Purran A.,Whittington Health |
Weller G.,Middlesex University |
Kerr C.,Middlesex University
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2016
An integrated care organisation requires a flexible workforce with a variable skill mix in all care settings. Organisations should ensure that education and training are maintained to support safe, high quality care that provides value for money, promotes flexibility, and increases workforce participation in achieving organisation objectives and the expansion of services. Peripherally inserted central catheter (PICC) care was identified as a challenging area for the nursing workforce in acute care and community services, following the integration and service enlargement of the Whittington Health NHS Trust. This article describes the evaluation of a new PICC care training programme that was developed and implemented to increase knowledge and awareness. The evaluation provides the clinical education team with information to help identify additional training needs to facilitate the integration of care.
Bates E.,Whittington Health |
Mason R.,University of East Anglia
British Journal of Occupational Therapy | Year: 2014
Introduction: The hand is a highly specialized part of the body used to perform many functions. Injury causing permanent change affects a person biologically, psychologically, and socially. This literature review aims to study coping strategies that people adopt in order to deal with a major hand injury. Method: A qualitative literature search was carried out using relevant databases. Inclusion/exclusion criteria were applied, which resulted in eight appropriate papers. Each one was critically appraised and analysed in a narrative way for patterns, consistencies, and variance. Findings: Coping strategies were found to alter over time. In the short term, strategies employed included avoidance, processing the trauma experience, seeking assistance, and maintaining control. In the long term, strategies included acceptance/ resignation, resuming occupations, and adjusting occupational roles. Recommendations for intervention included addressing psychosocial impacts, involving significant others in therapy, and incorporating occupational adaptation. Conclusion: The effectiveness of coping strategies depends on the individual and their unique circumstances; hand therapists must work in a holistic and client-centred way to find effective strategies that meet the individual's needs. This involves addressing psychosocial and functional adaptation, as well as physical rehabilitation. © The College of Occupational Therapists Ltd.
Leonard P.,Whittington Health
Supportive Care in Cancer | Year: 2017
Effective communication between clinicians and their patients has a positive impact not only on clinical outcomes but also on their experience of care. Communication skills are a core clinical skill, which can be taught by a number of methods. Understanding the impact of one’s own communication skills has on a patient and their family can help hone a clinician’s skills to improve both patient and clinician satisfaction. © 2017 The Author(s)
Hennis P.J.,University College London |
Meale P.M.,University College London |
Hurst R.A.,University of Hertfordshire |
O'Doherty A.F.,University College London |
And 8 more authors.
British Journal of Anaesthesia | Year: 2012
Background For several types of non-cardiac surgery, the cardiopulmonary exercise testing (CPET)-derived variables anaerobic threshold (AT), peak oxygen consumption (peak), and ventilatory equivalent for CO2 () are predictive of increased postoperative risk: less physically fit patients having a greater risk of adverse outcome. We investigated this relationship in patients undergoing gastric bypass surgery.Methods All patients (<190 kg) who were referred for CPET and underwent elective gastric bypass surgery at the Whittington Hospital NHS Trust between September 1, 2009, and February 25, 2011, were included in the study (n121). Fifteen patients did not complete CPET. CPET variables (peak, AT, and) were derived for 106 patients. The primary outcome variables were day 5 morbidity and hospital length of stay (LOS). The independent t-test and Fisher's exact test were used to test for differences between surgical outcome groups. The predictive capacity of CPET markers was determined using receiver operating characteristic (ROC) curves.Results The AT was lower in patients with postoperative complications than in those without [9.9 (1.5) vs 11.1 (1.7) ml kg-1 min-1, P0.049] and in patients with a LOS>3 days compared with LOS≤3 days [10.4 (1.4) vs 11.3 (1.8) ml kg-1 min-1, P0.023]. ROC curve analysis identified AT as a significant predictor of LOS>3 days (AUC 0.640, P0.030). The peak and were not associated with postoperative outcome.Conclusions AT, determined using CPET, predicts LOS after gastric bypass surgery. © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
PubMed | Belfast City Hospital, Birmingham Womens Hospital, Airedale General Hospital, King's College and 2 more.
Type: Journal Article | Journal: Neurourology and urodynamics | Year: 2016
This paper reports on the publication of a joint statement on minimum standards for continence care in the UK.A multidisciplinary working party were tasked with creating standards for both training and education in continence care, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies.The standards suggest a modular structure to continence training, including basic, male, female, catheter care etc. Discussions on service provision cover primary care through to expert tertiary centres.This is the first attempt to standardise continence care and training for all health care professionals nationally. The document is available on the United Kingdom Continence Society website www.ukcs.uk.net.
