Bristol, United Kingdom
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March 1, 2017 – CCube Solutions announces today that North Bristol NHS Trust has selected its electronic document management software (EDMS) to replace all paper case notes with an easy to use digital system providing instant access to patient medical records for 6,000 clinicians, nursing and administrative staff. The introduction of EDMS is part of the Trust’s phased Electronic Patient Record (EPR) strategy and will facilitate a more timely and extensive move towards creating a paperlite environment which also involves developing its EPR to reduce the amount of paper created on a daily basis. This will ensure that one of the largest hospitals in the UK serving people in Bristol, North Somerset and South Gloucestershire is paper free at the point of care – a key NHS England and Government goal. The new EDMS will enhance clinical effectiveness, reduce operational costs, ensure compliance with CQC guidance about records and data management, and ultimately boost patient safety and care. The choice of CCube Solutions’ EDMS will complement and augment the Lorenzo EPR solution – procured from CSC - which was implemented in November 2015. It is the first contract for CCube Solutions resulting from a new framework agreement with CSC announced in October 2016. This allows CSC to offer CCube’s EDMS to any Trust using Lorenzo who wishes to digitise and display information contained in paper medical records. Paper creates huge logistical challenges Currently North Bristol NHS Trust stores about 1.2 million medical folders off-site, with around 850 files being delivered to Southmead Hospital and other premises each day. The paperlite strategy will reduce costs and make the process more efficient. Neil Darvill, North Bristol NHS Trust’s director of informatics, says, “The business case for the EDMS project is predicated on a scan-on-demand model where only the patient notes for people booked to attend clinic will be processed, not everything in the library. This saves a huge amount of money given the other records will be destroyed in line with our retention policies and procedures as and when they reach their expiry dates.” Out of its total of 1.2 million folders, the Trust therefore estimates that it has 223,100 active patients who will need their records scanning. As each folder contains on average 150 sheets, this means 33,465,000 pages are likely to be scanned in total. The massive back scanning task will be outsourced to a scanning specialist. Darvill explains, “Our analysis shows that 70% of active patients have follow up appointments after an initial consultation. Once their records are scanned, it means for any subsequent visits, their records are available on the system for clinical staff to see.” Roll out will be staged with a paperlite project running in parallel North Bristol NHS Trust is currently piloting EDMS in two areas: lung cancer - a low volume high complexity clinic - and dermatology. This is the reverse - a high volume low complexity department. Based on lessons learnt, it will then adopt a phased approach to rolling out EDMS and scanning the records required – a process expected to take two years finishing in April 2019 given the volume of paperwork to digitize. In parallel, the Trust is working on a paperlite project to augment the investment in its EPR system. To date, PAS[1] functionality has been successfully implemented within Lorenzo with this now expanding to include real-time data capture. The Trust will customize Lorenzo to its own requirements, tailoring the system to match its own clinical pathways and ways of working. Darvill explains, “We simply can’t afford to keep generating paper at the pace we are given the number of patients we see - around 1,300 outpatient and 200 inpatient attendances each day. The purpose of the paperlite project is to look at how we capture clinical information immediately at the point of care rather than writing notes on paper and scanning them afterwards as this clearly defeats the purpose of putting in an EPR in the first place.” Until the paperlite initiative has evolved, so-called ‘day forward’ scanning will be managed in-house. During this period of transition, the Trust has purchased two production scanners from Kodak Alaris – the i4650 and i4850 – which process up to 130 and 150 pages per minute respectively. Kodak Capture Pro imaging software has also been selected which allows large batches of medical paperwork to be captured and indexed quickly and efficiently. It will then be imported into the CCube EDMS. An EDMS saves money and is simple for clinicians to use Capital expenditure on the CCube EDMS, Kodak Alaris scanners and capture software along with other implementation costs total £960,000. Over a four-year period, the Trust expects to save over £1.3 million in terms of the operational expenditure associated with the running of its paper-based processes and libraries. The cost savings come from closing the off-site facilities – expected by October 2018. Vijay Magon, CCube Solutions’ managing director, says, “EDMS in the NHS is all about transformation and presenting information contained on paper to clinicians in a much more efficient and effective way. Ease of use is crucial. Doctors have to be able to interact with the system in front of patients without it creating any unnecessary delays which could make consultations longer. Usability and effectiveness is very important which is what you get with CCube software.” About CSC Computer Sciences Corporation (NYSE: CSC) leads clients on their digital transformation journeys. The company provides innovative next-generation technology services and solutions that leverage deep industry expertise, global scale, technology independence and an extensive partner community. CSC serves leading commercial and international public sector organizations, including some of the world’s leading healthcare providers. CSC is a Fortune 500 company and ranked among the best corporate citizens. For more information, visit www.csc.com and www.csc.com/healthcare. About CCube Solutions CCube Solutions is an award-winning provider of enterprise content management solutions, comprising electronic document and records management, workflow, electronic forms, portal software, and systems integration. Founded in 1995, it has a proven track record working with the police, local government, NHS and in the private sector providing cost effective and scalable solutions, tailored to meet the individual requirements of customers. An AIIM Advisory Board member, CCube Solutions is active in developing and guiding the future direction of the ECM industry, and upholds AIIM’s principles of good information management, know-how applied on every customer engagement. CCube Solutions is headquartered in Milton Keynes. For further information, please visit www.ccubesolutions.com For further information, please contact Tom Herbst Tom Herbst PR T: 07768 145571 Email: tom@tomherbstpr.co.uk


