North Hertfordshire NHS Trust Research Articles

MO479: CKD Coding Across Hertfordshire and West Essex. Are We Missing the Chance for Early Intervention?

Abstract BACKGROUND AND AIMS Coding of chronic kidney disease (CKD) is associated with better outcomes through addressing the risk factors, and CKD-coded cases were found to have fewer unplanned hospital admission rates. We aim to compare the CKD coding across Hertfordshire and West Essex to the published CKD prevalence by Quality and Outcomes Framework (QOF) and New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA), and to demonstrate variation in coding across primary care practices within the region. METHOD In August 2020, we reviewed data for Clinical Commissioning Groups (CCG), Primary Care Networks (PCN), practice code and practice name. Data were obtained from 136/144 practices, including the numbers of adult patients, number of CKD-coded patients, and percentage as a total of the adult population by practice, PCN and CCG were derived. Then we compared the actual obtained data with predicted numbers and percentages of CKD patients estimated from practice-registered adult populations using QOF (2009–10) that demonstrated a 4.3% prevalence [1] and NEOERICA (2003) that demonstrated an 8.5% prevalence [2]. RESULTS Across the adult population of 1.2 million, 38 645 patients had a CKD code, giving a 3.2% CKD prevalence. Assuming a QOF of 4.3% prevalence, then 13 316 CKD patients are uncoded. While considering a NEOERICA 8.5% prevalence, this would yield the assumption of 64 160 CKD uncoded patients. East & North Hertfordshire NHS Trust had the lowest coded CKD percentage at 2.7% of the served adult population. All three CCG areas had considerable percentage variations in CKD coding across the 135 practices. CONCLUSION Across Hertfordshire and West Essex, CKD coding is below the published CKD prevalence from QOF and NEOERICA, suggesting significant numbers of patients are uncoded. There are variations in coding percentage between primary care practices within the PCN and CCG groups. Suboptimal coding may decrease the ability to offer early intervention to decrease CKD progression and would be associated with poor outcomes, including cardiovascular disease. This demonstrates the current unmet need for improved coding through community nephrology surveillance between primary and secondary care.

An audit on schools’ policy regarding emergency adrenaline auto-injector use and provision of spare pens in the East and North Hertfordshire region of the UK

With the increase in the incidence of food allergies and recent adrenaline auto-injector (AAI) shortage in the UK, it is important that schools remain updated about the policy on the emergency use of AAI in schools for children at risk of anaphylaxis. The purpose of this audit is to review current practice in schools in a UK region covered by the Paediatric Allergy Service at the East and North Hertfordshire NHS Trust. We were then able to identify whether schools are aware of and following the national Department of Health guidance regarding emergency AAI use, including provision of spare pens. An online questionnaire was developed to gather information on the schools’ respective policies regarding emergency AAI use, and their awareness and engagement with the recent “Spare Pens” policy. This was sent to all 230 schools within the districts of East and North Hertfordshire, Stevenage and Welwyn Hatfield, covering 78,450 students. Out of 230 schools, 180 completed the questionnaire, covering 62,695 children aged 3-18 years. Of this cohort, 814 children are diagnosed to be at risk of anaphylaxis and prescribed with AAIs. 649 (79.7%) have allergy action plans in school. 179 (99.4%) schools train their staff regarding management of anaphylaxis, with 138 (77.1%) training every year or less. Although 136 (75.6%) were aware of the Spare Pen policy, only 32 (17.8%) stock their own AAIs. 164 (91.1%) schools keep children’s own AAIs on site, (159/164) 97% of which have them within 5 minutes’ reach, and (118/164) 72.0% store them appropriately. Majority of the respondent schools are compliant with current guidance and are aware of the “Spare pen” policy. However, there remains a need to ensure that children at risk of anaphylaxis are provided with their own action plans and AAIs that are readily accessible, because only a minority of school’s stock spare pens.

Enhancing the recruitment and retention of overseas nurses from Kerala, India.