PubMed | Mental Health, Copenhagen University, Federal University of Rio Grande do Sul, Psychiatric Research Unit and 2 more.
Type: Journal Article | Journal: Evidence-based mental health | Year: 2016
Banaschewski and colleagues from the European Attention Deficit Hyperactivity Disorder (ADHD) guideline group make a number of critical comments regarding our systematic review on methylphenidate for children and adolescents with ADHD. In this article, we present our views, showing that our trial selection was not flawed and was undertaken with scientific justification. Similarly, our data collection and interpretation was systematic and correct. We have followed a sound methodology for assessing risk of bias and our conclusions are not misleading. We acknowledge that different researchers might make risk of bias judgments at higher or lower thresholds, but we have been consistent and transparent in applying our pre-defined and per reviewed protocol. Although we made minor errors, we demonstrate that the effects are negligible and not affecting our conclusions. We are happy to correct such errors and to engage in debate on methodological and ethical issues. In terms of clinical implications, we are advocating that clinicians, patients and their relatives should weight carefully risks and benefits of methylphenidate. Clinical experience seems to suggest that there are people who benefit from this medication. Our systematic review does, however, raise questions regarding the overall quality of the methylphenidate trials.
PubMed | Royal Free Hospital NHS Trust, University College London and Whittington Health
Type: Journal Article | Journal: The International journal of pharmacy practice | Year: 2016
To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU).Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions on optimising drug therapy or preventing harm from medication errors was rated on a 4-point scale.There was an increase in the mean daily rate of pharmacist interventions after the introduction of the specialist critical care pharmacist (5.45 versus 2.69 per day, P < 0.0005). The critical care pharmacist intervened on more medication errors preventing potential harm and optimised more medications. There was no significant change to intervention rates at the control sites. Across all study sites the majority of pharmacist interventions were graded to have at least moderate impact on patient care.The introduction of a specialist critical care pharmacist resulted in an increased rate of pharmacist interventions compared to a non-specialist pharmacist service thus improving the quality of patient care.
Rai G.S.,Whittington Health |
Abdulla A.,University of London
Clinical Risk | Year: 2012
Decisions to treat older people rely on accurate assessment of the patient, on clinical needs of the individual, based on risks and benefits of specific treatment and ethical principles, including the right of individuals to accept or refuse treatment. In those who lack capacity to make decisions, the physician tries to ensure that his decision is based on "best interests" principles set out in the Mental Capacity Act 2005. While no physician will admit to age discrimination, in reality there is evidence of inequalities in care and treatment in hospitals, and it is this fact that has led the Government to outlaw discrimination in healthcare under the new provision of the Equality Act 2010. This of course will not mean that all individuals with the same condition will have the right to receive the same treatment-decisions in each case will be based on an individual's clinical need-this fact alone may lead to difficult discussions with relatives and carers, particularly in relation to end-of-life care. This article provides an overview of the basis of management of older patients, and illustrates the importance of taking a holistic approach in the decision-making process.
Hunter M.,Whittington Health
British journal of community nursing | Year: 2015
Chronic oedema is a common problem in the UK and, given the country's ageing population, the numbers are predicted to rise. In an epidemiological study carried out in Derby, England, researchers found the prevalence of chronic oedema to be 3.99 in every 1000 people, with the prevalence increasing to 10.31 in those aged 65-74 years. Often, patients with untreated chronic oedema will develop an ulceration that can lead to further costs and hospital admissions. The cost of treating chronic wounds has been estimated at £2.3 billion-£3.1 billion a year. It is therefore surprising that given the number of patients living with these problems, there is still a lack of knowledge and skill among nurses when assessing patients with chronic oedema and associated ulceration. This article offers advice for nurses when assessing leg ulcers in patients with chronic oedema, detailing the visual skin changes most frequently seen in these patients. The article also discusses some of the treatment options available, briefly covering the advantages and disadvantages of each option.
Brennan E.J.,Whittington Health
British Journal of Nursing | Year: 2015
Heart failure affects 1-2% of the UK population with prevalence rates predicted to rise over the next decade. Ineffective education for patients with heart failure can lead to a failure to adhere to guidance, reduced self-care and increased hospital readmissions. The National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) have issued clear guidelines on patient-centred care in heart failure, particularly in relation to patients' cultural and linguistic needs. Patients with heart failure should have access to an interpreter or advocate if needed. Furthermore, heart failure educational materials should be tailored to suit the individual and be accessible to people who do not speak or read English. This article explores the practice recommendations for these patients with heart failure and provides an overview of current guidelines associated with optimal patient outcomes. It also includes practical advice on translation services, and information and educational materials available for patients with heart failure who do not speak English.