Independent report - Ockenden review into maternity services at Nottingham University Hospitals NHS Trust

FINAL REPORT: 

'This independent review of maternity services at the Nottingham University Hospitals NHS Trust (NUH) considered the quality of care relating to newborn, infant and maternal harm at the trust.

This report covers the findings, conclusions and essential actions of this independent review of maternity services.

Based on a review of over 2,500 family cases that formed part of this investigation, the final report outlines:

• local actions for learning that staff at the trust must do
• system-wide learnings
• immediate and essential actions to improve maternity and neonatal care

The Independent Maternity Review (known as the Ockenden review) was led by Donna Ockenden and involved a multi-professional team of more than 160 reviewers. The review team held individual meetings with over 500 families, and more than 830 current and former staff at NUH engaged with the review.'

https://assets.publishing.service.gov.uk/media/6a3bb59c4c7605ab567238ec/ockenden-report-review-of-maternity-services-nottingham-university-hospitals-nhs-trust-e-lay.pdf

https://www.ockendenmaternityreview.org.uk/

individual

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listening	Communication Processes  Health Systems
mothers families experience	LISTENING staffing funding

Previously: 'maternity' : 'risk' : 'safety' : 'compassion'

Thank you – on International Nurses Day (my emphasis)

Dear Peter*

On International Nurses Day, we want to recognise the vital role that nursing professionals play in delivering safe and equitable care. ...

This year’s theme, ‘Our Nurses. Our Future. Empowered Nurses Save Lives’, reflects the importance of supporting you to uphold high standards in a rapidly evolving health and care landscape, with rising demand for care. There are new models of care^ and rapid growth in the use of AI. There are also changing demographics – a more diverse nursing population, with a third of nursing professionals being Black, Asian and minority ethnic. There is also a more diverse patient community to care for, with a greater mix of complex mental, physical, cognitive, and behavioral care needs. To make matters even more challenging, there are sadly rising levels of racism and intolerance across our society, which is affecting health and care – with some Black, Asian and minority ethnic nursing professionals now being subjected to 1970s and 1980s style racism. This is unacceptable. That’s why we’re working to modernise practice learning the Code and the revalidation process, to support you, and students, to uphold high standards in the modern and changing world. We’re consulting on our proposals to strengthen practice learning, so that the next generation of professionals is equipped with the right knowledge, skills and experience to meet society’s future health and care needs. We encourage you to take part in the consultation and share your views, so that the changes we make are informed by your lived experience and professional insight. At the end of this month, we will be publishing anti-racist principles for nursing and midwifery education and practice, to help tackle health inequalities for patients who are Black, Asian and minority ethnic. Our work on the anti-racism principles reflects our responsibility to set clear standards that support equity, safety and public confidence – this has also been central to the ongoing reviews of the Code and Revalidation process. We know there is more to do, and we are listening – to your experiences, your insights and your ideas, as we shape the changes. International Nurses Day is an opportunity to hear directly from registrants, reflecting on what you enjoy about your work and how professional standards guide your practice. As Caroline Ogunsola, Professional Development Lead Nurse at East London NHS Foundation Trust, says: “Your contribution matters – nursing is a lifelong journey of impact and continuous development.” Roisin Devlin, Assistant Director of Nursing and Midwifery at South Eastern Health and Social Care Trust, says: “Take pride in your title and remember people will feel the impact you made on them long after you have forgotten.” To nursing professionals across all settings in the four countries of the UK – we would like to say: ''Thank you for your dedication, resilience, and the essential role you play for people and communities every day.''

Best wishes

Paul Rees MBE Chief Executive and Registrar Professor Donna O’Boyle MBE Acting Executive Director of Professional Practice

^There are older models too, that can help healthcare and education deal with racism, inequity, inequality and AI. 

 *Not to me personally, of course - part of a mass NMC mailing on this special day.

Previously: 'safety' : 'lifelong' : 'model' : 'nurse' : 'values' : 'racism'

100,000 signatures to win a parliamentary debate about the ownership of the water industry

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

'I feel thirsty!' 'It's really hot, let's have a swim!'	... Water ...
Public services Public health	I need 100,000 signatures to win a parliamentary debate about the ownership of the water industry. Do your thing internet.https://t.co/kZz1cXBtz3 pic.twitter.com/qWaQPmPEHv — Feargal Sharkey (@Feargal_Sharkey) April 29, 2026

My source: 
https://x.com/Feargal_Sharkey

Previously: 'water' : 'pollution'

Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL

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HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

Anti-Science countermeasures ...

'We are pleased to announce the winners for the 2025 Nature Awards for Standing Up For Science - The John Maddox Prize.

