprenticeship programmes and their potential impact upon the workforce. Whilst the benefits on recruitment and retention of staff through widening participation were acknowledged, there were concerns around apprentice pay and mentorship. Evidence of professional protectionism was uncovered, balanced by professional pride and a strong desire for team working within and between institutions., Conclusion: The study highlighted an urgent need for further research and awareness raising for employers and practitioners, prior to implementation of radiography-related degree apprenticeships., Implications for Practice: This is the first evaluation of stakeholder motivations related to the development of degree apprenticeships within the allied health professions. The results and recommendations for practise will inform the imminent implementation of degree apprenticeships for the three radiography related professions, facilitating a smooth transition to apprenticeships for clinical and education departments., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast., Method/design: We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included., Discussion: The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external validity. Accordingly, if significant clinical benefits and cost-effectiveness are demonstrated, EMADE should become a worthwhile treatment option. A larger-scale, multicentre trial may be required to influence national guidelines., Trial Registration: ISRCTN, ID: ISRCTN11212729 . Registered retrospectively on 20 March 2017.

Introduction: Adalimumab is effective in inducing and maintaining response/remission in patients with Crohn's disease either naive to biological therapies or after secondary failure of infliximab., Aim: To present the first 'real-life' survey data from England and Ireland on the use of adalimumab., Method: A retrospective audit conducted through a web-based questionnaire in England/Ireland., Results: We analysed data on 61 patients (35 female, 26 male) with a median age of 33 years (range 17-71 years) and an average follow-up of 8 months. The maximal maintenance dose was 40 mg every other week in 84% of patients, 40 mg weekly in 13% and 80 mg weekly in 3%. Maintenance adalimumab achieved remission in 57% of patients. The ongoing response rate was 83.6%. An additional 8% had a secondary loss of response after an average of 8.4 months (range 2-17). Adverse effects were observed in 23% of patients: of which there was local pain in 29%, infection in 36%, headaches in 14%, leucopenia (on azathioprine) in 7%, a painful rash in 7% and serum-sickness-type reaction in 7%. Adverse events led to discontinuation in two patients., Conclusion: This English/Irish audit shows an acceptable response/remission and safety profile of adalimumab in the treatment of Crohn's disease. In contrast to earlier data from Scotland, dose escalation was only observed in 16% of patients. The majority of responders were steroid-free at follow-up.