Royal Berkshire NHS Foundation Trust

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United Kingdom

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News Article | February 15, 2017
Site: www.newscientist.com

The future of healthcare could be in your pocket. Two new medical apps that help people monitor their health at home, reducing their need to visit a doctor, are set to be rolled out to as many as four UK National Health Service trusts over the next year. The apps, which are currently being trialled in four hospitals in Oxfordshire, UK, transmit patient data from a tablet or smartphone directly to clinicians. According to Ilan Lieberman, a member of the Royal Society of Medicine’s council on telemedicine and e-health, such apps will have a huge impact on the management of chronic diseases. One system, called GDm-health, helps manage the treatment of gestational diabetes – a condition that affects about 1 in 10 pregnant women. The smartphone app lets women send each blood glucose reading they take at home to their diabetes clinician. “Now when a diabetes midwife logs on between clinics, she will see all the patients who are most in need of attention,” says Lionel Tarassenko, of the Oxford University Institute of Biomedical Engineering, who led the development of the technology. A two-year trial at the Royal Berkshire NHS Foundation Trust found that the system meant that patients didn’t need to go in person to the clinic as often, reducing the number of patient visits by 25 per cent. “We’ve got three trusts wanting to install this for their gestation diabetes management,” Tarassenko says, but his research group is too small to support any more trials. To overcome this hurdle, Drayson Technologies, owned by entrepreneur and Labour peer Paul Drayson, is setting up a team of developers and support staff based in Oxford, UK, to commercialise it. The team will manage the rollout of this technology – as well as two other apps – at up to four as-yet-unnamed NHS trusts within a year. Beyond that, Drayson says he plans to eventually offer these products to the entire NHS. “This technology enables patients to go home and then be able to safely monitor their condition and be well connected back to the hospital,” Drayson says. Charles Lowe, managing director of the Digital Health and Care Alliance, says that these smartphone apps make it easier for patients to manage their conditions while carrying on with their daily routines. Another system being rolled out by Drayson Technologies, also developed by the Oxford University Insittute of Biomedical Engineering, is for managing chronic obstructive pulmonary disease (COPD), a condition that affects between 1 million and 1.5 million people in the UK. Patients with COPD use a finger probe to measure their heart rate and blood oxygen saturation every day and enter the results into an app. After three months of measurements, the app learns to recognise a patient’s specific range of normal oxygen saturation levels, and issues an alert to clinicians when the measurement falls below that range. “It is very important that the analysis adapts to individuals,” says Tarassenko. If the system is too sensitive, it will send too many alerts to clinicians, but if it’s not sensitive enough, it might miss problems. In a 12-month clinical trial, the app reduced hospital admissions by 17 per cent and GP visits by 40 per cent. “Patients are much more confident about managing themselves and are getting into trouble far less often,” Tarassenko says. A third product ready for rollout, called SEND, is an iPad app used by nurses to input details about patients’ vital signs as they make their rounds of the wards. It automatically calculates an early warning score based on the vital signs, giving an indication if the patient is deteriorating. Rury Holman, at the Oxford Biomedical Research Centre, thinks the NHS trials are the right way forward. Although smartphone app stores are already crammed full of medical apps designed to manage all kinds of conditions, he believes that if similar apps are going to be used in the UK healthcare system, it’s vital they are developed in close collaboration with the NHS. “It’s a bit like the Wild West out there with lots of keen and very motivated people producing these apps,” he says. “What we need are consistent standards and an interface with electronic patient records, particularly with the NHS, so that information, with permission from the patients, can be put to use centrally.” But approaches like this can raise privacy concerns. Last year, New Scientist revealed details of a data-sharing agreement between the NHS and Google’s DeepMind that gave the company access to healthcare data on 1.6 million patients including details of drug overdoses and abortions. Since late 2015, the AI company has been developing a healthcare app, Streams, that monitors the health of people with acute kidney injury. According to Tarassenko, his diabetes and lung disease apps only have access to information relating specifically to those conditions. The measurements sent to clinicians via the app are fed into existing patient records, but that process takes place outside of the app, within the NHS’s central patient record systems. Developing these apps has taken eight years, but Tarassenko says securing the appropriate ethical clearance and building up a clear evidence base for their use is a critical, journey. “It’s been very important for us to have credibility with our clinical colleagues, and we will continue to do that because it’s designed in the NHS, for the NHS.”


