Gloucestershire Hospitals NHS Foundation Trust Research Articles

Developing a foundation information and academic skills programme for potential Student Nursing Associates.

This article outlines the development of 'Prepare to Progress', a preapplication programme for potential Student Nursing Associate (SNA) applicants at Gloucestershire Hospitals NHS Foundation Trust. Created collaboratively by the Trust's Library and Knowledge Services and Professional Education teams, the programme aims to provide realistic course expectations, teach study skills and boost confidence in using library services. Evaluation results indicate increased understanding of the SNA course, improved application decision-making, and enhanced academic confidence among participants. The programme demonstrates the valuable role of library services in preparing healthcare support workers for further education and addressing library anxiety. The study suggests benefits for both participants and library services.

Phyllodes tumours at gloucestershire hospitals NHS foundation trust breast unit from 2016 to 2023

Phyllodes tumours at gloucestershire hospitals NHS foundation trust breast unit from 2016 to 2023

Promoting evidence-based practice and nursing excellence: How involvement in a Magnet4Europe® research study led to development of critically appraised topics sessions for health care staff.

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) is actively participating in the Magnet4Europe® research study, which aims to advance nursing excellence and promote evidence-based practice. As part of this initiative, the Nursing, Allied Health Professional and Midwifery Research Council at GHNHSFT has been actively engaging colleagues in evidence-based practice and research. This has been achieved through the development of sessions using the Critically Appraised Topics (CATs) framework, where clinical questions and relevant research articles are discussed. This article describes the collaborative approach between the Lead Nurse for Continual Professional Development and the Deputy Manager of the Library and Knowledge Services to develop and run the sessions. Collaboration between clinical staff and library and knowledge teams can be useful in encouraging healthcare professionals' engagement with the evidence base in order to consider changes to practice.

Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study

Learning ObjectivesUpon completion of this activity, participants will:Assess variables associated with primary anatomical outcome (anatomical failure within 6 months of surgery) after vitrectomy and internal tamponade for rhegmatogenous retinal detachment, based on a retrospective analysis of prospectively collected dataEvaluate risk stratification using a multivariate logistic regression model incorporating variables associated with anatomical failure within 6 months of rhegmatogenous retinal detachment surgery, based on a retrospective analysis of prospectively collected dataDetermine the clinical implications of variables associated with primary anatomical outcome (anatomical failure within 6 months of surgery) after vitrectomy and internal tamponade for rhegmatogenous retinal detachment, based on a retrospective analysis of prospectively collected data.Accreditation StatementsIn support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/eye; (4) view/print certificate.Credit Hours1.0Release date:Expiration date:Post-test link:https://medscape.org/eye/posttest983835EDITORSobha Sivaprasad, MD, Editor, EyeAuthors/Editors disclosure informationDavid Yorston, FRCOphth, Gartnavel Hospital, Glasgow, Scotland. Paul H.J. Donachie, MSc, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom, The Royal College of Ophthalmologists, National Ophthalmology Database Audit, London, United Kingdom. D.A. Laidlaw, MD, FRCOphth, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom. David H. Steel, MD, FRCOphth, Sunderland Eye Infirmary, Sunderland, United Kingdom, Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom. G.W. Aylward, MD, FRCOphth, Moorfields Eye Hospital City Road, London, United Kingdom. Tom H. Williamson, MD, FRCOphth, Guy’s and St. Thomas’ NHS Foundation Trust, London, United KingdomJournal CME author disclosure informationLaurie Barclay has disclosed the following relevant financial relationships: formerly owned stocks in AbbVie Inc.

Development of a novel secondary care lipid e-referral pathway within Gloucestershire Hospitals NHS Foundation Trust

Development of a novel secondary care lipid e-referral pathway within Gloucestershire Hospitals NHS Foundation Trust

Putting your HAT on

One in three deaths of people who are homeless are preventable. The morbidity and mortality of people who are homeless is shocking. With people who are homeless having a higher rate of emergency department attendance and hospital admission compared with the general population, we have a unique opportunity to change their health and their life.This led to the design and implementation of the Homeless Assessment Tool (HAT) at Gloucestershire Hospitals NHS Foundation Trust. The HAT is an opportunistic prompt to assist doctors in providing the best care for patients who are homeless upon (or during) hospital admission.Teaching sessions on the health of people who are homeless and the HAT were given to doctors and nurses. Feedback commended the HAT's comprehensiveness, ease of use, and utility in assessing and managing a patient who is homeless.As such, the HAT is accepted as a standard by the Faculty for Homeless and Inclusion Health, further demonstrating its merits in assessing patients who are homeless.