We are proud to announce that our Maddox Prize winner is Virginia Burkett, United States Geological Survey. Judges were impressed by her persistence, as a government adviser and an expert in coastal systems, in the face of opposition.' ...

https://www.nature.com/immersive/maddoxprize/winners/index.html

Virginia Burkett's five 'tips for resisting the anti-science lurch'

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2. KEEP RECEIPTS (your memory) know your institution's scientific integrity policy	2. Never compromise on scientific integrity
3. Find allies 5. Be prepared for setbacks, e.g. relying on family and religious faith.	keep receipts (your defence) 4. KNOW YOUR INSTITUTION'S  SCIENTIFIC INTEGRITY POLICY

My source:

Anjana Ahuja, Tips for resisting the anti-science lurch, Opinion, Research. Financial Times, Wednesday 5 November, 2025, p.20.

Single, dual aspect in architecture. What of care?

'The challenge of overheating in Britain is our buildings are built to retain heat in our temperate climate. Energy efficiency regulations for new dwellings now require high insulation and few drafts to reduce the need for heating in winter, but broadly make it harder to cool homes in summer. Residents of cities are particularly vulnerable to overheating due to urban heat island effects.

There are two ways buildings can be cooled – mechanical methods (primarily air conditioning) and passive cooling methods that use the design of the building to limit heat gain and retain cooler air inside the dwelling.

Passive cooling is much easier in dual-aspect dwellings with windows on multiple external facades, which as shown in Figure 1, are contrasted to single-aspect flats that face out on to only one external facade. Dual aspect allows breezes to blow through dwellings and easily exchange stuffy indoors air for cooler air from the outdoors. Even if outside temperatures are high, cross-ventilation or overnight air exchange and limits to solar gain (daylight indoors) can keep indoor environments cooler than the outdoors.'

https://www.centreforcities.org/reader/breaking-the-bottlenecks/overheating-and-dual-aspect/

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group-population

	Single and dual aspect flats

In Hodges' model at least, we seem to have dual aspect covered. 

That's why we say the model is situated.

Image source: https://www.centreforcities.org/reader/breaking-the-bottlenecks/overheating-and-dual-aspect/

My source:  Plimmer, G., Pickard, J., Steinberg, J., London planning rules face tweak in bid to build more homes. FTWeekend. 18/19 October 2025, p.2.

Previously on W2tQ: 'architecture' : 'situated' : 'housing'

On Care, Papers, Distance, Pressure, Academia and Falls

In my student nursing days late 1970s there was a big-stick of motivation. It wasn't management, and yet it was. There was a stigma attached to a patient developing a pressure sore - decubitus ulcers. The NHS then had many psychogeriatric wards, but that care is now with nursing homes. Despite the best efforts some patients did, especially on the mental health infirmary, which was staffed by 'general'  trained nurses too. Using aseptic technique wounds had to be packed (stage 3-4?). Some of the treatments, were not exactly 'evidence-based'. There is a historical account of previous treatments provided on 'Asylum Years'.

In the 1990s I was working on a 'book' about health, nursing and informatics (it was simpler then?). Submitting the project as a book proposal, a letter from one publisher reads: 'thanks but no thanks'. Although unsuccessful, that exercise accounts for the range of interests I still maintain today, and the scope of posts here on W2tQ. Continuing to clear and sort notes, one is for the 'book':

Abbott, P., & Payne, G. (Eds.). (1990). New Directions in the Sociology of Health (1st ed.). Routledge. https://doi.org/10.4324/9781351141727

From the above book, I've a page of notes headed "For chapter 2" drawing on a brilliant chapter 4:

Distance Decay and Information Deprivation: Health Implications for People in Rural Isolation

By George G. Giarchi

Abstract

Deprivation is frequently associated with the lives of inner city dwellers in old densely packed terraced housing, or with the residents in high-rise city slums and concrete council houses. In substantive socio-economic terms the deprivation of both the urban and the rural setting are the effects of the same structural dysfunctions, as aptly demonstrated by Townsend's 1968 classic study of poverty. On the basis of empirical studies rural deprivation affects the standards of health of many people in the countrysides of the UK particularly the most vulnerable dependent populations, such as younger children and older adults at the lower end of the social scale. The houses which are 'unfit' are damp, poorly lit, badly ventilated or lack healthy sanitation: clothes are rotten with mildew. Leschinsky's nationwide survey of rural health services indicates that centralization of health provision is a major reason for health disparities in rural areas.

I looked up the author, guessing that they were possibly still in academia, emeritus, or more likely (then, a decade or more in their career) retired by now. The search did not take long, but filled me with sadness and anger:

'A coroner has said there were "missed opportunities" to prevent the death of a hospital patient who died after developing a bedsore.

George Giacinto Giarchi, 86, died in November 2017 at Plymouth's Mount Gould Hospital after being treated for weeks at Derriford Hospital after a fall.

At Plymouth Crown Court coroner Ian Arrow said Mr Giarchi died of multi-organ failure from the pressure ulcer.

His family urged ministers to ensure hospitals had adequate staffing levels.

The former Plymouth University professor was admitted to Derriford Hospital after falling and fracturing his arm at home on 25 September 2017.

He was later transferred to Mount Gould where the lesion was first noticed.'

Pressure ulcers, known as bed sores, are injuries caused by pressure on the skin often seen in bedridden patients.'

https://www.bbc.co.uk/news/uk-england-devon-48798285

 Thank you and bless you Prof. George G. Giarchi RIP.