Foulkes M.,Royal Berkshire NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2013

Oral cancer occurs in a range of anatomical sites within the oral cavity and pharynx. Although oral cancer is relatively rare in the UK, it can have a significant effect on individuals, with treatment being associated with eating, drinking, speaking and breathing difficulties. Treatment may also result in alterations to body image and functionality, which can lead to depression. Therefore, nurses need to have knowledge of associated risk factors, treatment and nursing care to improve patient outcomes and enhance quality of life.


Sharma V.,Royal Berkshire NHS Foundation Trust | Verghese C.,Royal Berkshire NHS Foundation Trust | McKenna P.J.,Royal Berkshire NHS Foundation Trust
British Journal of Anaesthesia | Year: 2010

Background. The LMA-Supreme™ (SLMA) is a single-use, latex-free, supraglottic airway device with a drain tube which allows immediate assessment of correct positioning of the device at insertion and throughout the procedure and provides access to gastric contents. The anatomically shaped airway tube facilitates easy insertion in anaesthetized patients in the supine, lateral, and prone positions. We present a prospective audit in 205 consecutive adult patients presenting for elective spine surgery in the prone position. Patients positioned themselves in the prone position, on a Montreal or Wilson mattress to optimize patient comfort in this position. Anaesthesia was then induced, and an appropriate-sized SLMA was inserted. Methods. Prospective, descriptive audit of SLMA insertion in 205 consecutive adult patients, anaesthetized in the prone position for elective orthopaedic surgery with spontaneous (n=6) or positive pressure ventilation (PPV) (n=199). Results. First-pass success was achieved in 184 insertions. Forty-two SLMA insertions were performed by anaesthesia trainees with first-pass success achieved in 38 insertions. All problems encountered during insertion were minor, and no patient had to be turned to the supine position for an airway problem. Problems during insertion were independent of patients' BMI. There were no failures of SLMA insertion or of maintenance of PPV during surgery. Conclusions. The Results. suggest that the SLMA is a useful device for airway management in patients anaesthetized in the prone position and for subsequent airway management with PPV, with or without neuromuscular block. © The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.


Dua J.,Royal Berkshire NHS Foundation Trust | Clayton R.,Royal Berkshire NHS Foundation Trust
Australasian Journal of Dermatology | Year: 2014

We report a unique case of ascending cutaneous lymphangitis in a 72-year-old immunocompromised man from which a newly described Nocardia species was isolated by 16S ribosomal gene sequencing. Treatment with trimethoprim-sulfamethoxazole resulted in successful resolution of symptoms. To the best of our knowledge, this is the first case report of N. veterana implicated in causing ascending cutaneous lymphangitis. © 2013 The Authors Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.


Haviland J.S.,The Institute of Cancer Research | Haviland J.S.,University of Southampton | Owen J.R.,Cheltenham General Hospital | Dewar J.A.,Ninewells Hospital | And 14 more authors.
The Lancet Oncology | Year: 2013

Background: 5-year results of the UK Standardisation of Breast Radiotherapy (START) trials suggested that lower total doses of radiotherapy delivered in fewer, larger doses (fractions) are at least as safe and effective as the historical standard regimen (50 Gy in 25 fractions) for women after primary surgery for early breast cancer. In this prespecified analysis, we report the 10-year follow-up of the START trials testing 13 fraction and 15 fraction regimens. Methods: From 1999 to 2002, women with completely excised invasive breast cancer (pT1-3a, pN0-1, M0) were enrolled from 35 UK radiotherapy centres. Patients were randomly assigned to a treatment regimen after primary surgery followed by chemotherapy and endocrine treatment (where prescribed). Randomisation was computer-generated and stratified by centre, type of primary surgery (breast-conservation surgery or mastectomy), and tumour bed boost radiotherapy. In START-A, a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 41·6 Gy or 39 Gy in 13 fractions over 5 weeks. In START-B, a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 40 Gy in 15 fractions over 3 weeks. Eligibility criteria included age older than 18 years and no immediate surgical reconstruction. Primary endpoints were local-regional tumour relapse and late normal tissue effects. Analysis was by intention to treat. Follow-up data are still being collected. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59368779. Findings: START-A enrolled 2236 women. Median follow-up was 9·3 years (IQR 8·0-10·0), after which 139 local-regional relapses had occurred. 10-year rates of local-regional relapse did not differ significantly between the 41·6 Gy and 50 Gy regimen groups (6·3%, 95% CI 4·7-8·5 vs 7·4%, 5·5-10·0; hazard ratio [HR] 0·91, 95% CI 0·59-1·38; p=0·65) or the 39 Gy (8·8%, 95% CI 6·7-11·4) and 50 Gy regimen groups (HR 1·18, 95% CI 0·79-1·76; p=0·41). In START-A, moderate or marked breast induration, telangiectasia, and breast oedema were significantly less common normal tissue effects in the 39 Gy group than in the 50 Gy group. Normal tissue effects did not differ significantly between 41·6 Gy and 50 Gy groups. START-B enrolled 2215 women. Median follow-up was 9·9 years (IQR 7·5-10·1), after which 95 local-regional relapses had occurred. The proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy group (4·3%, 95% CI 3·2-5·9) and the 50 Gy group (5·5%, 95% CI 4·2-7·2; HR 0·77, 95% CI 0·51-1·16; p=0·21). In START-B, breast shrinkage, telangiectasia, and breast oedema were significantly less common normal tissue effects in the 40 Gy group than in the 50 Gy group. Interpretation: Long-term follow-up confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer. The results support the continued use of 40 Gy in 15 fractions, which has already been adopted by most UK centres as the standard of care for women requiring adjuvant radiotherapy for invasive early breast cancer. Funding: Cancer Research UK, UK Medical Research Council, UK Department of Health. © 2013 Elsevier Ltd.