In September 2016, a team of nurses from East and North Hertfordshire NHS Trust (ENHT) and the University of Hertfordshire in England travelled to Kerala, India to interview and recruit nurses for the trust's acute hospital. Before undertaking the interviews, the team visited a nursing college and two hospitals. Based on the findings from these visits and from meeting the interview candidates, the team designed a bespoke mentoring programme for Keralan nurses recruited to ENHT to ease the transition into nursing and living in the UK. This article explores the challenges associated with recruiting and retaining nurses from overseas, and discusses how these can be addressed to ensure that these nurses practise safely and are supported effectively.

Effect of a dairy diet on nasopharyngeal mucus secretion.

To examine the effects of dairy versus nondairy diets on self-reported levels of nasopharyngeal mucus secretion. Prospective, randomized, double-blinded controlled study. Twenty-six men and 82 consecutive women over the age of 15 years attending the otolaryngology department at East and North Hertfordshire NHS Trust who reported experiencing increased levels of nasopharyngeal mucus secretions were selected for a double-blinded trial of dairy versus dairy-free dietary supplementation for the last 4 days of a 6-day dairy-free diet. Main outcome measures were comparisons of mean daily reporting of subjective levels of nasopharyngeal secretions by linear scoring (1-100) and by an ordinal scale of 1 to 4. On each day, t tests were used to compare differences. There was a significant reduction in the reported linear secretion score seen from day 1 to 4 in nondairy (t[53] = 4.39, P < .01) and in dairy (t[53] = 3.94, P < .01) arms. There was a significant increase in secretion score days 4 to 7 in the dairy arm (t[53] = -2.56, P = .01), and a continued but nonsignificant reduction in the nondiary arm (t[53] = 1.54, P = .13, with an overall significant reduction between day 1 and 7 in the nondairy arm (t[53] = 4.79, P < .00). In the ordinal secretion scale, both dairy arm (t[53] = 2.754, P < .01) and nondiary arm (t[53] = 5.52, P < .01) scores decreased significantly from days 1 to 4. There was a significant decrease in scores from days 1 to 7 in the nondairy group (t[53] = 5.12, P < .01). In this blinded trial, a dairy-free diet was associated with a significant reduction in self-reported levels of nasopharyngeal secretions in adults who previously complained of persistent nasopharyngeal mucus hypersecretion. 1b Laryngoscope, 129:13-17, 2019.

'Always listen, reflect and learn'.

Jodie Deards, winner of the RCNi Nurse Awards 2017 Commitment to Carers category, earned her degree as part of Australia's first cohort of university-trained nurses in 1993. She came to the UK on a two-year working holiday in 2000 but stayed. After 10 years in the renal unit at Lister Hospital in Stevenage, she took up posts as a community diabetes specialist nurse, practice nurse and community matron. Her current role as carers lead has brought her back to Lister Hospital, part of East and North Hertfordshire NHS Trust.

Keeping accurate records

British Journal of MidwiferyVol. 24, No. 8 LegalKeeping accurate recordsRichard GriffithRichard GriffithSearch for more papers by this authorRichard GriffithPublished Online:4 Aug 2016https://doi.org/10.12968/bjom.2016.24.8.594AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Hall v North Hertfordshire NHS Trust 2016 (Queens Bench Division; 26th May) Google ScholarNursing and Midwifery Council (2015) The Code: Professional standards of practice and behaviour for nurses and midwives. NMC, London Google ScholarS (A Child) v Newcastle & North Tyneside HA [2001] EWCA Civ 1868 Google Scholar FiguresReferencesRelatedDetailsCited byRecords: What to include7 October 2016 | British Journal of Midwifery, Vol. 24, No. 10 2 August 2016Volume 24Issue 8ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 4 August 2016 Published in print 2 August 2016 Information© MA Healthcare LimitedPDF download

PWE-057 Stent Placement in Palliative Oesophago-Gastric Cancer: Changed Practice with Improved outcomes

IntroductionOesophageal cancer is often diagnosed late in its pathological process and as a consequence management is often focussed on palliation of symptoms. The insertion of oesophageal stents tend to occur...

PTU-168 ‘Tomatoes Wearing Sunglasses’ Are Hard to Swallow – an Analysis of the Prevalence, Presenting Features & Investigation Findings in Patients with Eosinophilic Oesophagitis at a District General Hospital

IntroductionEosinophilic Oesophagitis (EoE) is a recently described disorder of unclear aetiology and prevalence. Most published studies emanate from international and tertiary referral centres, with a greater focus on the paediatric...

