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Introduction: The COVID‐19 pandemic impacted the Foundation Programme for doctors in the United Kingdom. Foundation doctors were working under increased pressure and significant changes were made to their training. Aims: The aim of this study is to explore the educational impact the COVID‐19 pandemic had on foundation doctors and to understand how this resulted in doctors choosing to take time away from structured training programmes within the United Kingdom to make up for lost educational opportunities. Methods: In this phenomenological research, semi‐structured interviews were carried out with post‐foundation doctors who had completed their training during the pandemic. The data collected from these interviews were coded to carry out a thematic analysis. Results: All 12 participants reported that their formalised teaching had been cancelled, and due to the pandemic, many doctors felt that service provision was prioritised over their postgraduate education. Some doctors had positive experiences of informal teaching; however, many felt they missed out on educational opportunities. Doctors acknowledged that this was a contributing factor when deciding to take time out of training. This also resulted in doctors seeking educational opportunities outside of training. Discussion: The pandemic created many educational challenges for foundation doctors; this has contributed to doctors deciding to take time away from training. In some cases, due to a focus on service provision and their 'lost education', doctors are using time away from training to address their own specific educational needs. The impact of this 'lost education' requires further research and needs to be considered when doctors do apply to speciality training. [ABSTRACT FROM AUTHOR]

Background: Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management. Aim: To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium). Design: With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible. Setting/participants: In-patient admissions in three English hospices. Results: Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%–28%; delirium risk assessment 0%–16%; screening on admission 7%–35%. Conclusions: Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study. [ABSTRACT FROM AUTHOR]

Purpose of review: Tapentadol is the first of a new class of analgesics, having synergistic µ-opioid receptor agonist and noradrenaline reuptake inhibitory actions. It has been widely researched in many areas of pain, often in noninferiority studies against potent opioids. This review describes all randomized and recent nonrandomized studies of tapentadol in adults with cancer pain. Recent findings: Tapentadol has been shown to be at least as effective as morphine and oxycodone in five randomized (two of which were multicenter and double-blind) and a range of nonrandomized trials, although caution is needed when interpreting these results. It is effective in both opioid-naive patients and those already taking opioids. By having a lower µ-opioid receptor binding affinity, it has fewer opioid-related toxicities such as constipation and nausea. A recent randomized trial comparing tapentadol to tapentadol plus duloxetine in patients with chemotherapy-induced peripheral neuropathy shows similar improvement in both groups in a range of pain relieving and quality of life measures, with similar adverse effects. Summary: Tapentadol has been shown in a range of studies to be an effective analgesic and thus should be considered as an alternative to morphine and oxycodone, especially when opioid toxicities are an issue. [ABSTRACT FROM AUTHOR]