Jones, P. (2012). Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model. The Journal Of Community Informatics. 8(3). Retrieved from https://www.academia.edu/3794699/Reflecting_on_the_glocal_through_the_conceptual_framework_of_Hodges_s_model

Online: Artificial Intelligence (AI) in Healthcare - Weds 17th Sept 2025 BCS Coventry Branch

Online event organised by British Computer Society (BCS)

Full details: 
https://www.bcs.org/events-calendar/2025/september/webinar-ai-in-healthcare-neural-ai-v-symbolic-ai-why-we-need-neuro-symbolic-ai/

*** Agenda (UK time) *** 

18:30 - Meeting opens
Welcome and Introductions
18:40 - Hand-over to speaker
19:30 - Questions
20:30 - End

Scope of workshop

This is to support you in putting together your application for the FEDIP application and the workshop will focus on:

• What level you should apply for
• How to work with the Standard
• How to map your evidence
• Putting together context
• Preparing your evidence in the best way 
• What the assessors will look for

Free-of-charge registration to obtain the Zoom link

https://www.eventbrite.co.uk/e/ai-in-healthcare-neural-ai-v-symbolic-ai-why-we-need-neuro-symbolic-ai-registration-1383661000299?aff=oddtdtcreator
___________________________

My source: Dr Mercedes Arguello Casteleiro.

FEDIP: https://www.fedip.org/

BCS - AI Health 2025 - Artificial Intelligence SG (reminder)

Date and time: Friday 7 November, 9:30am - 4:30pm

Location: BCS, The Chartered Institute for IT, Ground Floor, 25 Copthall Avenue, London, EC2R 7BP

Price: 42 - 108 GBP

Synopsis

BCS-SGAI, the BCS, The Chartered Institute for IT's Specialist Group on Artificial Intelligence, was founded in June 1980. Its mission is: "To foster achievement, capability and awareness in both business and research in Artificial Intelligence, and to promote the interests of the related community". It is one of Europe's longest-established groups working to support the community of artificial intelligence developers and users and is the organiser of one of the longest-running annual series of AI conferences in Europe: the AI-20xx series.

In England, 189 out of 208 (91%) hospital trusts are using electronic health records (EHRs) bringing opportunities and challenges and for Artificial Intelligence (AI). In the morning, there will be a session about EHRs with speakers from UK (animal health records), France (European Health Data Space infrastructure for the use and exchange of EHRs), and Spain (personal health records). Before lunch break, there will be a brief 101 hands-on tutorial about Neuro-Symbolic AI with short exercises. In the afternoon, there will be a session about clinical decision, exemplifying the use of AI-based healthcare technologies. Come along if you are interested in AI and its potential in healthcare.

• A comparison between open-source biomedical LLMs and general-domain LLMs (e.g. DeepSeek, Gemini, Claude, and ChatGPT-4)
• How to lower the technical skills overhead (understanding of AI and programming code) needed to use open-source LLMs for content generation and content analysis of text, images and audio
• Exploring the plausible benefits of neuro-symbolic AI, combining neural AI (to process and extract patterns for health issues from unstructured data) with symbolic AI (explicit representations of background knowledge)

There will be Certificates of Attendance for those who register and attend the event.

We hope that you will come and join us, and that you enjoy this new offering from the BCS SGAI.

Speakers

Programme

More details and registration ...

(I look forward to attending.)

My source: BCS SGAI mail list.

Richardson et al. 'The entities enabling scientific fraud at scale are large, resilient, and growing rapidly'

Abstract

'Science is characterized by collaboration and cooperation, but also by uncertainty, competition, and inequality. While there has always been some concern that these pressures may compel some to defect from the scientific research ethos—i.e., fail to make genuine contributions to the production of knowledge or to the training of an expert workforce—the focus has largely been on the actions of lone individuals. Recently, however, reports of coordinated scientific fraud activities have increased. Some suggest that the ease of communication provided by the internet and open-access publishing have created the conditions for the emergence of entities—paper mills (i.e., sellers of mass-produced low quality and fabricated research), brokers (i.e., conduits between producers and publishers of fraudulent research), predatory journals, who do not conduct any quality controls on submissions—that facilitate systematic scientific fraud. Here, we demonstrate through case studies that i) individuals have cooperated to publish papers that were eventually retracted in a number of journals, ii) brokers have enabled publication in targeted journals at scale, and iii), within a field of science, not all subfields are equally targeted for scientific fraud. Our results reveal some of the strategies that enable the entities promoting scientific fraud to evade interventions. Our final analysis suggests that this ability to evade interventions is enabling the number of fraudulent publications to grow at a rate far outpacing that of legitimate science.'