The Care Certificate at Gloucestershire Hospitals NHS Foundation Trust

British Journal of Healthcare AssistantsVol. 15, No. 11 ProfessionalThe Care Certificate at Gloucestershire Hospitals NHS Foundation TrustSam LignelliSam LignelliChief Nurse Fellow, Practice Educator—Trainee Nursing Associated and Care Certificate, GloucestershireSearch for more papers by this authorSam LignelliPublished Online:10 Dec 2021https://doi.org/10.12968/bjha.2021.15.11.540AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 December 2021Volume 15Issue 11ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 10 December 2021 Published in print 2 December 2021 Information© MA Healthcare LimitedPDF download

30-Day Mortality Following Systemic Anti-Cancer Treatment (SACT) Review in Driving Quality of Care in Hematologic Malignancies in a Tertiary Care Hospital

IntroductionThere is growing evidence to support SACT 30-day mortality rate as a key metric for assessing quality of cancer care and a key indicator of avoidable harm to patients from SACT due therapy-related or poor patient selection factors. This has been established for solid organ malignancy. However, data in patients with hematologic malignancy is limited. At the Gloucestershire Hospitals NHS Foundation Trust, a large district general hospital providing specialist care to over 600,000 people, we collated data from our in-house SACT dataset to assess factors that impact the 30-day SACT mortality and establish a benchmark for multidisciplinary, educational mortality meeting discussions on mortality in patients receiving SACT. We aimed to review cases characterizing patients, causes of death and the role of SACT in deaths.MethodsThis retrospective study included all patients aged 18 years or older with a hematologic malignancy who received SACT between Jan 1, 2016, and Mar 31, 2021, irrespective of the number of previous treatment cycles or regimens and irrespective of their response within the disease trajectory. SACT was defined as any cytotoxic chemotherapy, immunotherapies such as monoclonal antibodies, and targeted biological treatments. We calculated 30-day mortality after the most recent cycle of SACT for these patients. We analyzed whether patient, tumor type, and therapy-related factors were associated with the risk of 30-day mortality.ResultsA total of 1903 patients with hematologic malignancy received SACT. The 30-day mortality rate for our center was 3.89% for patients receiving SACT and 4.9% of all-cause mortality. In the 30-day mortality cohort the median patient age at death was 71 years (interquartile range (IQR) 52-86); ratio of men to women, 1.18. 30-day mortality increased with age for patients treated with palliative intent or intent to remission (OR 4.9, 95% CI .985-26.255; p=0.0171). Median duration of 30-mortality post SACT was 17 days (IQR 8-22). The commonest malignancy was plasma cell dyscrasias (54%) and 68% receiving treatments with intent to remission. ECOG performance status was 0-2 at final SACT cycle in 65%, 3 in 27% and 4 in 8%. 47% of patients were receiving their first cycle (median number of cycles received 2; IQR 1-3) and 43% receiving first line therapy (median lines of therapy 2; IQR 1-3). Therapy naïve patients had significantly higher 30-day mortality than those who received previous SACT (OR 3.435, 95% CI 2.06-5.66; p<0·0001). 42% of deaths occurred in hospital and 54% were attributed to primary refractory and/or aggressive disease. Other causes of death included infection (19% neutropenic, 15% non-neutropenic) including COVID-19 (3%), major bleed (5%), thromboembolism (1%) and cardiac event (1%).ConclusionsSACT data provides “real world” assessment of treatment patterns and outcomes in routine malignant hematology practice. It highlights the importance of systematic data collection and analyses to better inform factors associated with higher risk of 30-day mortality in patients with hematologic malignancy, which ultimately promotes review of clinical decision making and offers an opportunity for service improvements. Our findings shed light into some of the factors that affect the risk of early mortality of patients with hematologic malignancy and provides a way to measure if the health service is improving. The insights into risk factors for 30-day mortality will aid in better understanding for treating clinicians and their patients on predictors of potential harms and benefits of SACT thereby carefully balancing patients' personalized expectations with representative outcomes and treatment risks and should be the focus of discussions about SACT, particularly in pretreated or older patient groups. Neutropenic sepsis remains a significant cause of SACT related mortality warranting further improvements in care. Prospective case discussions together with this retrospective review have generated service improvements at our center including standardizing chemotherapy helpline pathways, systematizing SACT mandatory data recording on e-prescribing system and mandatory response assessments as part of SACT protocols' review. Future research work to examine outcomes based on subtypes of hematologic malignancy and on larger datasets is critical for improving our understanding at delivering the right drugs to the right patients. DisclosuresNo relevant conflicts of interest to declare.

