Staff Publication

The role of ultrasound scanning (USS) in right iliac fossa (RIF) pain: Is USS imaging delaying emergency appendicectomies? (2015)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Luke D.

Citation:
International Journal of Surgery, November 2015, vol./is. 23/(S114)

Abstract:
Aim: This project investigates USS results from patients who had undergone appendicectomies to assess the sensitivity and specificity in detecting a histology positive acute appendicitis. We also investigated whether the decision to USS delayed an emergency procedure. Methods: Retrospective data collection between January-June 2014. Data was collected from Theatre log books, Pathology/PACS systems. Results: Between January-June 2014, 226 appendectomies were performed on the emergency-operating list. 15% (n = 34) ha d undergone pre-operative USS (74% Female, Mean age = 27 years). 76% (n = 26) of those who had a scan went onto have a diagnostic laparoscopy and appendicectomy, 24% (n = 8) had an open appendicectomy.53% (n = 18) were found to have a histology proven positive appendicitis. USS as an investigation to detect acute appendicitis demonstrated a sensitivity of 22.2% an d specificity of 68.8%, PPV of 44.4% and a NPV of 44.0%. A mean delay of 0.97 days was observed from admission to operation due to USS. Conclusion: US S result often does not change the definitive management in patients with ongoing RIF pain. Diagnostic laparoscopy can be therapeutic even in the absence of appendicitis. With USS delaying time to theatre and increasing hospital stay we conclude the USS has a limited role in investigating RIF pain in a patient presenting with the classic acute appendicitis.

Smoking cessation and best medical therapy (BMT) how well are vascular surgeons doing? (2015)

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Type of publication:
Conference abstract

Author(s):
Slade R., *Sukha A., *Sykes T.

Citation:
International Journal of Surgery, November 2015, vol./is. 23/(S131)

Abstract:
Aim: BMT is a key component in the management of patients with vascular disease. The aim of this study is to determine how well BMT is documented in the correspondence to primary care with particular reference to the preoperative clinic letter and discharge summary following a surgical intervention. Methods: Patients between Jan-Jun 2014 were identified from a prospectively maintained vascular-database and the corresponding clinic letters and discharge summaries were retrieved. Results: 107 patients underwent vascular surgery between Jan-Jun 2014. The operations identified were: AAA repair n=21,Carotid endarterectomy n=23,Femoral endarterectomy n= 12,Vascular bypass n=43 and Revision surgery n=8. Overall, antiplatelet therapy was documented in 79%(n=85) of pre: operative clinic letters and 96%(n=103) of discharge summaries. Similarly, lipid-lowering therapy was recorded in 79%(n=85) and 92%(n=98). Smoking status was recorded in 32 %(n=34) of pre-operative clinic letters; 21%(n=23) were smokers and all identified smokers were offered advice to stop smoking. Conclusion: Documentation of smoking status and advice is poorly recorded in the pre and post -operative correspondence to primary care and unrecorded in the discharge summary. Similarly, pre-operative anti platelet and lipid lowering therapy documentation is suboptimal. 'Best Medical Therapy,' has been implemented into a standardised clinic template and a 'smoking status/advice' section in the electronically generated discharge summary has been implemented.

Introducing a realistic and reusable quinsy simulator (2016)

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Type of publication:
Journal article

Author(s):
*Giblett, N, *Hari, C

Citation:
The Journal of Laryngology and Otology, Feb 2016, vol. 130, no. 2, p. 201-203

Abstract:
An increasing number of inexperienced doctors are rotating through otolaryngology departments and providing care to ENT patients. Numerous acute ENT conditions require basic surgical or technical intervention; hence, effective and efficient simulation induction training has become paramount in providing a safe yet valuable educational environment for the junior clinician. Whilst simulation has developed over the years for numerous ENT skills, to date there has not been a realistic and easily reproducible model for teaching the skills to manage one of the most common ENT emergencies, a peritonsillar abscess or 'quinsy'. We have adapted the Laryngotech trainer, a well-established ENT simulation tool, to present a readily accessible, reusable and realistic simulation model. The model provides safe training for the drainage of quinsy.

Multidrug-resistant (MDR) Gram-negative bacteria information leaflets (2016)

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Type of publication:
Journal article

Author(s):
Brown C., Livermore D.M., Otter J.A., *Warren R.E., Jenks P., Enoch D.A., Newsholme W., Oppenheim B., Leanord A., McNulty C., Tanner G., Bennett S., Cann M., Bostock J., Collins E., Peckitt S., Ritchie L., Fry C., Hawkey P., Wilson A.P.R.

Citation:
Journal of Hospital Infection, January 2016, vol./is. 92/1(86-87)

 

Prevention and control of multiresistant Gram-negative bacteria: recommendations from a Joint Working Party (2016)

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Type of publication:
Journal article

Author(s):
Wilson, A P R, Livermore, D M, Otter, *J A, Warren, R E, Jenks, P, Enoch, D A, Newsholme, W, Oppenheim, B, Leanord, A, McNulty, C, Tanner, G, Bennett, S, Cann, M, Bostock, J, Collins, E, Peckitt, S, Ritchie, L, Fry, C, Hawkey, P

Citation:
The Journal of Hospital Infection, Jan 2016, vol. 92 Suppl 1, p. S1

 

Factors contributing to student nurses'/midwives' perceived competency in spiritual care (2016)

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Type of publication:
Journal article

