Dorset County Research Articles

Evaluating Transperineal Prostate Biopsies Performed by a New Operator: A Prospective Clinical Audit at Dorset County Hospital.

Introduction The transperineal (TP) approach for prostate biopsy offers advantages such as a low risk of infection, the ability to target lesions in difficult locations, and a rapid acquisition of proficiency. This prospective clinical audit aims to evaluate the outcomes and patient experiences of TP prostate biopsies performed by a new operator to determine the feasibility of adopting the TP biopsy as the primary method for prostate evaluations. Methods The study included all patients who underwent a TP prostate biopsy from August 1 to September 30, 2022, at Dorset County Hospital National Health Service Foundation Trust. The operator, a member of the urology team, had recently begun performing these biopsies independently after completing a four-month supervised training program and receiving approval from two consulting trainers. The biopsy technique was evaluated based on diagnostic yield and patient experience, comparing pre-procedure imaging results with histology reports and analyzing patient-completed questionnaires. Results Among the 42 patients, the cancer detection rate was 79%. The highest core positivity rate was 100% in two patients (5%), with 90% in 11 patients (26%). Of the patients, 57% showed complete agreement between magnetic resonance imaging findings and histology. A questionnaire assessing patient experience received a 64% response rate. The most common pain score reported was 2 (on a scale of 0-10), noted in 25% of patients. Most reported mild lower urinary tract symptoms (88%) and mild hematuria (85%). Of the patients, 44% rated their overall satisfaction as 10 (on a scale of 0-10), and no urinary tract infections were reported. Conclusion The findings support the adoption of TP biopsy as the primary method for prostate biopsies due to its short learning curve, high diagnostic yield, and favorable patient satisfaction. Training for new operators should be encouraged to achieve this goal.

EGS P25 Patient outcomes after percutaneous cholecystostomy at Dorset County Hospital

Abstract Background No guideline for percutaneous cholecystostomy exists at Dorset County Hospital, nor has an audit looking into patient outcomes after percutaneous cholecystostomy previously been carried out. This audit aims to identify the indications for cholecystostomy insertion, timing of insertion, complications thereafter, timing of any tubograms, and follow-up of patients after cholecystostomy. No universal management guidelines for percutaneous cholecystostomy currently exist, though studies have proposed treatment algorithms. Methods Retrospective cohort audit of all patients who underwent cholecystostomy insertion at Dorset County Hospital over 6 years from January 2017 – December 2022. Data was provided by the local radiology department of all abdominal drains inserted in this period, with further information collected from discharge summaries, clinic letters and tubogram data on local clinical systems. Data was inputted to and analysed on Microsoft excel. Results Between 2017 – 2022, 38 cholecystostomy drains were inserted. More men than women received drains, with a mean age of 71.8 at insertion. Inpatient stay varied from 2-71 days, with mean of 3 days between admission and drain insertion. 30 patients avoided cholecystectomy, whilst 34% of patients were re-admitted with drain-related or underlying pathology-associated complications. Conclusions Indications for drain insertion are in keeping with medical literature as a means of biliary sepsis control. Cholecystostomy was the definitive gallstone disease procedure for most patients. Most also had tubograms, yet tubogram timings varied significantly likely reflecting the lack of universally accepted management guidelines. This audit identified patients who have benefited from cholecystostomy insertion, allowing creation of a local management guideline for patients with biliary sepsis who undergo percutaneous cholecystostomy.

‘Circumstances Sufficiently Appalling to the Country People’: Suicide Burial in Thomas Hardy’s ‘The Grave by the Handpost’

Abstract Thomas Hardy’s 1897 short story, ‘The Grave By the Handpost,’ set in early nineteenth-century Dorset, explores the custom of suicide burial at the crossroads before the practice was outlawed in 1823. The story, which draws from family history, local accounts, and articles in the Dorset County Chronicle, tells of a widowed sergeant who feels forsaken by his son, and in a state of despair, takes his life. The coroner rules a felo de se (or ‘felon of himself’), and the sergeant’s body is buried at the parish boundary between two villages. In contrast with other customs, suicide burial was characterized by a unique capacity to shame both the deceased and the deceased’s family in perpetuity. While suicide itself would not be decriminalized until 1961, I argue that Hardy sought to destigmatize the coupling of suicide and shame that had predominated in British culture for centuries. This approach follows from Thomas Hardy: Folklore and Resistance (2016) in reading Hardy’s view of folk culture in flux, as rural communities evolved to reimagine their inherited customs. Hardy espoused what he called ‘evolutionary meliorism’, a belief that communities might develop more ethical responses to human situations than were codified in the law. I argue that the villagers’ response in ‘The Grave’ demonstrates this idea in practice, and I conclude that their decision to reject this custom on ethical grounds marks ‘The Grave’ as an important late Hardy work.

