East and North Herts NHS Trust

United Kingdom

East and North Herts NHS Trust

United Kingdom
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Guy H.,East and North Herts NHS Trust | Guy H.,University of Hertfordshire | Gilroy P.,West Hertfordshire Hospitals NHS Trust | Downie F.,Papworth Hospital NHS Foundation Trust | Downie F.,Anglia Ruskin University
Wounds UK | Year: 2013

The current attention on pressure ulcer (PU) prevention has been welcomed by tissue viability nurses in the UK. However, it has also created a need for clarity and a deeper understanding around what is, and what is not, a PU as well as a need to define when PU development may be unavoidable. Two areas in PU development that remain difficult to prevent and classify as avoidable or unavoidable are suspected deep tissue injuries (SDTIs), and device-related pressure ulcers (DRPUs). The aim of this article is to provoke debate around these two complex areas of skin damage. In terms of serious incident reporting, and associated financial penalties or reimbursements, it is important to distinguish correctly if SDTIs and DRPUs are PUs, or something quite different. Therefore, it is imperative to investigate, define, and classify these lesion types correctly, based on robust evidence.


Downie F.,Papworth Hospital NHS Foundation Trust | Downie F.,Anglia Ruskin University | Guy H.,East and North Herts NHS Trust | Guy H.,University of Hertfordshire | And 3 more authors.
Wounds UK | Year: 2013

In 1987, 1988, and 1998, Hibbs asserted her hypothesis that 95% of pressure ulcers (PUs) are preventable. But until recently, few UK healthcare organisations have collected data on PU incidence - or the avoidability or otherwise of the damage. In 2012, NHS Midlands and East launched a campaign to eliminate avoidable grade 2-4 PUs by year end. Five hospitals within NHS Midlands and East pooled data collected between April 2012 and March 2013 on hospital-acquired grade 3-4 PUs and found the percentage of avoidable PUs to be less than half Hibbs' figure of 95%.


Wilkinson E.,University of Bedfordshire | Randhawa G.,University of Bedfordshire | Brown E.A.,Imperial College Healthcare NHS Trust | Da Silva Gane M.,East and North Herts NHS Trust | And 6 more authors.
Journal of Renal Care | Year: 2014

South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.


PubMed | University of Bedfordshire, Imperial College London, University of Leicester, Bradford Teaching Hospitals NHS Foundation Trust and East and North Herts NHS Trust
Type: | Journal: BMC palliative care | Year: 2016

Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes(T2DM) and end stage kidney failure(ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting.The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here.Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriersand informal carers roles in mediating communication; and contrasting cultures in end of life kidney care.Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.


Lamb B.W.,Imperial College London | Lamb B.W.,University of London | Taylor C.,King's College London | Lamb J.N.,East and North Herts. NHS Trust | And 4 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Multidisciplinary teams (MDTs) are the standard means of making clinical decisions in surgical oncology. The aim of this study was to explore the views of MDT members regarding contribution to the MDT, representation of patients' views, and dealing with disagreements in MDT meetings - issues that affect clinical decision making, but have not previously been addressed. Methods: Responses to open questions from a 2009 national survey of MDT members about effective MDT working in the United Kingdom were analyzed for content. Emergent themes were identified and tabulated, and verbatim quotes were extracted to validate and illustrate themes. Results: Free-text responses from 1,636 MDT members were analyzed. Key themes were: (1) the importance of nontechnical skills, organizational support, and good relationships between team members for effective teamworking; (2) recording of disagreements (potentially sharing them with patients) and the importance of patient-centered information in relation to team decision making; (3) the central role of clinical nurse specialists as the patient's advocates, complementing the role of physicians in relation to patient centeredness. Conclusions: Developing team members' nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration. © 2012 Society of Surgical Oncology.