R.A.K. Richardson, S.S. Hong, J.A. Byrne, T. Stoeger, & L.A.N. Amaral, The entities enabling scientific fraud at scale are large, resilient, and growing rapidly, Proc. Natl. Acad. Sci. U.S.A. 122 (32) e2420092122, https://doi.org/10.1073/pnas.2420092122 (2025).
https://www.pnas.org/doi/10.1073/pnas.2420092122

My source: The Economist, 9th August 2025. 

https://www.economist.com/science-and-technology/2025/08/06/fraudulent-scientific-papers-are-booming

Online: Hodges' model in Safety presentation

Later this week I've an online presentation to deliver. The brief is to introduce Hodges' model and relate the model to the matter of safety - some thoughts ...

individual

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SOCIOLOGY : POLITICAL

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PATIENT safety Task: Attention - Concentration Rest - Sleep psychological environment - safety to ERR is human HUMAN as weakest link risk to SELF Cognitive support - lists, names, informational analysis of environment Critical thinking Situational awareness Therapeutic - OBSERVATIONS ethics- video surveillance

PATIENT - PROCESS safety  - e.g. diagnosis, handover physical safety: 1st law 1st aid. SELF-harm : SELF-neglect Assessments, Plan, Evaluation environment:safety, construction, buildings occupational/disciplinary safety Comms - Information theory  safety as security: lone working signals - alarms, protocols medical safety: medicines, devices risk reduction - management Human factors Human- Computer/Tech/AI Interaction Research - Records Interfaces Public Health Safety: Food, Pollution

risk to others stereotypes - assumptions risk from others - bullying social media teamwork: simulation PRACTICE safety

Law - Health & Safety Reporting - Statistics Transparency Mandatory Training / Learning Whistleblowing safety standards ISO safety organisations The Learning Organisation Other sectors e.g. Aviation, Formula 1 ... Risk of 'groupthink'

 Is it a risk to assume parity of estem in patient safety? What of 'a' patient's safety?

safety
https://hodges-model.blogspot.com/search?q=safety

Variety really is the spice of Hodges' model

In the previous post - RCN Congress iii 2025 Accountability for patients in ambulances I wrote of how corridor care has become variegated, as it is bound to, in a system(?).

Variegation means difference, and yet in organisational accountability, there should be reliance upon a procedure, if not a standard operating procedure. The experience of individual patients should be nuanced, standardised and yet catering for individual differences.^ The resolution at congress was questioning the need for guidance amid legal ambiguities.

This is also helpful in two senses. 

1. In exploring ways that Hodges' model might help encompass and explain the dual character category*, [or other, or not] as may apply to person-centredness and service-centredness?
2. Plus, (and potentially confusing for me) in seeking a basic understanding of dual categories in a mathematical sense.

* Book review iii: 'Categories we live by'

from the above post:
Knobe J, Prasada S, Newman GE. Dual character concepts and the normative dimension of conceptual representation. Cognition. 2013 May;127(2):242-57. doi: 10.1016/j.cognition.2013.01.005. Epub 2013 Mar 1. PMID: 23454798.

^This highlights a quality of what it is to care/and caring. It relies upon relationship building, the nurse getting to know the patient, person and vice-versa (to a degree) as befits the emergence of empathy, rapport, generation of trust; and the nurse's ability to anticipate not only care needs (that arise from direct observation), but those that are unique to the patient as an individual. In the previous post which mentioned corridor care, the physical, emotional, social and political environment is not established. Noise, on several levels stymies care, disrupting communication and interpersonal skills - even presence and touch - amid the chaos of the corridor. 

RCN Congress 2025 ii - Losing direct nursing skills

No longer an issue for me, but in the mix of careers: health, education, work - professional; employees often find that they are pulled away from what originally brought them to their chosen career. "I want to help people, care for them, make them better." Especially, if they are ambitious, seek better pay and prospects, for themselves and (a) their family. 

This was an issue and tension for discussion at the RCN Congress:

'Climbing the ladder often means leaving the “bedside”, this is something that can leave mixed emotions for the individual. As a result, we are losing years of clinical experience and expertise which could impact on the future training and on-the-job development for early career or inexperienced colleagues.

The secondary issue that arises with nurses leaving the bedside is skill decay, where a person loses the skills developed in the clinical area through lack of everyday practice. This is being increasingly acknowledged in health care literature (Maehle, 2017). However, the biggest barrier is the resulting lack of confidence in personal skills and ability, particularly where someone is now seen as a senior colleague by those at the bedside.' cont. ...

Discussion - Losing direct nursing skills

I didn't make notes but reflected on how your 'basic training' (for me ...) registered mental nurse (RMN) and state registered nurse (SRN) provides the foundation for professional (and lifelong?) learning? This is, after all, what continuing professional development and post-registration refer to. I did realise that in returning to mental health nursing after qualifying as a SRN, I would surrender much learning - instead of consolidating.

Lecture 101, sets in train the scope of your theory and practice. This is why, and where I see Hodges' model having a role at this point in our professional education, whatever the discipline, or profession. Congress included a resolution for debate: Physician associates. 