Using clinical surveillance software to support effective infection prevention and control for managing COVID-19

The speed, severity and scale of the COVID-19 pandemic challenged infection prevention and control (IPC) efforts at hospitals worldwide. Dorset County Hospital NHS Foundation Trust in Dorchester had an established pandemic plan, which had been developed in response to the swine flu (H1N1) pandemic in 2009. However, the COVID-19 pandemic developed to a level that modern health care had not seen before and it remains the largest challenge for health care to date. This article outlines the experience of a rural district general hospital using digital solutions for infection prevention and control before and during the pandemic. The author will explore the experience of a hospital that implemented specialised clinical surveillance software, how it was applied to management and control of COVID-19 cases, and how the availability of that system allowed for continued focus on controlling other pathogens in the hospital environment, even at the height of the pandemic.

392 The Role of MRI in the Management of Scaphoid Fractures: A Closed-Loop Audit by Dorset County Hospital, UK

Abstract Prompt and accurate diagnosis of scaphoid fractures are crucial in preventing complications such as non-union, avascular necrosis & early-onset arthritis. Research has shown that initial radiographs detect a fracture in 85–90% of cases, but it can be occult in up to 10–15%. In 2016 NICE recommended that MRI should be considered for first-line imaging in patients with suspected scaphoid fractures. Our aim is to determine whether the clinical practice at DCH is matched with the recommendations set by NICE, and whether the implementation of a ‘Scaphoid Management Protocol’ led to increased compliance. Retrospective analysis of all patients with suspected scaphoid fracture presenting to ED between May – September 2017, with reaudit between December 2017 - February 2018 and June – October 2020. Those patients who had gone on to have further MRI imaging were then identified, and the average time taken to MRI requests to MRI being performed was evaluated. Prior to the protocol, 16% of patients with normal X-ray but clinical signs weren't referred to further MRI imaging – this reduced to 1% in re-audit. The average recorded time to MRI from the requested date improved with each audit cycle, with 37.6, 19.9 & 11.4 days, respectively. However, a new finding found that 35% of patients presenting to ED with scaphoid injury were not referred further for Orthopaedic assessment to exclude scaphoid fracture. Implementation of a ‘Scaphoid Management Protocol’ significantly improved compliance to NICE guidelines of MRI imaging resulting in earlier fracture diagnosis and improved prognosis, as well as improving time to MRI from the request date.

The CIO role: a relentless march forward

Abstract Stephen Slough CITP CHCIO FBCS, CIO of the Dorset County Hospital NHS Foundation Trust and Dorset Clinical Commissioning Group, talks to Johanna Hamilton AMBCS about the digital legacy of COVID and the relentless speed of change within the NHS.

Patient and public involvement and engagement: Practice case study with reflections and learnings from a small rural district general hospital

The notion of patient and public involvement and engagement (PPIE) in research has been around for some time, and it is considered essential to ensure high-quality relevant research that is shared and that will make a difference. This case study of practice aims to share the PPIE practice from Dorset County Hospital NHS Foundation Trust, a small rural district general hospital. It describes the process of recruiting patients and members of the public as research volunteers, as well as the plethora of engagement and involvement activities with which they have been involved to date. This is followed by a reflection on the process and an overview of plans for the future, highlighting key challenges as well as learnings. A dedicated role to support/oversee PPIE activities is recommended to coordinate large groups of research volunteers, as well as to monitor the important impact of their input, which is considerable. Increasing diversity and access to under-served groups, and embedding the research volunteer role within the wider clinical research team, are also highlighted as fundamental challenges, as well as opportunities to make the most from this valuable resource. The case study of practice puts forward a recommendation to all research departments to embed PPIE in all of the work that they do.

The ABT BioMystery

This final BioMystery for 2020 is accompanied by multiple questions and can teach us a number of lessons about the history and science of biology. Certainly, this is some sort of fossil and must be important since it is framed as if it were a valued work of art. It was found in the sea cliffs below the village of Charmouth on the Dorset coast of England in 1828. But, what it this? What is the taxonomic class of this creature? What evolutionary principle does this animal represent? Finally—and for extra credit—who found this specimen and what nursey rhyme did this famous collector inspire? The answers can be found on page 656.Photos by W.F. McComas taken in the Oxford University Museum of Natural History and at Charmouth beach in England’s Dorset County

Response Rates to Newly Implemented Neoadjuvant TCHP Chemotherapy in the Dorset Cancer Network

Purpose: The neoadjuvant chemotherapy regimen: docetaxel, carboplatin, trastuzumab and pertuzumab (TCHP) was first introduced to the Dorset Cancer Network (Royal Bournemouth County Hospital, Dorset County Hospital and Poole Hospital Foundation Trust) formulary in January 2017. The purpose of this audit was to assess the response to treatment and adherence to local guidelines.