PTH-167 The Investigation of Dyspepsia in Primary Care- The Burning Truth

IntroductionDyspepsia is a common symptom, thought to affect up to 46% of the population1. In order to streamline investigation and management in primary care, guidelines have been formulated by both...

PTU-259 Stent placement in palliation of oesophago-gastric cancer: the story so far

IntroductionThe majority of patients with oesophago-gastric cancer are diagnosed at an advanced incurable stage where palliation of symptoms remain the cornerstone of management. Most centres now palliate patients endoscopically with...

81 Lung cancer audit at East and North Hertfordshire NHS Trust – comparison with national results and impact of service developments over 2008–2010

81 Lung cancer audit at East and North Hertfordshire NHS Trust – comparison with national results and impact of service developments over 2008–2010

80 Service improvement and impact on the East and North Hertfordshire NHS Trust lung cancer service

80 Service improvement and impact on the East and North Hertfordshire NHS Trust lung cancer service

A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion

IntroductionChronic obstructive pulmonary disease (COPD) patients with mucus hypersecretion tend to demonstrate increased frequency of infective exacerbations and a steeper slope of decline in lung function. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO) devices previously used in cystic fibrosis and bronchiectasis patients may offer the opportunity for community-based, self-managed therapy to improve quality of life and lung function.Study design and methodsA randomized controlled crossover pilot study of HFCWO compared with conventional treatment was conducted in 22 patients with moderate to severe COPD and mucus hypersecretion. Patients spent 4 weeks using an HFCWO (SmartVest®) device and 4 weeks in a conventional phase with a 2-week washout. Eleven patients started with HFCWO and changed to conventional treatment, whereas the other eleven patients started conventional treatment and crossed over to HFCWO.ResultsThe patients were elderly with a mean age of 71 (standard deviation [SD] 10) years and were at the upper end of the normal range of body mass index (25 [SD 4.2] kg/m2). The majority of patients had moderate to severe COPD with a mean percentage predicted forced expiratory volume in 1 second of 41 (SD 15.6) and percentage predicted forced vital capacity of 73 (SD 17.7). Baseline sputum production was negatively correlated to lung function and positively to St George’s Respiratory Questionnaire. Symptom scores and St George’s Respiratory Questionnaire symptom dimension improved significantly (−8, P < 0.05). Sputum production showed a declining trend in the HFCWO phase, although not reaching statistical significance. The HFCWO device was well tolerated with good reported compliance.ConclusionThis pilot study demonstrated that patients with advanced COPD and mucus hypersecretion at increased risk of declining lung function tolerated the HFCWO treatment well, leading to improvement in quality of life and reduced symptoms.

64 Patient choice in lung cancer at the East and North Hertfordshire NHS Trust

64 Patient choice in lung cancer at the East and North Hertfordshire NHS Trust

Raising the profile of older people’s care in hospital through training

Two-thirds of patients requiring inpatient acute hospital care are aged over 65. Older people also have a greater need for the use of health and social care (Department of Health (DH) 2001). It is therefore no surprise that the majority of patients cared for by nurses care in general wards are older people. It is vital that health professionals caring for patients, in all ward settings, have the knowledge and skills to care for the complex needs of older people. This article describes a project carried out at East and North Hertfordshire NHS Trust, to address aspects of general hospital care for older people.

Clots and Cancer

2003). 13. Miller GJ, Bauer KA, Howarth DJ, Cooper JA, Humphries SE, Rosenberg RD: Increased incidence of neoplasia of the digestive tract in men with persistent activation of the coagulant pathway. J. Thromb. Haemost. 2(12), 2107–2114 (2004). 14. Schulman S, Lindmarker P: Incidence of cancer after prophylaxis with warfarin against recurrent venous thromboembolism. Duration of Anticoagulation Trial. N. Engl. J. Med. 342(26), 1953–1958 (2000). Affiliations • S Nasim Ali, Specialist Registrar in Medical Oncology, Lister Hospital, East & North Hertfordshire NHS Trust, Corey’s Mill Lane, Stevenage, Hertfordshire, UK Tel.: +44 143 878 1416; Fax: +44 143 878 1241; s_nasim_ali@hotmail.com • Justin Stebbing, Senior Lecturer in Medical Oncology Imperial College School of Medicine, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK Tel.: +44 208 383 5828; Fax: +44 208 383 5830; j.stebbing@imperial.ac.uk • Danish Mazhar, MA, PhD, MRCP, Consultant Medical Oncologist Lister Hospital, East & North Hertfordshire NHS Trust, Department of Oncology, Corey’s Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK Tel.: +44 143 878 1416; Fax: +44 143 878 1241; dmazhar@doctors.org.uk