We really do need to get this right. Get it wrong, and the quality of care and safety of the public are threatened. If existing standards and professional relationships are perturbed, the effects can be long-lasting and (grossly) injurious. Especially at a time of increasing demographic pressures globally for health systems and services.

individual

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1. Is the divide represented by parity of esteem in healthcare MIND :: BODY associated with the fact that in mental illness patients do not ordinarily need to be nursed, cared for in bed?	png image from pngtree.com
2. But, wait! What does history, medical sociology have to say?	3. Is the 'bed' the signifier of instititionalised care? It appears to be. The pejorative term 'big bins' seems to epitomise the mechanisation of care. In prisons do they throw away the key?

Previously: 'RCN' : 'skills' : 'beds'.

Also at Congress was the RCN Northwest Multicultural Group, which may be of interest if you are UK based (and not just in the NW). The following is edited from an email ...

Dear All,

I would like to congratulate everyone for an amazing Congress 2025 and take this opportunity to welcome the new members. It was really lovely to meet all of you in person.

Please see below the link to the webpage of multicultural group:

https://www.rcn.org.uk/northwest/Get-Involved/NW-Multicultural-Group

I will be sharing the details of the next meeting and other information via the group and email.

Kind regards,

Olanike Babalola (She/Her/Hers)
Chair/Cofounder RCN Northwest Multicultural Group
Email: olanike.babalola AT reps.rcn.org.uk

Safety testing time - evaluations - for users of Hodges' model to be extended

The time to test Hodges' model* is to be extended (in my dreams...).

Or. Do not underestimate 'simple' models.

The time to evaluate Hodges' model:

• for individual users
• cross-curricula
• professional groups (e.g. registered mental health; and general nurses)
• within multidisciplinary / skilled teams / venues (Nursing home, Community Mental Health Team)

Given the universal, multicontextual scope of the model for public and patient safety it was decided to extend the time for testing by a further month to two quarters [ 😉] - six whole calendar months.

When applied it is important that checkpoints are agreed:

• Data gathering - initial interview
• initial formulation / care plan
• care review / evaluation
• discharge - staying well 

There is no agreed standard for testing a generic model in healthcare. Is there?

• Not for the medical / bio-medical model
• Nor, for the biopsychosocial model?

What chance then for a biopsychosociopolitical model?

*Per user and group of users of course.

My source: 
Christina Criddle, Concerns raised after OpenAI slashes time taken to test potential risks of latest models, FTWeekend, 12-13 April, 2025, p.14. (italicised terms discussed).

See also:
Radhika Rajkumar, Editor. OpenAI used to test its AI models for months - now it's days. Why that matters, ZDNET.

https://www.zdnet.com/article/openai-used-to-test-its-ai-models-for-months-now-its-days-why-that-matters/

Book TSR ii - Mental illness/health: History, process and progress

As posted yesterday through a book review, I developed an awareness for the role of process much earlier than previously thought. It wasn't Enid Mumford's work on the benefits of a socio-technical approach to successful deployment of information systems. I only discovered this well after the advent of home computing with the ZX81 and BBC micro 1981-1995.

It was 1978-79 to be more exact; on an admission ward during my three year student Registered Mental Nursing course at Winwick Hospital. On first recollection, I thought it was a clinic, with patients coming in for Clomipramine (Anafranil) infusion on to the ward. As students on placement we were allocated to support the clinic, completing regular observations, including pulse and blood pressure. Clearly, it was a long time ago. There is a paper (paywall), quite a significant one for me:

O’Flanagan PM. A Clomipramine (Anafranil) Infusion Unit. Journal of International Medical Research. 1973;1(5):375-381. doi:10.1177/030006057300100519 

I remember this Consultant's name being mentioned, but this was before my time(?). From the paper's first - accessible - page I can see the patients involved were actually in-patients. Which given the procedures, safety, observation makes better sense. There is reference to a film, in a hospital newsletter 'The Standard':

'Anafranil Film

In response to the interest shown in the film on Anafranil Infusion, Dr. P. O'Flanagan was present in the In-Service Training Room on Monday, October 29th for a second showing of the film, and to answer any questions from the audience.'

https://winwickremembered.org.uk/mags/mag316.htm

I wonder if the film is archived somewhere?

It isn't a surprise to see my former Community MH manager and friend David McKendrick listed on the Publications Committee. I do miss David - a great mentor!

In the previous post about 'The Sleep Room' I contrasted the mind-body dichotomy. In terms of evidence on 'both sides' of this divide, many people have made the observation of how you can see a broken arm, or leg, and other physical ailments, but mental health issues are often not obvious:

Powell J, Clarke A. Information in mental health: qualitative study of mental health service users. Health Expect. 2006 Dec;9(4):359-65. doi: 10.1111/j.1369-7625.2006.00403.x. PMID: 17083562; PMCID: PMC5060370.

The evidence-base of general medicine - physical health and psychiatry must be dynamic. The volume of publications bears testimony to the relentless change across all the sciences, research, technologies, knowledge, theory, practice, management and policy. On Twitter there is constant 'debate' between psychiatry and anti-psychiatry. 