246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)

Abstract Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma &amp; Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.

An emergency urology skills course for the multidisciplinary team

Urological presentations account for approximately 1.7% of emergency hospital admissions, 7.8–20% of the acute surgical take and 5–10% of visits to general practice. Training in this area is often unsatisfactory, with a third of final year medical students not feeling confident in managing urological emergencies and 6% receiving no exposure at all. Urology is a multidisciplinary speciality, and many emergency urological presentations require urgent treatment with specialised equipment or skills. A quality improvement project was set up at Gloucestershire Hospitals NHS Foundation Trust with the aim of improving experience and confidence among junior doctors and allied health-care professionals with common urological practical skills using a simulation-based course. There was an emphasis on multidisciplinary team working to mirror the clinical environment. Pre-course questionnaires showed that most participants lacked confidence with common urology practical skills, such as haematuria management (80–85%), nephrostomy management (93–95%) and suprapubic catheters (93–100%). After attending the course, confidence improved in all skills, and participant satisfaction was high, with 100% finding the course relevant to clinical practice. The course was run at low cost, free to participants and without the need for long periods of study leave, making it accessible to all. We suggest the model of this course could be easily transferred to other hospital trusts and applied to other surgical specialities for similar simulated training. Level of evidence: Level 5.

Four phases in the metamorphosis of the consultant urologist

BJU InternationalVolume 128, Issue 4 p. 425-427 Comment Four phases in the metamorphosis of the consultant urologist Faith McMeekin, Corresponding Author Faith McMeekin faith.mcmeekin@nhs.net orcid.org/0000-0003-2036-3872 Cheltenham General Hospital, Cheltenham, UK Correspondence: Faith McMeekin, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Sandford Road, Cheltenham GL53 7AN, UK. e-mail: faith.mcmeekin@nhs.netSearch for more papers by this authorJoanne Cresswell, Joanne Cresswell The James Cook University Hospital, Middlesbrough, UKSearch for more papers by this authorSteve R. Payne, Steve R. Payne orcid.org/0000-0001-5359-1877 Department of Psychology, Bournemouth University, Bournemouth, UKSearch for more papers by this author Faith McMeekin, Corresponding Author Faith McMeekin faith.mcmeekin@nhs.net orcid.org/0000-0003-2036-3872 Cheltenham General Hospital, Cheltenham, UK Correspondence: Faith McMeekin, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Sandford Road, Cheltenham GL53 7AN, UK. e-mail: faith.mcmeekin@nhs.netSearch for more papers by this authorJoanne Cresswell, Joanne Cresswell The James Cook University Hospital, Middlesbrough, UKSearch for more papers by this authorSteve R. Payne, Steve R. Payne orcid.org/0000-0001-5359-1877 Department of Psychology, Bournemouth University, Bournemouth, UKSearch for more papers by this author First published: 22 July 2021 https://doi.org/10.1111/bju.15557Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume128, Issue4October 2021Pages 425-427 RelatedInformation