915 AN INVESTIGATION OF REGISTERED NURSES' KNOWLEDGE AND ATTITUDE TOWARDS PAIN AND PAIN MANAGEMENT

European Journal of PainVolume 10, Issue S1 p. S237-S237 915 AN INVESTIGATION OF REGISTERED NURSES' KNOWLEDGE AND ATTITUDE TOWARDS PAIN AND PAIN MANAGEMENT P.A. Van Raders, P.A. Van Raders East & North Hertfordshire NHS Trust, UKSearch for more papers by this authorP. Kelly, P. Kelly Barts and The London NHS Trust, UKSearch for more papers by this authorS. Ward, S. Ward Barts and The London NHS Trust, UKSearch for more papers by this authorM. Killilea, M. Killilea Barts and The London NHS Trust, UKSearch for more papers by this author P.A. Van Raders, P.A. Van Raders East & North Hertfordshire NHS Trust, UKSearch for more papers by this authorP. Kelly, P. Kelly Barts and The London NHS Trust, UKSearch for more papers by this authorS. Ward, S. Ward Barts and The London NHS Trust, UKSearch for more papers by this authorM. Killilea, M. Killilea Barts and The London NHS Trust, UKSearch for more papers by this author First published: 13 January 2012 https://doi.org/10.1016/S1090-3801(06)60918-XRead 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, IssueS1September 2006Pages S237-S237 RelatedInformation

Evaluating compliance with national guidelines for the clinical, laboratory and public health management of tuberculosis in a low-prevalence English district

School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK Department of Microbiology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK Department of Medicine, Lister Hospital East and North Hertfordshire NHS Trust, Stevenage, UK East and North Hertfordshire Health Protection Unit, Health Protection Agency, Welwyn Garden City, UK North Hertfordshire and Stevenage Primary Care Trust, Letchworth, UK

Privatisation of pathology services Trust hospital exonerated by district auditor

EDITOR, - The article concerning the proposal by North Hertfordshire NHS Trust to enter into a contract with a private company for the provision of pathology services referred to the complaint made by the BMA to the district auditor alleging impropriety and a failure by the trust to follow proper procedures during its tendering process.1 We have now received the report of the district auditor on the inquiries he made into these complaints. The report shows that the complaints made by the BMA were completely without foundation and that the trust behaved properly in every respect. I hope this letter will assist North Herts Trust in remedying the unfair and unnecessary damage done to its reputation by the making …

Trust hospital criticised for privatising pathology services

An NHS trust hospital that is about to privatise its pathology service has been reported to the district auditor by the British Medical Association (BMA), which wants an investigation into the way the trust conducted the tendering process. In a separate move the Royal College of Pathologists has said that it fears that the quality of the service could suffer if the privatisation goes ahead. North Hertfordshire NHS Trust said last October that it was awarding the contract for pathology services at the Lister Hospital in Stevenage to United Laboratories. Bob Ewings, chief executive of the trust, rejected the college's criticism that the quality of the service could suffer with independent management. “The service could suffer if the trust does not manage it properly. But we will have in place proper systems and proper structures to make sure that does not happen.” The contract is one of the first to be given to an independent company for pathology services in the NHS. It comes in advance of a review of pathology services by the Department of Health, due later this year, which will produce guidelines for developing “high quality, cost effective services responsive to the needs of patients and users.” Doctors' leaders fear that pathology is one of many clinical specialties that could be privatised and are worried that the quality of patient care could suffer. Dr Sandy Macara, chairman of the BMA's council, said: “We are concerned …