Blackburn J.,Southmead Hospital | Mansell J.P.,Southmead Hospital
Bone | Year: 2012

Lysophosphatidic acid (LPA) is the simplest signalling lipid eliciting pleiotropic actions upon most mammalian cell types. Although LPA has an established role in many biological processes, particularly wound healing and cancer, the participation of LPA in skeletal biology is just beginning to emerge. Early studies, identified in this review, gave a solid indication that LPA, via binding to one of several cell surface receptors, activated multiple intracellular systems culminating in altered cell morphology, growth, motility and survival. More recently the ablation of murine LPA1 and 4 receptors implies that this lipid has a role in skeletal development and post natal bone accrual. Greater understanding of the ability of LPA to influence, for example, osteoblast growth, maturation and survival could be advantageous in developing novel strategies aimed at improving skeletal tissue repair and regeneration. Herein this review provides an insight into the diversity of studies exploring the actions of a small lipid on those major cell types key to skeletal tissue health and homeostasis. © 2011 Elsevier Inc.


This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2009 and the acceptance rates for RRT in Primary Care Trusts and Health Boards (PCT/HBs) in the UK. The basic demographics and clinical characteristics are reported on patients starting RRT from all UK renal centres. Late presentation, defined as time between first being seen by a nephrologist and start of RRT being <90 days was also studied. Age and gender standardised ratios for acceptance rates in PCT/HBs were calculated. In 2009, the incidence rate in the UK and England was 109 per million population (pmp). Acceptance rates in Scotland (104 pmp), Northern Ireland (88 pmp) and Wales (120 pmp) had all fallen although Wales still remained the country with the highest acceptance rate. There were wide variations between PCT/HBs with respect to the standardised ratios. The median age of all incident patients was 64.8 years (IQR 50.8, 75.1). For transplant centres this was 63.0 years (IQR 49.0, 74.2) and for non-transplanting centres 66.3 years (IQR 52.6, 75.9). The median age for non-Whites was 57.1 years. Diabetic renal disease remained the single most common cause of renal failure (25%). By 90 days, 69.1% of patients were on haemodialysis, 17.7% on peritoneal dialysis, 6.7% had had a transplant and 6.5% had died or stopped treatment. The mean eGFR at the start of RRT was 8.6 ml/min/1.73 m2 which was similar to the previous two years. Late presentation (<90 days) has fallen from 27% in 2004 to 19% in 2009. There was no relationship between social deprivation and presentation pattern. Acceptance rates have fallen in Northern Ireland, Scotland and Wales whilst they have plateaued in England over the last four years. Wales continued to have the highest acceptance rate of the countries making up the UK. Copyright © 2011 S. Karger AG, Basel.