Wellbeing support for foundation doctors during COVID-19 in GHNHSFT

AimsThe COVID-19 pandemic highlighted the importance of wellbeing amongst healthcare professionals. Medical professionals, notably junior doctors, are at increased risk of developing poor mental health and burnout. The GMC Barometer Study in 2020 showed that 32% of doctors found the first wave of the COVID-19 pandemic detrimental to their wellbeing and mental health.The aim of this quality improvement project was to assess and improve hospital wellbeing support available to foundation doctors within Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) by learning and reflecting on the impact of COVID-19.MethodAfter identifying a lack of resources within GHNHSFT, wellbeing information boards were displayed in communal areas and distributed by email. These encompassed trust wide support, practical information including childcare and relaxation resources concentrating on mindfulness, exercise and culture. A survey of foundation doctors was completed to assess doctors’ focus and approach to wellbeing. Questions assessed influential factors in maintaining wellbeing, access to current hospital resources and future interventions.Result94% of respondents recognised that their focus on wellbeing increased during COVID-19. One third of foundation doctors found it challenging to maintain their wellbeing, with 40% reporting difficulty accessing hospital support and advice. The most important factors foundation doctors identified in maintaining wellbeing were exercise, cooking and baking, and social networks. Colleagues were a significant source of wellbeing support, followed by notice boards, email resources and social media.ConclusionCOVID-19 highlighted the importance and burden on wellbeing of foundation doctors, with a significant number struggling to access support. Future recommendations include the use of a ‘buddy system’, regular and accessible exercise classes and improved communication of wellbeing support and resources to staff members.Buddy systems have already shown success amongst teams however it is important these are accessible to all foundation doctors and universally offered within the trust. A weekly yoga class is being reintroduced to be available to all doctors.A particular focus has been the development of a health and wellbeing section to feature in the trusts weekly communications, with the aim to regularly signpost staff to ongoing wellbeing resources and support.Social networking and media were highlighted as important in both maintaining wellbeing and accessing resources. A future goal is to develop an official GHNHSFT Instagram or Twitter account focused on wellbeing. We hope to continue to learn from the impact of COVID-19, improving the availability of wellbeing support at GHNHSFT that will continue into the future.

P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

IntroductionElderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients.MethodsA retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review.ResultsOur study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%).DiscussionOur study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

The role of RCP chief registrars in the COVID-19 pandemic response

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) was an early adopter of the Royal College of Physicians (RCP) Chief Registrar Programme and has four chief registrars (two in medicine and two in emergency medicine). The COVID-19 pandemic created an unprecedented requirement for process and protocol change. The chief registrar role evolved as the pandemic did, providing numerous opportunities but also unique challenges. The first COVID-19 case confirmed at the trust was on 14 March 2020, and to date 874 positive cases have been seen at the trust, the highest level of COVID-19 activity in the south west of England. The …

Cerebral visual impairment‐related vision problems in primary school children: a cross‐sectional survey

To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)-related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems. We conducted a survey of primary school children aged 5 to 11years, using whether they were getting extra educational help and/or teacher- and parent-reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI-related vision problems. We compared the usefulness of potential red flags using likelihood ratios. We received questionnaires on 2298 mainstream-educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo-11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI-related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI-related vision problem had reduced visual acuity. Children with CVI-related vision problems were more prevalent than has been appreciated. Assessment of at-risk children may be useful so that opportunities to improve outcomes for children with CVI-related vision problems are not missed.

Writing’s on the wall: improving the WHO Surgical Safety Checklist

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory...

Variation in UK guidelines for the first-line antimicrobial management of paediatric orbital cellulitis-time for national recommendations.

