Hampshire Hospitals NHS Foundation Trust Research Articles

Qualitative exploration of patients’ experiences with Intrabeam TARGeted Intraoperative radioTherapy (TARGIT-IORT) and External-Beam RadioTherapy Treatment (EBRT) for breast cancer

ObjectiveTo gather a deep qualitative understanding of the perceived benefits and impacts of External-Beam RadioTherapy (EBRT) and TARGeted Intraoperative radioTherapy (TARGIT-IORT) using Intrabeam to assess how the treatments affected patient/care...

Precision medicine for liver tumours with quantitative MRI and whole genome sequencing (Precision1 trial): study protocol for observational cohort study

IntroductionRadiogenomic analysis of patients being considered for liver resection is seldom performed in the clinic despite recent evidence indicating that quantitative MRI could improve posthepatectomy outcomes. Meanwhile, the increasingly accessible...

Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting

AimsThere is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application...

Incorporating Simulation-Based Education Into Stroke Training.

Incorporating Simulation-Based Education Into Stroke Training.

A bleeping nightmare to a dream: Implementation of Hospital at Night

Hospital at Night (H@N) is a well-established system of providing out-of-hours (OOH) care to patients and has been shown to improve patient safety, reduce mortality and increase productivity. In 2018, Hampshire Hospitals NHS Foundation Trust still had no formal system for OOH working, causing unmanageable workloads for junior doctors, with repeated trainee surveys and the General Medical Council highlighting this as a concern. This led to unsafe working environments, low morale and a high degree of burnout. Initial stakeholder mapping …

Radiation dose audit at Hampshire Hospitals NHS Foundation Trust’s computed tomography coronary angiography clinical service

Radiation dose audit at Hampshire Hospitals NHS Foundation Trust’s computed tomography coronary angiography clinical service

Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?

In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust. Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum. Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74-£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74-£31,670.10. Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.

Dabigatran Versus Warfarin for Direct Current Cardioversion in Atrial Fibrillation.

IntroductionDirect current cardioversion (DCCV) is considered as the most effective treatment for atrial fibrillation (AF). AF is associated with an increased risk of thromboembolism, and DCCV may increase this risk. The current recommendation is, therefore, to anticoagulate for at least 3 weeks before DCCV and 4 weeks after the procedure.MethodsA retrospective study of patients referred for elective DCCV as treatment for AF in Hampshire Hospitals NHS Foundation Trust was performed to compare the safety and efficacy of dabigatran with warfarin in this setting.ResultsDuring a 12-month period, 129 patients were referred for DCCV for the treatment of AF and 107 patients received DCCV. Fifty-four patients were anticoagulated with dabigatran, 42 patients with warfarin, and 11 patients with other direct oral anticoagulants (DOACs) with choice of agent determined following an informed discussion with the patient. The average number of days between the date of referral for DCCV and the date of DCCV for patients who were on dabigatran was 51 days, while for warfarin, this was 82 (P = 0.001). The proportion of cancelation and rescheduling for warfarin patients was 21.4%, while for dabigatran, this was 5.5%. Patients were reviewed 6–20 weeks after DCCV; the success rate of DCCV for dabigatran patients was 61%, whilst for warfarin patients, this was 52%. The success rate went up to 69% for patients who received DCCV within 45 days of referral (P = 0.165).ConclusionThis retrospective study supports clinical experience that DCCV is more likely to be successful when there is a shorter duration between the onset of AF and the date of DCCV, and shows that the use of dabigatran in comparison with warfarin facilitates earlier DCCV.

The University College London/Medical Research Council/National Institute of Health Research-Health Technology Assessment PROMIS Trial: An Update

Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Academic Urology, Royal Marsden Hospital, Sutton, UK; MRC Clinical Trials Unit, University College London, London, UK; Department of Health Sciences, University of York, York, UK; Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK E U R O P E A N U R O L O G Y F O C U S 1 ( 2 0 1 5 ) 2 1 2 – 2 1 4

P102. Therapeutic mammoplasty: Use of wire localization and margin involvement

P102. Therapeutic mammoplasty: Use of wire localization and margin involvement

P100. Management of positive sentinel node biopsy. Audit of practice 2010–2012

P100. Management of positive sentinel node biopsy. Audit of practice 2010–2012

The use of Surgihoney to prevent or eradicate bacterial colonisation in dressing oncology long vascular lines.

A pilot evaluation was performed to assess the effects of Surgihoney, an engineered honey with highly active antimicrobial activity, on bacterial colonisation in long lines in oncology patients. This prospective service evaluation was conducted at Hampshire Hospitals NHS Foundation Trust (HHFT) in England, UK, between 2012 and 2013. The study population consisted of oncology patients with central intravenous lines who were receiving outpatient chemotherapy. All patients were offered line dressing with or without Surgihoney, applied to the line exit site. The primary outcome measure of the study was the presence or absence of bacterial colonisation of the line site. There were 30 patients in each arm - with or without Surgihoney. In the Surgihoney arm, 2 patients with existing line site colonisation were cleared of bacterial colonisation and none acquired colonisation during the study period. In the non-treatment arm, 6 patients were colonised at the line site prior to screening or during the evaluation. Bacterial colonisation was maintained throughout the period. Surgihoney is an effective antimicrobial line-site dressing, significantly reducing line site colonisation and eradicating existing colonisation. It was well tolerated by the patients. Surgihoney supplies were donated by Healing Honey International (HHI) who also provided some funding to Hampshire Hospitals Foundation Trust for microbiological investigation. MD and JC have provided clinical advice in an advisory capacity to HHI.