Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: the NED APRIQOT Randomised Controlled Trial

BACKGROUND AND AIMS

Post-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention.

METHODS

This multicentre, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control. Intervention-arm endoscopists were emailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention.

RESULTS

From November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-months post-intervention period. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was non-significantly higher (7%, 95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1-20%) and polyp detection rate (PDR) (10%, 95%CI 4-16%) were significantly higher. Differences were not maintained in the post-intervention period. In the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03).

CONCLUSION

Although our automated feedback intervention did not increase aMNP significantly in the intervention period; MNP and PDR did significantly improve. Engaged endoscopists benefited most and improvements were not maintained post-intervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. www.isrctn.org ISRCTN11126923.

The impact of developmental language disorder in a defendant's description on mock jurors' perceptions and judgements

BACKGROUND

While it has been posited that young people with language needs may be viewed more negatively (e.g., as more rude, less cooperative) than those without language needs, the impact of knowing about a person's language needs on others' perceptions has yet to experimentally tested.

AIMS

To examine whether the presence of a developmental language disorder (DLD) diagnosis in a defendant's information would affect mock juror ratings of guilt, sentence length, credibility and blameworthiness.

METHODS & PROCEDURES

A total of 143 jury eligible participants read a vignette of a non-violent crime. Half of the participants (N = 73) were told the defendant has a diagnosis of DLD, while half (N = 70) were not told.

OUTCOMES & RESULTS

Preregistered analyses found that DLD information affected ratings of credibility and blameworthiness, though not judgements of guilt or sentence length. Unregistered content analyses were applied to the justifications participants gave for their ratings: these suggested that participants who did not have the DLD information judged the defendant more on his personality and attitude, and drew more links to his (perceived) background, while participants who received the DLD information condition made more reference to him having cognitive problems.

CONCLUSIONS & IMPLICATIONS

Unlike in previous studies of the impact of autism information, information about a defendant's DLD did not affect mock jurors' likelihood of finding them guilty, or lead participants to give longer sentences. However, our findings suggest knowing a person has DLD does affect others' perceptions of credibility and blameworthiness.

WHAT THIS PAPER ADDS

What is already known on the subject There is already evidence that some conditions that affect communication, specifically autism, also affect juror perceptions. Research also shows that knowing whether or not a defendant has autism influences how jurors rate defendants. However, autism is not the only condition that is relevant to juror perceptions, as we also know that a high rate of young offenders have language needs, and many have language profiles like DLD. What this paper adds to existing knowledge There is little research on how behaviours associated with DLD impact others' perceptions. This study reports the impact of knowing about a defendant's DLD on juror perceptions, investigating whether knowing about DLD improves judgements on guilt, sentencing lengths, credibility and culpability. Beyond the content of youth offending, this study suggests behaviours associated with DLD lead people to form more negative judgements about youth with DLD. This is important because there is still a lack of awareness of DLD both in- and outside the criminal justice system. What are the potential or actual clinical implications of this work? This study shows that knowing about a person's DLD has largely positive effects on others' perceptions of them. This implies that recognizing undetected language needs in young offenders, and supporting colleagues and members of the public to know what DLD is and how it affects people, is critical for youth with DLD to be judged fairly. This study will support the case for raising awareness of vulnerability within the youth justice population, and will assist in clinicians evidencing the need for our roles in justice settings.

How to achieve a work-life balance

Understanding who you are in terms of your values, skills, passions and motivations will help you to make the most of your abilities and improve your work-life balance. This article sets out steps to achieve this.

Managing difficult behaviour

People can be identified in various ways, such as lazy, argumentative or stubborn, all describing behaviours that can lead to difficulties in the workplace. It is important to recognise that, to improve situations, what needs to be tackled is not the person, but his or her attitude.

Using a template to coach yourself and others

Coaches question, inspire, motivate and support other people to change their lives. In doing so, they need enthusiasm and accountability, and the ability to set goals and create action plans. This article explains how to combine these qualities, and the techniques discussed in previous articles in this series, to create great coaching results.

Six simple steps to ensure you achieve your aims

Goal setting is a common method for managers and leaders to set the direction of activities. Without clear goals, activities can continue for too long or never reach fruition. This article presents two simple templates for easy and straightforward goal setting that can involve health or other issues, and can be used at work or home.

Changing your focus to achieve your goals

To achieve their goals, nurses must be able to visualise and plan for them. This article, the second in a series of six, explains how changes in focus can lead to success.

Leading by example to aid personal development

Nursing is a stressful and challenging profession that requires good leadership. This article, the first in a series of six, highlights some of the basic principles of personal development that nurse leaders can follow.

Employee well-being support: a workplace resource £29.99 Employee well-being support: a workplace resource 978-0470059005 0470059001 Andrew Kinder , Rick Hughes and Cary L Cooper John Wiley and Sons , West Sussex 360 [Formula: see text]

THIS IS an extremely well-researched and referenced work that contains a wealth of information covering organisational and mental health issues in the workplace.

Talk it through

Claire Westwood describes how she managed to improve communications between a child's parents and the nursing and medical teams.

Transformation of human mesenchymal stem cells increases their dependency on oxidative phosphorylation for energy production

An increased dependency on glycolysis for ATP production is considered to be a hallmark of tumor cells. Whether this increase in glycolytic activity is due mainly to inherent metabolic alterations or to the hypoxic microenvironment remains controversial. Here we have transformed human adult mesenchymal stem cells (MSC) using genetic alterations as described for differentiated cells. Our data suggest that MSC require disruption of the same pathways as have been shown for differentiated cells to confer a fully transformed phenotype. Furthermore, we found that MSC are more glycolytic than primary human fibroblasts and, in contrast to differentiated cells, do not depend on increased aerobic glycolysis for ATP production during transformation. These data indicate that aerobic glycolysis (the Warburg effect) is not an intrinsic component of the transformation of adult stem cells, and that oncogenic adaptation to bioenergetic requirements, in some circumstances, may also rely on increases in oxidative phosphorylation. We did find, however, a reversible increase in the transcription of glycolytic enzymes in tumors generated by transformed MSC, indicating this is a secondary phenomenon resulting from adaptation of the tumor to its microenvironment.