Singh D.K.,Lister Hospital | Winocour P.,LMC Diabetes & Endocrinology | Summerhayes B.,LMC Diabetes & Endocrinology | Viljoen A.,East and North Herts NHS Trust | And 2 more authors.
Acta Diabetologica | Year: 2010

The aim of this study is to establish whether abnormal mineral metabolism is present in patients with type 1 DM with normal renal function and in the absence of microalbuminuria. Serum levels of 1,25-dihydroxyvitamin D, osteoprotegerin (OPG) and receptor activator for nuclear factor kappa β ligand (RANKL) and other determinants of bone metabolism were measured in 35 patients with type 1 DM and in 25 age-, sex- and ethnicity-matched healthy controls. Serum OPG (1.98 vs. 2.98 pmol/l: P = 0.001), 1,25-dihydroxyvitamin D (41.1 vs. 48.2 pmol/l: P = 0.035) and magnesium (0.84 vs. 0.89 mmol/l P = 0.029) levels were significantly lower in patients with type 1 DM compared to normal controls. RANKL levels were similar in both groups. The groups did not differ with respect to calcium, phosphate, PTH, 25-hydroxyvitamin D, tubular reabsorption of phosphate and cross-linked N-telopeptides of type 1-collagen levels. Abnormalities of mineral metabolism including low serum OPG and 1,25-dihydroxyvitamin D levels occur in patients with type 1 DM with normal renal function and in the absence of microalbuminuria. These abnormalities may promote altered bone metabolism and vascular pathology. © 2009 Springer-Verlag.


Singh D.K.,Renal Unit | Winocour P.,East and North Herts NHS Trust | Summerhayes B.,East and North Herts NHS Trust | Kaniyur S.,East and North Herts NHS Trust | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2012

Aims: To determine predictors of prevalence and progression of peripheral vascular calcification (VC) in type 2 diabetes (DM) subjects with preserved kidney function. Methods: Fifty-eight subjects (age 63 ± 11.6 years) with type 2 DM and serum creatinine <125. μmol/l were studied. A CT scan of femoral, posterior tibial and dorsalis pedis arteries was carried out at baseline and at one year. Serum osteoprotegerin (OPG) and RANKL were measured along with routine biochemistry. Results: Seventy-eight percent of patients had baseline VC, 47% with femoral VC, 49% with VC at two sites - femoral and foot, and 4% foot VC alone. Age, ethnicity, peripheral neuropathy and eGFR were independent predictors of baseline VC. Baseline calcification was the most important predictor of VC progression and was present in all subjects with progression compared to 35% of non-progressors (p<0.001). Exclusion of demographic factors from models revealed neuropathy and serum OPG levels as independent predictors of both; baseline VC and progression. Conclusions: Subjects with type 2 DM and well-preserved renal function had a high prevalence of VC, which was rapidly progressive especially in those with baseline VC. Age, ethnicity, neuropathy, smoking and eGFR were predictors of baseline VC and progression. © 2012 Elsevier Ireland Ltd.


Winocour P.H.,East and North Herts NHS Trust
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2014

There is increasing recognition that type 1 diabetes mellitus (T1DM) acquired in childhood and adolescence requires a sophisticated approach that facilitates better self-management through adherence to generic principles in managing chronic disease in this age group, allied to the complex clinical needs of managing T1DM and related conditions. Transitional care should be seen as a process over time supported by both paediatric and adult diabetologists within a multidisciplinary team, given the complementary skills that can be brought to bear. Undoubtedly, there is a need for more effective training of all healthcare professionals working in this service. However, the accumulation of older teenagers over time and new diagnoses in those aged 19 years or more confirms that a new paradigm is necessary for the successful care of young adults beyond transitional care. Traditional clinical models will often not work for those in employment and higher education, with evidence that ongoing engagement following transfer to adult services often ceases. The alarming evidence of progressive complications in T1DM of longer duration in patients under the age of 40 years is a wake-up call to transform the care of this most vulnerable group. © Royal College of Physicians 2014. All rights reserved.


PubMed | East and North Herts NHS Trust.
Type: Journal Article | Journal: British journal of nursing (Mark Allen Publishing) | Year: 2011

Tissue viability nurses (TVNs) have always been interested in pressure ulcers. Many found our way into the specialism because of this interest and passion. We have always believed most of them could be prevented and our desire, our goal has been to prevent all avoidable pressure ulcers.


Kouchard J.,East and North Herts NHS Trust
British Journal of Oral and Maxillofacial Surgery | Year: 2013

Over a three-year period we devised, developed, and implemented a simple proforma, validated by a previous audit, to improve the accuracy of data collected on maxillofacial trauma. It covers both sides of an A4 sheet and functions as an aide-memoire for junior staff and prompts the comprehensive recording of all necessary medicolegal details should further documentation be required by the police, judiciary, or compensatory body. © 2012 The British Association of Oral and MaxilloFacial Surgeons. All rights reserved.

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