Author(s):
Ross, Linda, Giske, Tove, van Leeuwen, René, Baldacchino, Donia, *McSherry, Wilfred, Narayanasam y, Aru, Jarvis, Paul, Schep-Akkerman, Annemiek

Citation:
Nurse education today, Jan 2016, vol. 36, p. 445-451

Abstract:
The spiritual part of life is importa nt to health, well-being and quality of life. Spiritual care is expected of nurses/midwives, but it is not clear how students can achieve competency in spiritual care at point of registration as required by regulatory bodies. To explore factors contributing to undergraduate nurses'/midwives 9; perceived competency in giving spiritual care. A pilot cross-sectional, multinational, correlational survey design. Questionnaires were completed b y 86% (n=531) of a convenience sample of 618 undergraduate nurses/midwive s from six universities in four countries in 2010. Bivariate and multivaria te analyses were performed. Differences between groups were small. Two fact ors were significantly related to perceived spiritual care competency: perc eption of spirituality/spiritual care and student's personal spiritual ity. Students reporting higher perceived competency viewed spirituality/spi ritual care broadly, not just in religious terms. This association between perceived competency and perception of spirituality is a new finding not pr eviously reported. Further results reinforce findings in the literature that own spirituality was a strong predictor of perceived ability to provide spiritual care, as students reporting higher perceived competency engaged in spiritual activities, were from secular universities and had previous healthcare experience. They were also religious, practised their faith/belief and scored highly on spiritual well-being and spiritual attitude/involvement . The challenge for nurse/midwifery educators is how they might enhance spi ritual care competency in students who are not religious and how they might encourage students who hold a narrow view of spirituality/spiritual care t o broaden their perspective to include the full range of spiritual concerns that patients/clients may encounter. Statistical models created predicted factors contributing to spiritual care competency to some extent but the picture is complex requiring further investigation involving a bigger and mor e diverse longitudinal sample.

Clinical Validation of the UKMS Register Minimal Dataset utilising Natural Language Processing (2016)

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Type of publication:
Poster presentation

Author(s):
Rod Middleton, Ashley Akbari, Hazel Lockhart-Jones, Jemma Jones, *Charlotte Owen, Stella Hughes, Richard Gain, David Ford

Citation:
IPDLNC 2016

Abstract:
Objectives
The UK MS Register is a research project that aims to capture real world data about living with Multiple Sclerosis(MS) in the UK. Launched in 2011, identified data sources were: Directly from People with MS (PwMS) via the internet, from NHS treatment centers via ‘traditional’ database capture and by linkage to routine datasets from the SAIL databank. Data received from the NHS, though ‘gold standard’ in terms of diagnosis, is dependent on clinical staff finding both time and information to enter into a clinical system. System implementations across the NHS are variable, as is clinical time. Therefore, we looked to other complementary methodologies.

Approach
The Clix enrich natural language processing (NLP) software was chosen to see if it could capture a portion of the MS Register minimum clinical dataset, the software matches clinical phrases against SNOMED-CT. 40 letters, from 2 NHS Trusts, from 28 patients were loaded. The letters were a mix of MS patients with differing disease subtypes and were dictated by Neurologists, Specialist General Practitioners and MS Specialist Nurses. 20 of the letters were in docx format and 20 as PDF.
The letters were parsed by a domain expert for clinical content, scored by data item for sensitivity and specificity. Next the output from the software was scored by another researcher to see if the 12 relevant clinical concepts from the Register dataset had been elicited. Lastly a ruleset was created to look for particular clinical concepts and scored in the same way.

Results
Of the 40 letters one failed to load, the rest were analysed for the specific data items. Date related items were clearly challenging, with only 7% of appointment dates being matched and 22% for date of diagnosis. MS Type (93.3%) and EDSS score (93.75%) were well recognised, additionally symptoms of MS that would be poorly reported in traditional databases were recognised, with fatigue being well highlighted (78.5%) and gait and walking issues (68.7%) Of concern, were a number of false positive results in DMT’s with 15% patients being identified as being on a DMT when this was just being ‘considered’.

Conclusion
The NLP pathway could be extremely useful for obtaining hard to capture clinical data for the Register. Further work is needed to reduce errors, even with the current minimal configuration, it's possible to ascertain MS Type, functional score of MS, current medication and potentially disabling symptomology within the condition.

Ultrasound guided musculoskeletal interventions: professional opportunities, challenges and the future of injection therapy (2015)

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Type of publication:
Journal article

Author(s):
Sue Innes, Mark Maybury, Alison Hall, *Gordon Lumsden

Citation:
Sonography (2015) 2(4): 84-91

Abstract:
The demand for ultrasound guided injections for musculoskeletal presentations has increased in recent years as practitioners and patients seek verification of needle position. Musculoskeletal management pathways regularly include injection therapy for pain relief and are sometimes indicated as a single intervention but may need to be supported by rehabilitation. Workload in radiology departments has expanded in volume and complexity as radiologists perform new interventional procedures that require medical expertise. Innovative responses are required to meet the demand for ultrasound guided musculoskeletal injections; one option is offering appropriate education to musculoskeletal sonographers, enabling them to extend their current scope of practice. The role of the extended scope physiotherapist in the United Kingdom provides evidence that role diversification can produce excellent patient outcomes whilst preserving financial resources. The professional, legal and clinical requirements of extending service provision to include new clinical staff presents challenges that have to be met with strong leadership and the provision of high quality education in ultrasound guided interventions. There are many indicators that the patient experience is enhanced by guiding musculoskeletal injections, and access to this service has impact on patients’ confidence in their treatment pathway.