Mathieson P.W.,Southmead Hospital
Nature Reviews Nephrology | Year: 2012

Injury to the podocyte results in proteinuria and often leads to progressive kidney disease. As podocytes have limited ability to repair and/or regenerate, the extent of podocyte injury is a major prognostic determinant in diabetic nephropathy and other common causes of end-stage renal disease. Therapies aimed at preventing or limiting podocyte injury and/or at promoting podocyte repair or regeneration therefore have major potential clinical and economic benefits. Many current therapies-including glucocorticosteroids and calcineurin antagonists-have potent effects on podocytes. The nonspecific natures of these agents lead to undesirable systemic adverse effects: an agent with a more specific focus on podocytes would cause less treatment-associated morbidity. Recent years have seen dramatic advances in our understanding of podocyte biology and in particular regulation of its actin cytoskeleton, the major determinant of the complex architecture on which these cells depend for their function. This advance has allowed the identification of potential therapeutic targets and the next few years should see the development and testing of specific therapies aimed at the podocyte. Thus we are about to move from a situation where some of our 'blunderbuss' older therapies fortuitously happened to have beneficial effects on podocytes to a new era where advances in biological knowledge about a key cell type in the kidney will allow targeted drug design. As well as being intellectually more satisfying, every reason exists to believe that patients of the future will benefit and that the scourge of progressive kidney disease will be more effectively tackled. © 2011 Macmillan Publishers Limited. All rights reserved.


Saleem M.A.,Southmead Hospital
Pediatric Nephrology | Year: 2013

Nephrotic syndrome is a disorder of the glomerular filtration barrier, a highly specialised tri-layer structure with unique functional properties. Recent advances emanating from the field of molecular genetics have revealed the podocyte as probably the central player in the control of glomerular filtration. More specifically, the cell-cell junction between adjacent podocyte foot processes, namely, the slit diaphragm, has been revealed to be made up of a sophisticated multi-protein complex which dynamically controls foot process architecture via signalling to the actin cytoskeleton. Key genes that have been identified from the study of inherited nephrotic syndromes include those encoding nephrin, podocin, TRPC6 (transient receptor potential canonical channel-6) and α-actinin-4, and more remain to be found. It is now possible to identify genetic causes underlying a proportion of nephrotic syndromes presenting at any age. The next big challenge for clinicians and researchers is to translate the molecular information learnt into the understanding of acquired, non-inherited forms of the disease and to guide therapeutic options. In this regard several exciting advances have been made, both in understanding the molecular mechanisms of current therapies and in revealing circulating plasma factors and the molecular pathways they trigger in the podocyte, that could be targeted by novel therapies. © 2012 IPNA.


RRT incidence rates and the proportion of patients using a home dialysis modality (peritoneal or home haemodialysis) varies widely between centres and persists even after area differences in age, ethnicity and social deprivation structure are taken into account. A nationwide survey was undertaken to identify possible drivers of this variation. A systematic literature review followed by a two-stage Delphi consensus technique was employed to identify renal centre characteristics and practice patterns that may be important in determining either RRT incidence or home modality usage. All 72 (100%) of UK adult renal centres responded. Questions about staffing numbers, interface with primary care, interface with other secondary care sites, capacity within the HD programme, constituents of pre-dialysis education programmes, conservative management programmes, range of treatments available, dialysis access and training and physician attitudes to home modalities were included. There was wide variation in practice patterns and centre characteristics across the UK. Overall, physician enthusiasm for home dialysis modalities was greater than the actual usage of home dialysis. Copyright © 2011 S. Karger AG, Basel.


Cuzick J.,Queen Mary, University of London | Sestak I.,Queen Mary, University of London | Cawthorn S.,Southmead Hospital | Hamed H.,Guys and St Thomas Hospital | And 3 more authors.
The Lancet Oncology | Year: 2015