Odell M.,Royal Berkshire NHS Foundation Trust
Journal of Clinical Nursing | Year: 2015

Aims and objectives: To audit ward nursing practice in the adherence to an early warning scoring protocol in the detection and initial management of the deteriorating ward patient and investigate factors that may impact on practice. Background: Hospital inpatients can experience unexpected physiological deterioration leading to poor outcomes and death. Although deterioration can be signalled in the patients' physiological symptoms, evidence suggests that ward staff can miss, misinterpret or mismanage the signs. Rapid response systems have been implemented to address this problem. The rapid response systems consists of two phases: the afferent phase involves monitoring the patient, recognising deterioration and referring to more expert help and the efferent phase involves expert teams assessing and treating the patient. Research has tended to concentrate on the efferent phase of the process and has so far failed to show a significant impact on patient outcome. Methods: Using cardiac arrest as a surrogate marker for deterioration, patient records were retrospectively reviewed during the 12 hours prior to the cardiac arrest event. Data relating to nursing practice and adherence to the early warning scoring protocol were extracted and analysed. Findings: The findings suggest that ward nurses' monitoring of patients' observations has improved compared with earlier research, but errors in early warning scoring and nonadherence to referral protocols are still a problem. A number of potentially influential factors on nursing practice were tested, but only deterioration occurring outside normal weekdays was associated with a reduced quality of nursing adherence to protocol. Conclusions: The implementation of rapid response systems may have been an oversimplified solution to the highly complex problem of undetected patient deterioration. There are a multitude of contributory factors to the problem of noncompliance to early warning scoring protocols, and possible solutions will need to reflect the breadth, depth and complexity of the problem if we are to improve patient experience and outcome. Relevance to clinical practice: An audit of nursing practice against an early warning scoring protocol based on national recommendations and standards in the recording of and response to physiological deterioration in the ward patient has shown that vital signs recording has improved, but early warning scoring accuracy and referral to more expert help remain suboptimal. By identifying areas of suboptimal practice, strategies for education and training and service development can be better informed. More in-depth evidence on factors that may impact the quality of nursing practice has been identified. Problems with rapid response systems assumptions have been highlighted, which may facilitate the implementation of more realistic solutions for managing the deteriorating ward patient. © 2014 John Wiley & Sons Ltd.


Foulkes M.,Royal Berkshire NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2011

Nursing metrics have been used increasingly in UK health services over the past two years to measure and improve nursing performance and to aid commissioners in linking funding to quality. This article provides an introduction to nursing metrics, including some of the nurse-sensitive indicators and the background to their development. It also provides examples of how metrics are used in practice to improve the care and experience of patients.