Stimes GT, Girotto JE. Applying pharmacodynamics and antimicrobial stewardship to pediatric preseptal and orbital cellulitis. Paediatr Drugs. 2019;21:427–38. Article Google Scholar Georgakopoulos CD, Eliopoulou MI, Stasinos S, Exarchou A, Pharmakakis N, Varvarigou A. Periorbital and orbital cellulitis: a 10-year review of hospitalised children. Eur J Ophthalmol. 2010;20:1066–72. Article Google Scholar Tsirouki T, Dastiridou AI, Ibanez Flores N, Castellar Cerpa J, Moschos MM, Brazitikos P, et al. Orbital cellulitis. Surv Ophthalmol. 2018;63:543–53. Article Google Scholar Amin N, Syed I, Osborne S. Assessment and management of orbital cellulitis. Br J Hosp Med. 2016;77:216–20. Article Google Scholar Wong SJ, Levi J. Management of pediatric orbital cellulitis: a systematic review. Int J Pediatr Otorhinolaryngol. 2018;110:123–9. Article Google Scholar Markham JL, Hall M, Bettenhausen JL, Myers AL, Puls HT, McCulloh RJ. Variation in care and clinical outcomes in children hospitalized with orbital cellulitis. Hosp Pediatr. 2018;8:28–35. Article Google Scholar European Centre for Disease Prevention and Control. Surveillance Atlas of Infectious Diseases. European Centre for Disease Prevention and Control; 2020. http://atlas.ecdc.europa.eu/public/index.aspx. Accessed 28 Jun 2020. Paediatric Formulary Committee. BNF for children 2016–2017. London, UK: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2016. Mathur S, Jackson C, Urus H, Ziarko I, Goodbun M, Hsia Y, et al. A comparison of five paediatric dosing guidelines for antibiotics. Bull World Health Organ. 2020;98:406–12F. Article Google Scholar McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: a systematic review and guidelines. Lancet Infect Dis. 2016;16:e139–52. Article Google Scholar World Health Organization. Global action plan on antimicrobial resistance. World Health Organization; 2015. https://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/. Accessed 28 Jun 2020. Sharland M, Butler K, Cant A, Dagan R, Davies G, de Groot R, et al. editors. Manual of childhood infections: the blue book. 4th ed. Oxford, UK: Oxford University Press; 2016. The Royal Children’s Hospital Melbourne. Clinical Practice Guidelines: periorbital and orbital cellulitis. The Royal Children’s Hospital Melbourne; 2019. https://www.rch.org.au/clinicalguide/guideline_index/Periorbital_and_orbital_cellulitis/. Accessed 28 Jun 2020. National Centre for Disease Control. National treatment guidelines for antimicrobial use in infectious diseases. Version 1.0. National Centre for Disease Control; 2016. http://pbhealth.gov.in/AMR_guideline7001495889.pdf. Accessed 28 Jun 2020. Jackson TL, editor. Moorfields manual of ophthalmology. 2nd ed. London, UK: JP Medical Ltd; 2016. ENT UK. Orbital cellulitis management guidelines—for adults & paeds. ENT UK; 2017. https://www.entuk.org/sites/default/files/files/ENT%20UK%20Revised%20Orbital%20Cellulitis%20Flow%20Chart%202017.pdf. Accessed 28 Jun 2020. Horizon Strategic Partners. MicroGuide. Horizon Strategic Partners; 2020. http://www.microguide.eu. Accessed 28 Jun 2020. Brighton and Sussex University Hospitals NHS Trust. Management of pre-septal and orbital cellulitis. Brighton and Sussex University Hospitals NHS Trust; 2014. https://www.bsuh.nhs.uk/library/wp-content/uploads/sites/8/2019/03/Paediatric-Guidelines-Pre-septal-and-orbital-cellulitis-2014.pdf. Accessed 28 Jun 2020. Gloucestershire Hospitals NHS Foundation Trust. Orbital cellulitis/peri-orbital cellulitis (paediatric). Gloucestershire Hospitals NHS Foundation Trust; 2017. https://www.gloshospitals.nhs.uk/gps/antimicrobial-resources/paediatric-antibiotic-treatment-guidelines-site-infection/orbital-peri-orbital-cellulitis-paediatric/. Accessed 28 Jun 2020. Northern Care Alliance NHS Group. Antibiotics guidelines: paediatric prescribing guidelines. Northern Care Alliance NHS Group; 2018. https://www.srft.nhs.uk/EasysiteWeb/getresource.axd?AssetID=21914t 2018. https://www.networks.nhs.uk/nhs-networks/north-west-paediatric-allergy-immunology-infection/documents/antimicrobial-paediatric-guidelines-15-11-2018/view. Accessed 28 Jun 2020. University Hospitals of Leicester NHS Trust. Management of children with preseptal and orbital cellulitis. University Hospitals of Leicester NHS Trust; 2017. https://secure.library.leicestershospitals.nhs.uk/PAGL/Shared%20Documents/Preseptal%20and%20Orbital%20Cellulitis%20UHL%20Childrens%20Hospital%20Guideline.pdf. Accessed 28 Jun 2020. Brady MT, Jackson MA, Kimberlin DW, Long SS, editors. Red book: 2018–2021 report of the committee on infectious diseases. 31st ed. Itasca, USA: American Academy of Pediatrics; 2018. World Health Organization. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. 2nd ed. World Health Organization; 2013. https://www.who.int/maternal_child_adolescent/documents/child_hospital_care/en/. Accessed 28 Jun 2020. Download references University of Nottingham School of Medicine, Nottingham, UK David McMaster University Hospital Southampton NHS Foundation Trust, Southampton, UK Sanjay Patel The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK Catherine Marsh You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar Correspondence to David McMaster. The authors declare that they have no conflict of interest. Publisher’s note Springer...