A quality improvement project on discharge summaries completion in a nephrology ward

Discharge summary is an essential part of patient care and is a patient safety issue if not completed on time. The NHS England Standard Contract guidance insists that discharge summaries should be completed and sent to general practitioner within 24 hours of discharge. Dorset County Hospital aims

A quality improvement project on discharge summaries completion in a nephrology ward

Discharge summary is an essential part of patient care and is a patient safety issue if not completed on time. The NHS England Standard Contract guidance insists that discharge summaries should be completed and sent to general practitioner within 24 hours of discharge. Dorset County Hospital aims

INTERVIEW TO ALEXANDRA COULTER

Alexandra Coulter has been Director of Art & Health South West since 2010. Before that she managed the Arts in Hospital project at Dorset County Hospital for 15 years and worked as a free lance arts and health consultant in the acute and primary care sectors. And before that she was an artist! Arts & Health South West is the lead organisation for a new national body, the Culture, Health and Wellbeing Alliance.

The potential of e-health in inflammatory bowel disease

IBD nurses Pearl Avery of Dorset County Hospital and Lynn Gray of Wirral University Hospital answer questions on the uses of e-health

Międzykulturowe kompetencje komunikowania się polskich emigrantów zarobkowych w Anglii a ich poczucie sukcesu

The aim of the research was to determine the most important intercultural competences of Polish employees in England in their own opinion and in the opinion of their employers. The study was placed in an objectivist paradigm using the method of a diagnostic survey with the questionnaire technique and the research tool in the form of a questionnaire developed by the author. The empirical material was collected in the Dorset County – in England in the southwestern region (South West). 123 questionnaires, which were correctly completed by employees and 36 employers, were used in the research. Analysis of the results obtained has shown that both the Polish respondents and their employers regarded nearly all competences as important for the employee’s career. The situation looks different as regards the level of their mastering by the Polish respondents. Poles functioning on the British job market are fully satisfied by the mastering level as opposed to their employees who have a much more critical opinion of the mastering level of these competences by their employees.

Audit Into The Appropriate Activation of Trauma Team at Dorset County Hospital Foundation Trust

Audit Into The Appropriate Activation of Trauma Team at Dorset County Hospital Foundation Trust

Weymouth and Portland Integrated Care Hub

Background; Weymouth and Portland Integrated Care Hub was started in November 2015, as a multiagency, co-designed project, aiming to support people who are frail, elderly or have complex needs. The 'hub', based in Westhaven Community Hospital, collocates duty workers and administrators from the locality's physical health, mental health, social care, ambulance services and third sector teams. Key features; No significant additional investment – reconfiguration of existing community services Local single point of access - reverting to Countywide SPOA overnight Admission avoidance and supported hospital discharge 'No hand offs' Systm One IT module for integrated referral management and information sharing to local teams, including primary care Three Health and Social Care Coordinator posts, working over 7 days Community Geriatrician Step up community beds Acheivements - one year on; The hub, very quickly moved from being a brave trial to a mainstream, sustainable and successful way of working. The team are working with people who have high and very high levels of frailty. Excellent patient and informal care giver feedback, gathered through semi structured interviews Reduction in acute bed days and ED admissions for over 65s Stabilisation of emergency admissions for locality against a predicted increase High referrer satisfaction - 'I make one call and things just get sorted' Staff are now seeing themselves as 'one team' and putting the patient at the centre of everything that they are doing. The hub is a factor in staff recruitment in the area. 50% step up use of community hospital beds - a community bed is now always available as an alternative to acute admission. Model being used as a blueprint to roll out to all other localities in Dorset Barriers to change: Key barriers that have needed to be overcome are; Working across different organisations with differing priorities/objectives Culture change for staff - 'one team' approach Trail blazer - creating and selling a vision Existing management structures are becoming a barrier to progress Insufficient data to fully evaluate work Future plans and next steps: Although Weymouth and Portland Integrated Care Hub is proving to be a successful model, advances are already being made. A proactive element to hub working - risk profiling, MDT meetings, and advance care planning and follow up for those referred in crisis to reduce the likelihood of deterioration in the future. Integrated working with Dorset County Hospital's acute hospital at home Consideration of rising frailty and patient activation/community support Can all community referrals be managed through the hub? Review of management structures to consider a full locality integrated team. Conclusions: Weymouth and Portland Integrated Care Hub was formed just over a year ago as a multiagency project, which has, with little additional cost, transformed the service provided to local people who are frail, elderly, and have complex needs. The learning from this project is being rolled out to all other localities in Dorset, and also used to make key developments that will improve the service provided going forwards.