Background: Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. Methods: In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35-70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928. Findings: Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16·0 years (IQR 14·1-17·6), 601 breast cancers have been reported (251 [7·0%] in 3579 patients in the tamoxifen group vs 350 [9·8%] in 3575 women in the placebo group; hazard ratio [HR] 0·71 [95% CI 0·60-0·83], p<0·0001). The risk of developing breast cancer was similar between years 0-10 (226 [6·3%] in 3575 women in the placebo group vs 163 [4·6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0·72 [95% CI 0·59-0·88], p=0·001) and after 10 years (124 [3·8%] in 3295 women vs 88 [2·6%] in 3343, respectively; HR 0·69 [0·53-0·91], p=0·009). The greatest reduction in risk was seen in invasive oestrogen receptor-positive breast cancer (HR 0·66 [95% CI 0·54-0·81], p<0·0001) and ductal carcinoma in situ (0·65 [0·43-1·00], p=0·05), but no effect was noted for invasive oestrogen receptor-negative breast cancer (HR 1·05 [95% CI 0·71-1·57], p=0·8). Interpretation: These results show that tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit-to-harm ratio of the drug for breast cancer prevention. © 2015 Cuzick et al. Open Access article distributed under the terms of CC BY.


Abrams P.,Southmead Hospital
Journal of Urology | Year: 2013

Purpose: The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease. Materials and Methods: A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system. Results: The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms. Conclusions: The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used. © 2013 American Urological Association Education and Research, Inc.


This chapter describes the characteristics of adult patients on renal replacement therapy (RRT) in the UK in 2009. The prevalence rates per million population (pmp) were calculated for Primary Care Trusts in England, Health and Social Care Areas in Northern Ireland, Local Health Boards in Wales and Health Boards in Scotland. These areas will be referred to in this report as 'PCT/HBs'. Data were electronically collected from all 72 renal centres within the UK. A series of cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent RRT patients in 2009 at centre and national level. Age and gender standardised ratios for prevalence rates in PCT/HBs were calculated. There were 49,080 adult patients receiving RRT in the UK on 31st December 2009, equating to a UK prevalence of 794 pmp. This represented an annual increase in prevalent numbers of approximately 3.2% although there was significant variation between centres and PCT/HB areas. The growth rate from 2008 to 2009 for prevalent patients by treatment modality in the UK was 4.2% for haemodialysis (HD), a fall of 7.2% for peritoneal dialysis (PD) and a growth of 4.4% with a functioning transplant. There has been a slow but steady decline in the proportion of PD patients from 2000 onwards. Median RRT vintage was 5.4 years. The median age of prevalent patients was 57.7 years (HD 65.9 years, PD 61.2 years and transplant 50.8 years). For all ages, prevalence rates in males exceeded those in females: peaks for males were in the 75-79 years age group at 2,632 pmp and for females in the 70-74 years age group at 1,445 pmp. The most common identifiable renal diagnosis was biopsy-proven glomerulonephritis (16.0%), followed by diabetes (14.7%). Transplantation was the most common treatment modality (48%), HD in 44% and PD 8%. However, HD was increasingly common with increasing age and transplantation less common. The HD and transplant population continued to expand whilst the PD population contracted. There were national, regional and dialysis centre level variations in prevalence rates. This has implications for service planning and ensuring equity of care for RRT patients. Copyright © 2011 S. Karger AG, Basel.


Bradley M.,Southmead Hospital
Clinical Radiology | Year: 2012

Aim: To outline the pitfalls for image-guided percutaneous removal of foreign bodies (FBs). Materials and methods: Three hundred and fifty prospective patients were referred for ultrasound imaging for FB diagnosis and percutaneous removal during 2008-2010. Those patients with suitable FBs were offered guided percutaneous removal. The procedural methods and difficulties were recorded and all outcomes were noted, including surgical success and complications. Results: Sixty-three patients had a negative ultrasound for FB and they were discharged with no subsequent attendances. Of the remaining 287 patients, 12 were deemed unsuitable for percutaneous removal, 15 attempted percutaneous removals failed, and eight were not attempted due to lack of symptoms. The remaining 252 patients underwent successful retrieval and there were no procedural complications. The procedural limitations were mainly related to the anatomical site, type of FB, instrumentation, bubbles, ultrasound beam width, and mobility of the FB. Conclusion: Ultrasound-guided percutaneous removal of FBs is a safe and viable approach to the management of FBs achieving at least 88% success overall and with attention to the pitfalls, the learning curve should improve the success rate. © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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