Healthy diets arguably offer the greatest potential for improving the health of the population. 1 Improving the nutritional intake of children is a priority as eating habits are established in childhood and behaviours adopted in childhood transcend into adult life. 2 The consumption of a poor diet during childhood and adolescence leads to poor health outcomes. 3 A range of social and environmental issues are recognised as contributing to children's dietary intake, including the school food environment. School canteens in Australia offer food services within schools being a key part of the school food environment. 4 Influencing the food provided in school canteens offers a potential strategy to improve children's nutritional intake and health outcomes. [5][6][7][8] While governments across the world have implemented guidelines and policy to support improving the quality and nutrition in schools, compliance to this guidance and policy remains low. 9,10 Little is known about what makes for success in supporting school canteens.
Renal colic is a common pre-hospital presentation that is often conveyed to hospital due to diagnostic uncertainty. The use of the STONE score and a greater understanding of computerised tomography (CT) requirement in the diagnostic process can aid the pre-hospital clinician in making an informed decision about the management of these patients. Case: A 48-year-old female presenting with symptoms of renal colic who was assessed, managed and treated at home. Methods: A literature search was carried out on Medline, Cinahl, BNI and Embase. In addition, searches of the NHS evidence database ( www.evidence.nhs.uk ) and the Cochrane Database of Systematic Reviews ( www.cochrane.org ) were completed. Results: The search yielded 536 results, each of which were browsed for relevance, duplicates removed and their references reviewed. 16 articles were relevant to the use of CT to diagnose renal calculi and four addressed the derivation and validation of the STONE score. These were critically reviewed and conclusions drawn about their applicability to the pre-hospital environment. Conclusions: The STONE score, when combined with clinical judgement and if applied to the right patient group, is an appropriate clinical decision tool to identify uncomplicated renal calculi. CT imaging of this low-risk patient group is not required to confirm diagnosis; however, delayed CT scanning is required to form a management plan.
Background: Since 2015, the Royal College of Emergency Medicine (RCEM) has championed an advanced clinical practitioner (ACP) credentialling process for clinicians working in advanced practice roles in the emergency department. While this process ensures a standard of advanced practice that is both governable and robust, it requires structure and support to complete successfully. This article reports the design and implementation of a regional programme aimed at supporting trainees through the RCEM ACP training process to the point of credentialling. Methods: A regional training programme was implemented and a mixed-methods approach (that included a quantitative analysis of training programme completion rates and a qualitative review of trainee feedback) was used to analyse the outcomes. The programme incorporated a structured educational programme, educational supervision and annual review, alongside integration into the deanery school board and facilitation of training time. Results: Between 2016 and 2022, a total of 46 trainee RCEM ACPs were recruited to the programme. Of these, 19 had credentialled by spring 2022 and 20 were in ongoing training, aiming for credentialling. During this time, these participants accounted for 19% of the nationally credentialled ACP workforce (19 of 99). Since 2020, the first pass rate for programme trainees has been 71%, compared to the national average of 38%. Credentialled ACPs, when asked how well the programme prepared them to credential with the RCEM, responded positively, with most scoring the programme between 4 and 5, with 5 being marked as ‘excellent’. Free text comments in feedback on the programme were collated and reviewed for common themes resulting in key themes of ‘supportive’, ‘excellence’ and ‘adequate preparation for credentialling’. Conclusion: Meeting the criteria for RCEM credentialling as an ACP is a demanding process that requires support and structure. The development and implementation of a regional training programme not only meets these requirements but yields higher credentialling success rates and creates trainee satisfaction in the process.
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