Abram S.G.F.,Royal Berkshire NHS Foundation Trust | Pollard T.C.B.,Royal Berkshire NHS Foundation Trust | Andrade A.J.M.D.,Royal Berkshire NHS Foundation Trust
Bone and Joint Journal | Year: 2013

The Gamma nail is frequently used in unstable peri-trochanteric hip fractures. We hypothesised that mechanical failure of the Gamma nail was associated with inadequate proximal three-point fixation. We identified a consecutive series of 299 Gamma nails implanted in 299 patients over a five-year period, 223 of whom fulfilled our inclusion criteria for investigation. The series included 61 men and 162 women with a mean age of 81 years (20 to 101). Their fractures were classified according to the Modified Evans' classification and the quality of fracture reduction was graded. The technical adequacy of three points of proximal fixation was recorded from intra-operative fluoroscopic images, and technical inadequacy for each point was defined. All patients were followed to final follow-up and mechanical failures were identified. A multivariate statistical analysis was performed, adjusting for confounders. A total of 16 failures (7.2%) were identified. The position of the lag screw relative to the lateral cortex was the most important point of proximal fixation, and when inadequate the failure rate was 25.8% (eight of 31: odds ratio 7.5 (95% confidence interval 2.5 to 22.7), p < 0.001). Mechanical failure of the Gamma nail in peri-trochanteric femoral fractures is rare (< 1%) when three-point proximal fixation is achieved. However, when proximal fixation is inadequate, failure rates increase. The strongest predictor of failure is positioning the lateral end of the lag screw short of the lateral cortex. Adherence to simple technical points minimises the risk of fixation failure in this vulnerable patient group. ©2013 The British Editorial Society of Bone & Joint Surgery.


Grant
Agency: GTR | Branch: EPSRC | Program: | Phase: Research Grant | Award Amount: 708.30K | Year: 2014

According to statistics from charities such as Every Eight Hours and Spinal Research, there are an estimated 40,000 spinal cord injured people in the UK and a new person is injured every eight hours. Many primary causes of death are now no longer direct results of spinal cord injury but are conditions linked to age and inactivity. This means that there are long-term demands on medical support; in particular, treatment of osteoporotic bone fractures often results in lengthy spells in hospital for individuals with spinal cord injury. It is therefore important to minimize the effect of osteoporosis after spinal cord injury; this highlights the need for exercise programmes to target bone health. The proposed research aims to develop effective Functional Electrical Stimulation (FES) induced weight bearing exercises to improve and maintain bone health in the lower extremities of spinal cord injury patients. The type of exercises proposed will be completed using a novel smart standing frame and FES system to cyclically activate different sets of muscles whilst maintaining standing and crouch poses. The hypothesis is that these exercises will induce sufficient joint contact forces to be beneficial for bone health in the ankle, knee and hip joints. Using biomechanical modelling software an optimal combination of these exercises will be sought in order to design a rehabilitation programme to target bone health. To be beneficial to bone health, these exercises need to be repeated several times a week and there is a good chance patients will get bored or frustrated doing the same thing every day. To solve this problem, rehabilitation aids will be developed to keep patients motivated. These aids will use video game technology (based on the Xbox Kinect), to make the sessions more engaging for the patient to encourage compliance and give a sense of achievement. This will also allow the patient and clinician to monitor the progress of a rehabilitation programme and modify it as necessary.


Grant
Agency: GTR | Branch: STFC | Program: | Phase: Research Grant | Award Amount: 46.81K | Year: 2014

Radiotherapy treatment is delivered to over half of cancer patients, and due to the ageing population and lifestyle factors the prevalence of cancer is rising. EPIDs (electronic portal imaging devices) are used during the treatment delivery process to control patient set-up and positioning. The demand for accurate treatment verification has led to the possibility of using EPIDs to acquire dosimetric information. Recent government guidelines require that each radiotherapy centre should have protocols for in vivo dosimetry monitoring and that it should be used at the beginning of treatment for most patients. Within the radiotherapy physics community EPID dosimetry is widely seen to have the potential to become an accurate and efficient means of large-scale patient specific in-vivo dose verification for Intensity Modulated RadioTherapy at any radiotherapy department. Current EPID technology is based upon passive amorphous silicon flat panel imagers. In this proposal we plan to investigate the application of next generation sensor technology, developed by the STFC CMOS Sensor Design Group, which has both superior image quality and active functionality. We propose to carry out a feasibility study with a long-term view to developing the following transit dosimetry technology: a large area, ultra high image quality flat panel imager displaying real-time, calibrated dose map updates throughout treatment delivery. The core of the system will be an STFC developed CMOS Active Pixel Sensor. It will not only introduce large area, radiation hard CMOS technology to EPID systems but will go a significant step further and introduce next generation Active Pixel Sensor technology.

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