The highs and lows of Medisoft as an audit tool: lessons from a 5-year upper eyelid ptosis audit.

Increasing demand for surgeon accountability requires regular audit of individual and institutional performances. Electronic record systems proclaim efficient audit systems, but how does Medisoft live up to the hype? We present our experiences and examine how well Medisoft's audit suite meets clinical audit needs. Medisoft audit suite was used to audit all ptosis procedures undertaken during 2010-14 in Gloucestershire Hospitals NHS Foundation Trust. Repeat audit identified all ptosis procedures done in the trust since Medisoft was introduced; these data were cross-referenced to determine true re-operation rates. 350 operations were performed on 304 patients over 427 eyes in 5 years. 40 of 304 patients (13%) have thus far required more than one operation on at least one eye. Cross-referencing the data revealed that 11 of these patients' audit-period operations were re-operations, and 18 patients were re-operated after the audit period. In total 26/40 patients (65%) would have been missed if the data had not been cross-referenced. 17 patients had post-operative complications recorded, 7 of whom had repeat surgery. Medisoft supports high volume audits, reducing overall workload and increasing efficiency. However, consistent use across clinical staff is necessary to ensure all data are recorded and available for audit. When assessing re-operation rates, search parameters must be widened and cross-referenced to prevent missing vital information regarding procedures performed outside of the audit window. This could be eliminated in future if Medisoft made small changes to input of data that highlights repeat operations and their indications.

Audit of HbA1c improvement in newly diagnosed type 1 diabetes paediatric patients in Gloucestershire Hospitals NHS Foundation Trust

Audit of HbA1c improvement in newly diagnosed type 1 diabetes paediatric patients in Gloucestershire Hospitals NHS Foundation Trust

PTU-125 Laboratory Investigations for Patients Meeting Diagnostic Criteria for Irritable Bowel Syndrome: Are We Meeting the Standards?

Introduction Alongside a thorough clinical assessment NICE clinical guideline 61 recommends that patients meeting diagnostic criteria for irritable bowel syndrome (IBS), as defined by the Rome III criteria, should undergo laboratory testing for inflammation (C-reactive peptide (CRP) and plasma viscosity (PV) or erythrocyte sedimentation rate (ESR)), full blood count (FBC) and antibody testing for coeliac disease to exclude non-organic pathology.1 Faecal calprotectin is a reliable and cost effective adjuvant test to help differentiate between functional and inflammatory bowel disease (IBD).2,3 Our aim was to assess local adherence to NICE guidelines on investigating patients who meet diagnostic criteria for IBS. Methods As part of a wider study into the use of faecal calprotectin as a diagnostic tool within Gloucestershire Hospitals NHS Foundation Trust, we interrogated clinic letters, endoscopy reports and pathology results for patients in whom a negative ( Results Of the 148 patients (age range: 16–81, median age: 35; 72% female) who satisfied inclusion criteria, 63.5% (n = 94) had not undergone at least one of the recommended laboratory tests around the time of faecal calprotectin measurement. PV/ESR had not been checked in a majority (54.1%). Notably, 7.4% of patients had never had coeliac serology checked, 72.7% of whom presented with a change in bowel habit. Conclusion Although clear guidance exists for the investigation of patients meeting diagnostic criteria for IBS and use of faecal calprotectin as a diagnostic tool, insufficient essential accessory investigations are being completed. This risks conditions such as IBD, gastrointestinal cancer and coeliac disease being misdiagnosed as IBS with significant implications for delays in management and ongoing avoidable morbidity. We are reviewing measures to improve local adherence to NICE guidance, and call on other Trusts nationally to reflect on their own practice. References 1 Irritable bowel syndrome in adults: diagnosis and management. NICE guidelines [CG61]. Published: February 2008. 2 Konikoff MR, Denson LA. Role of faecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflammatory Bowel Diseases 2006;12(6):524–34. 3 Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance [DG11]. Published: October 2013. Disclosure of Interest None Declared