Staff Publication

A prospective evaluation of undiagnosed joint hypermobility syndrome in patients with gastrointestinal symptoms. (2014)

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Author(s):
Fikree A, Grahame R, *Aktar R, Farmer AD, Hakim AJ, Morris JK, Knowles CH, Aziz Q

Citation:
Clinical Gastroenterology & Hepatology, 10 2014, vol./is. 12/10(1680-87.e2), 1542-3565;1542-7714 (2014 Oct)

Abstract:
BACKGROUND & AIMS: The Joint Hypermobility Syndrome (JHS) is a common connective tissue disorder characterized by joint hyperflexibility, dysautonomia, and chronic pain. Gastrointestinal (GI) symptoms are reported in JHS patients attending rheumatology clinics, but the prevalence and symptom pattern of previously undiagnosed JHS in GI clinics are unknown.METHODS: By using validated questionnaires, a prospective cross-sectional study in secondary care GI clinics estimated the prevalence of JHS in new consecutively referred patients, compared GI symptoms in patients with and without JHS, and by using multiple regression determined whether the burden of GI symptoms in JHS patients was dependent on chronic pain, autonomic, psychological, and medication related factors. A positive control group consisted of JHS patients referred from rheumatology clinics with GI symptoms (JHS-Rh).RESULTS: From 552 patients recruited, 180 (33%) had JHS (JHS-G) and 372 did not (non-JHS-G). Forty-four JHS-Rh patients were included. JHS-G patients were more likely to be younger, female with poorer quality of life (P = .02) than non-JHS-G patients. After age and sex matching, heartburn (odds ratio [OR], 1.66; confidence interval [CI], 1.1-2.5; P = .01), water brash (OR, 2.02; CI, 1.3-3.1; P = .001), and postprandial fullness (OR, 1.74; CI, 1.2-2.6; P = .006) were more common in JHS-G vs non-JHS-G. Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors.CONCLUSIONS: JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations. Copyright 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Torrential epistaxis in the third trimester: a management conundrum. (2014)

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Author(s):
Crunkhorn RE, *Mitchell-Innes A, Muzaffar J

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Although epistaxis is common during pregnancy, large volume epistaxis is rare. Many standard epistaxis management options are limited in pregnancy due to absolute or relative contraindications. Ear, nose and throat surgeons need to be aware of what options can be used safely and effectively. We present a case of a 32-year-old woman, 32 weeks pregnant, who was admitted with heavy epistaxis refractive to conservative management. Several potential interventions including bismuth iodoform paraffin paste (BIPP) and Floseal were contraindicated or involved additional risk in pregnancy necessitating unorthodox management. This challenging case highlights suitable alternatives for managing large volume epistaxis during pregnancy, as well as discussing the differential diagnosis and relevant investigations. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2014-203892.abstract

Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care. (2014)

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Author(s):
Wright, Stella, *McSherry, Wilfred

Citation:
Journal of Clinical Nursing, 01 July 2014, vol./is. 23/13/14(1866-1876), 09621067

Abstract:
Aims and objectives To demonstrate how a national programme aimed to increase the amount of direct time nurses spend with patients’, impacts on both staff and patient experience. Background The Productive Ward is an improvement programme developed by the NHS Institute for Innovation and Improvement (2007, ) which aims to enable nurses to work more efficiently by reviewing process and practice, thus releasing more time to spend on direct patient care. However, there is little empirical published research around the programme, particularly concerning impact, sustainability and the patient perspective. Design This manuscript presents the findings from qualitative interviews involving both staff and patients. Methods Semi-structured one-to-one interviews were conducted with patients ( n = 8) and staff ( n = 5) on five case study wards. Seven focus groups were held according to staff grade ( n = 29). Results Despite initial scepticism, most staff embraced the opportunity and demonstrated genuine enthusiasm and energy for the programme. Patients were generally complimentary about their experience as an inpatient, reporting that staff made them feel safe, comfortable and cared for. Conclusion Findings showed that the aims of the programme were partially met. The implementation of Productive Ward was associated with significant changes to the ward environment and improvements for staff. The programme equipped staff with skills and knowledge which acted as a primer for subsequent interventions. However, there was a lack of evidence to demonstrate that Productive Ward released time for direct patient care in all areas that implemented the programme. Relevance to clinical practice Developing robust performance indicators including a system to capture reinvestment of direct care time would enable frontline staff to demonstrate impact of the programme. Additionally, staff will need to ensure that reorganisation and instability across the NHS do not affect sustainability and viability of the Productive Ward in the long term.