Studies of intravenous clomipramine continue, the intervention much changed from the 1960-70s:

Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous Clomipramine for Obsessive-Compulsive Disorder Refractory to Oral Clomipramine: A Placebo-Controlled Study. Arch Gen Psychiatry. 1998;55(10):918–924. doi:10.1001/archpsyc.55.10.918

Persson M-L. Adler Mats y Hetta J. Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT: A pilot study. Eur. J. Psychiat. [online]. 2007, vol.21, n.4 [citado 2025-04-07], pp.263-267. Disponible en: <http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000400003&lng=es&nrm=iso>. ISSN 0213-6163.

Karameh WK, Khani M. Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder. Int J Neuropsychopharmacol. 2015 Jul 28;19(2):pyv084. doi: 10.1093/ijnp/pyv084. Erratum in: Int J Neuropsychopharmacol. 2016 Apr 27;19(10):pyw031. doi: 10.1093/ijnp/pyw031. PMID: 26221004; PMCID: PMC4772819.

Perhaps, someone can please enlighten me? Given the time between William Sargant's practice, and today how much more do we know? We know the gap can't be fully closed (phenomenologically?), but has the evidence-gap been reduced? What are the evidential mile[Km]stones in psychiatry - mental health nursing? What are 'the standard' measures? If we look at a model that is bio-psycho-socio-political, what difference might this make, to the 'debate', theory, practice, research, management and politics (policy)? 

'Woke' is a tainted word these days, but in mental health care and nursing we all need to wake up and in a safe space.

AI, Nursing, Safety and presentation - 1st Aug 2-3pm

Hodges' model was not created primarily as a safety tool. It cannot claim to achieve or adhere to an ISO standard. ISO 45001 - health and safety management standard, for example. There is however a relation to clinical risk across healthcare professions, disciplines and clinical fields, including community and public (mental) health. To which of course we must now add planetary health. That said, the question of ISO safety and quality standards for Hodges' model has not been assessed. What exactly would certification entail? Would this process be appropriate for what is a generic - foundational tool?

What this means, however, is that as a situated model for reflection, reflective practice and critical thinking Hodges' model constitutes a deliberative step in the right (formal) direction. As noted previously, in template form, Hodges' model acknowledges the initial personal, professional and organisational standards that (must) shape our clinical encounters. That is, if assessed (as students - and our peers clearly are, and you would expect to be), unconditional positive regard would be observed, supported by the required standards of professional behaviour. 

There is another step here. The ethical and legal edict of 'do no harm' must also be central to care delivery, outcomes and evaluation. So from the outset, implicit in Hodges' model is the (NON-LEGAL) statement:

You, the practitioner - agent (student - and your mentor/supervisor) will not knowingly, or through professional ignorance, or neglect  cause physical, psychological, social (cultural), political (power), or spiritual harm to the patient - subject (or their carer - guardian/proxy).

There is no escape from AI and Large Language Models as I noticed in FTWeekend:

'Jilin University Hospital in the eastern city of Changchun has rolled out a diagnostic tool it claims can produce treatment plans through DeepSeek consulting the hospital's database, medical guidelines and drug efficacy results. Jinxin Women and Children's Hospital in south-western China said it had a tool for patients to track their ovulation cycles, with test results combined with the hospital's patient data to produce personalised fertility plans.

One doctor at public hospital in Hubei province in central China said the institution's leadership had issued a directive that DeepSeek should be used as a third-party arbiter if two doctors have differing views on treatment.

 
There have been rollouts in public hospitals in Chengdu, Hangzhou and Wuhan for less complex applications, such as digital nurses directing patients to the right consulting room or explaining complicated medical reports.

 
Several industry insiders warned against taking all the announcements at face value, as some companies were trying to capture investor enthusiasm around DeepSeek without meaningfully deploying its models. Meanwhile, government bodies are also under political pressure to be seen as aligned with China's AI darling.

 
The SOE tech supplier said "much work still needs to be done to make these models useful" for more complex work such as medical diagnosis. "It must be trained on enough medical data to produce good results. This will take time and needs collaboration from leading AI companies. It is not something hospitals can buld on their own."

Another doctor described a move to deploy DeepSeek last week at a hospital in eastern Zhejiang as a "publicity stunt".

Even if some announcements should be treated with scepticism, experts say the willingness to test out its models still marks a step change.'

Edited for formatting, some text is emphasised. A vast array of conditions can be substituted (parametrised) for 'fertility'. While nursing is mentioned there is little on testing, but for 'plans' we can read nursing assessment, plans, and evaluations. 

Returning to safety. Following an online chat yesterday, I've an online presentation to the Patient Safety Management Network [Patient Safety Hub] pencilled in for 1st August 2-3pm. Comprised of 40 minutes with questions following - I will, as discussed - focus upon:

• Introduction to the model
• How it can be applied in different situations – safety/risk/improvement
• Examples of its use

This is progress - a step to develop Hodges' model and reveal the limits of the bio-psycho-social model.

^soe - state-owned enterprises.

Olcott, E., Ding, W. AI challenger DeepSeek spreads rapidly across China with the blessing of Beijing, FTWeekend, 1-2 March, 2025. p.13.