Elderly patients with chronic kidney disease: do they really need referral to the nephrology clinic?

IntroductionChronic kidney disease (CKD) is becoming increasingly common, especially in the elderly. In the UK, there has been a marked increase in the awareness and detection of CKD over the last decade. This is largely attributable to the introduction of automated estimated glomerular filtration rate (eGFR) reporting and renal indicators in the primary care Quality and Outcomes Framework (QOF) initiative, both of which were introduced in 2006. These two initiatives have had a significant impact on referral patterns to renal services. Across the UK there has been a sustained increase in patients referred to nephrology clinics. The increased referrals have led to an older patient cohort, for whom specialist nephrology input is of questionable clinical benefit. This study aims to assess the outcomes of such patients referred to nephrology clinics in Dorset.MethodsRetrospective data were collected on all new referrals to the nephrology outpatient clinic at Dorset County Hospital between April 2006 and March 2007. We specifically examined all patients >80 years of age who had CKD Stage 4 or 5. Outcomes of interest included the rate of decline in eGFR, renal-specific management implemented by the clinic, need for renal replacement therapy and death. These outcomes were used to compare the difference between those patients kept under regular follow-up in the nephrology clinic and those discharged back to primary care. Patients were followed up until March 2014.ResultsIn all, 124 patients who were ≥80 years of age had CKD Stage 4 (115 patients) or 5 (9 patients). The mean age was 84.4 (range 80–95) years. In all, 66 patients were kept under regular follow-up in the clinic and 58 patients were discharged back to primary care. Patients kept under follow-up tended to have a lower median eGFR at referral (22 mL/min/1.73 m2 versus 26 mL/min/1.73 m2; P = 0.051) and had a significantly more rapid decline in mean eGFR over the next 7 years (1.58 mL/min/1.73 m2/yr versus 0.357 ml/min/1.73 m2/yr; P = 0.023) compared with those discharged back to primary care. More patients were commenced on erythropoietin (12 versus 3; P = 0.03) and more patients were commenced on dialysis (5 versus 0; P = 0.03) in the follow-up group compared with those discharged back to primary care. No patients from either group underwent a kidney biopsy. In those patients followed up, 55 (83%) died, with a median time to death of 2.66 years [interquartile range (IQR) 1.14–4.97]. Of the patients discharged, 45 (78%) died, with a median time to death of 3.57 years (IQR 2.31–5.68).ConclusionsThis study highlights the uncertain clinical benefit gained from referral to the nephrology clinic for the majority of elderly patients and suggests that for many cases their care could be safely and appropriately managed in the primary care setting. With the increasing prevalence of CKD in the elderly and increasing pressure on new patient clinic slots, referral of a select group in which a specific intervention is being considered may be more appropriate.

Acute hospital at home: a new age

We aim to assess the effectiveness and impact of the Acute Hospital at Home (AHAH) service at Dorset County Hospital. The AHAH service has 15 beds, and can be seen as a virtual inpatient ward. Patients are transferred from inpatient care to under the umbrella of AHAH. This is treated as a ward

A Case Report for a Complex Denture Case on a Special Care Patient with Osteogenesis Imperfecta

This case report presents a patient with Dentogenesis Imperfecta (DI) associated with Osteogenesis Imperfecta (OI) and its subsequent dental manifestations. The patient in this report (see Figure 1) has spent his life living with his disability type III OI (also known as brittle bone disease) and its degenerative affects. The patient is independent and enjoys his social life but felt his existing dentures were having an adverse effect on the quality of his life. The patient attended Dorset County Hospitals Special Care Dentistry and on clinical examination it was noted the patient was partially dentate with a class III malocclusion and brownish discoloration of the remaining teeth caused by enamel hypoplasia. Treatment for this patient would entail making a maxillary complete denture and a mandibular partial chrome denture, normally quite simple tasks but due to the DI and its dental manifestations, the treatment would be complicated. This case demonstrates how a complex case treated by a collaborative dental team using their different skills and knowledge can lead to a successful and rewarding treatment for both patient and team.

Effectiveness of epidural analgesia in enhanced recovery protocols following colorectal surgery

Effectiveness of epidural analgesia in enhanced recovery protocols following colorectal surgery