Living document - "Semantic Web: Past, Present, and Future"

Dear Semantic Web community

As the year ends, the question remains: How will the Semantic Web look in 2025?

Together with Katja Hose, Maria-Esther Vidal, Gerd Groener, and Petr Škoda, we contributed this year an article titled "Semantic Web: Past, Present, and Future", see

https://drops.dagstuhl.de/entities/document/10.4230/TGDK.2.1.3 to the new Diamond Open Access journal on Transactions on Graph Data and Knowledge (TGDK, https://tgdk.org/). This primer has been a living document for 13 years; see the link for details!

As many of us cannot resist checking emails over the break, I ask you to consider the question:
What is our future in 2025?

Many "classical" Semantic Web researchers have witnessed the rise of Linked Open Data, Freebase being bought by Google (largely seen as a big win), and the beginning and success of the Knowledge Graph era. Many of us have moved on to or added topics like graph representation learning, graph neural networks, language models, etc., to our research portfolio. So, how much of the classical topics are left? How much will come back? Should we work more on knowledge graph embeddings obeying OWL axioms? Shall we have federated queries not only over multiple data sources but also include hybrid queries using similarities in graph embeddings?

In the current 2024 version of the primer, we include the latest W3C standards developed by the Semantic Web community. But we also explain the journey from the famous Linked Data principles via Knowledge Graphs to the hot topic of machine learning on graphs!

*The article linked above is an invitation to contribute. Contact me if you are interested!* 

It will be updated from time to time. We like to receive your feedback, and perhaps you would like to contribute to a future version.

Best wishes and happy holidays,

Ansgar

PS: For 2025, there is a plan to update the German version of the article in an introductory textbook on artificial intelligence. It will add Shallow Graph Embeddings, Graph Neural Networks, and the interplay of Knowledge Graphs and Language Models. Once ready, I plan to ping this back to the English version.

My source:

Ansgar Scherp
From:mail AT ansgarscherp.net
To:semantic-web AT w3.org

4.3   3-12

'Domain Ontologies represent knowledge specific to a particular domain [48, 109]. Domain ontologies are used as external sources of background knowledge [48]. They can be built on foundational ontologies [110] or core ontologies [131], which provide precise structuring to the domain ontology and thus improve interoperability between different domain ontologies. Domain ontologies can be simple such as the FOAF ontology or the event ontology mentioned above, or very complex and extensive, having been developed by domain experts, such as the SNOMED medical ontology.' ...

3-13

'Foundational Ontologies have a very wide scope and can be reused in a wide variety of modeling scenarios [24]. They are therefore used for reference purposes [109] and aim to model the most general and generic concepts and relations that can be used to describe almost any aspect of our world [24, 109], such as objects and events. An example is the Descriptive Ontology for Linguistic and Cognitive Engineering (DOLCE) [24]. Such basic ontologies have a rich axiomatization that is important at the developmental stage of ontologies. They help ontology engineers to have a formal and internally consistent conceptualization of the world, which can be modeled and checked for consistency. For the use of foundational ontologies in a concrete application, i.e., during the runtime of an application, the rich axiomatization can often be removed and replaced by a more lightweight version of the foundational ontology.
 In contrast, domain ontologies are built specifically to allow automatic reasoning at runtime. Therefore, when designing and developing ontologies, completeness and complexity on the one hand must always be balanced with the efficiency of reasoning mechanisms on the other. In order to represent structured knowledge, such as the scenario depicted in Figure 1, interconnected ontologies are needed, which are spanned in a network over the Internet. For this purpose, the ontologies used must match and be aligned with each other.'

Health - See also 4.2 (A post in 2025 ...re. SKOS?).

NURSING -:- INFOTECH - worlds apart? Software testing

Another draft from over a decade ago ... duly revisited and updated:

https://www.statista.com/statistics/793628/worldwide-developer-survey-most-used-languages/

Reading up on Ruby and Rails and attending Scotland on Rails, I've been struck by the emphasis on testing. Testing in this context is about reliable software and building this into the 'product' from the outset. A book on Rails gets criticized because it leaves the chapter on 'Testing' until the end (even if the authors had their reasons - as they explained).

This take on testing is sufficient if (of course) it is appropriate and it is applied (as per the manual) to the application concerned. There are other more formal methods that extend to writing a specification for code which entails the use of formal specification languages such as Zed (as encountered in BA(Hons.) studies. This arises in situations were software is being developed for safety-critical situations. Clearly, robotic surgery, nuclear energy, and keeping an aircraft in the sky, take-off and landing are mission-critical. In the latter case a company is still dealing with life threatening loss of life that can follow, should the software system fail or more covertly introduce an error.

Reading about Rails, there are specific tests and these are provided as a result of scaffolding, a process whereby the bones of a web application are created within the Rails framework: with tests.

Rails creates a test directory for you as soon as you create a Rails project using bin/rails new application_name. If you list the contents of this directory then you will see:

$ ls -F test
application_system_test_case.rb  controllers/                     helpers/                         mailers/                         system/                          fixtures/                        integration/                     models/                          test_helper.rb

Source: https://guides.rubyonrails.org/testing.html

Rails uses a popular convention to organise and integrate the elements of a web application that includes a database, and dynamic interface. The approach is known as:

Models, Views and Controllers - MVC

MVC underpins several programming languages and frameworks. As displayed above, the tests that Rails creates have specific names and you can quickly see where they come from and how they encompass Rails (an essential property of course).

Today, I still wonder [ what's new! 😉 ] what is the equivalent to MVC in nursing? Models seems to fit! Over the years at many IT events, you can't help but reflect on nursing and its 'API' - application programming interface. Worryingly, in humanistic terms there is an instrumental potential in Hodges' model. If Nursing on Rails was a thing, what would the tests look like? Identity would be a feature, to demonstrate person-centredness, safety in medication and other treatment procedures. Is there a way to demonstrate the integration of care, and for a patient - the extent of holistic bandwidth? Of course, nursing comprises just a part of a clinical information system. It must be in sync in accord with other disciplines, medical and pharmacy and other multidisciplinary team members and yet ensure that 'nursing is visible'.

Previously: API : 'Waste not - want not'

Ethics and the 'big picture'

'It has been my experience that many of the most successful and creative heads of major research labs around the country came to their place from other disciplines. For example, one prominent geneticist that I know has his Ph.D. in chemistry. He told me that coming to genetics from outside the discipline gave him an awareness of structures and values that were invisible to those laboring inside the established system. Much as one has critical insights into the ambience of a city or culture when one comes from outside as a foreigner, so also is there critical understanding of academic disciplines. Thus, one response to the add-on question is to reply that the material you are providing can make your students better scientists by giving them a more global, contextual perspective. A global, contextual perspective allows one to consider divergent research designs that approach a problem in many directions. This is sometimes called "big picture" thinking. Part of the big picture includes other scientific contexts. For example, biology is seen in the context of chemistry, and chemistry is seen in the context of physics. But it is more than that. It also includes values. Should I, as a scientist, pursue all questions with the same vigor? Are there some questions that should be avoided because of the social consequences of their results? Is the scientist compelled to think in terms of helping humankind or helping himself to a Nobel Prize in any way he can? All of these involve values and ethics. They are critical components to global big picture thinking. Such a perspective is a valuable tool for anyone seeking excellence in scientific research.' p.28.

Boylan, M., & Donahue, J. (2003). Ethics across the curriculum : a practice-based approach. Lexington Books. 

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

|

GROUP

PERSONAL ETHICS INDIVIDUAL INTEGRITY MY EXPERIENCE MY REFLECTIONS INTERSUBJECTIVITY PURPOSE BELIEFS CHARACTER EDUCATION PROFESSIONAL EDUCATION

PROCESS OBJECTIVITY FACTS  EMPIRICISM 'We define ethics as the process of reflection on the moral meaning of actions.' p.5. 'BIG PICTURE' PROFESSIONAL EDUCATION

PRACTICE COMMUNITY OF PRACTICE ETHOS^ (Chap. 6) 'Ethics is not a discrete body of knowledge that one simply acquires for application and use in particular situations. It entails the ongoing appropriation of ideas of the good as they relate to the changig situations, contexts, and developments in individuals and groups lives. ^ Ethics reflects on actions the actions of individuals and groups.' p.5.

PROFESSIONAL BODIES PROFESSIONAL STANDARDS PROFESSIONAL & COMMERCIAL - ACCOUNTABILITY PROFESSIONAL ETHICS DUTY OF CARE POLICY LAW JUSTICE autonomy; nonmaleficence; beneficence; justice*

^Stackhouse, M. (1972) Ethics and the Urban Ethos: An Essay in Social Theory and Theological Construction, Boston: Beacon Press. (Chap. 6, Boylan & Donahue)

*Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press. (Chap. 6, Boylan & Donahue)

Book received: 'Handbook on the Ethics of Artificial Intelligence'

Many thanks to Edward Elgar Publishing for a review copy of this book which arrived today:

Edited by David J. Gunkel, Professor of Communication, Northern Illinois University, US, and Professor of Applied Ethics, Łazarski University, Poland

Publication Date: 2024 ISBN: 978 1 80392 671 1 Extent: 336 pp

This engaging Handbook identifies and critically examines the moral opportunities and challenges typically attributed to artificial intelligence. It provides a comprehensive overview and examination of the most pressing and urgent problems with this technology by drawing on a wide range of analytical methods, traditions, and approaches.

This is timely, prior to next month's event on AI and Planetary Health, about which news to follow shortly, especially if you are based near London and southern England.

I also can't believe it is 34 years since publication of the following case study:

Davies, M. and Owen, K. ‘Complex uncertain decisions: medical diagnosis’, Case Study 10 in Expert System Opportunities from the DTI’s Research Technology Initiative, HMSO 1990.

Ethics in AI 2024 :: Expert Systems 1990