Oxford University Hospitals NHS Foundation Research Articles

Computed tomography follow-up identifies radically treatable new primaries after resection for lung cancer.

The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26-262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44-28.97%) and specificity was 89.83% (79.17-96.18%). Negative likelihood ratio was 0.92 (0.8-1.07). CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.

Corrigendum.

Diabetic MedicineVolume 36, Issue 10 p. 1320-1320 CorrigendumFree Access Corrigendum This article corrects the following: Prevention and reversal of Type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference R. Taylor, J. Valabhji, P. Aveyard, D. Paul, Volume 36Issue 3Diabetic Medicine pages: 359-365 First Published online: January 25, 2019 First published: 17 September 2019 https://doi.org/10.1111/dme.14105AboutSectionsPDF 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 The article by Taylor et al. 1 was published without the funding information and disclaimer text. The missing funding information and disclaimer text are given below: Paul Aveyard is funded by the NIHR Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors would like to include an additional affiliation for the third author. The additional affiliation is given below: Dr Paul Aveyard, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK The authors regret the error. Reference 1Taylor R, Valabhji J, Aveyard P, Paul D. Prevention and reversal of Type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference. Diabet Med 2019; 36: 359– 365. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume36, Issue10October 2019Pages 1320-1320 ReferencesRelatedInformation

Testing a digital system that ranks the risk of unplanned intensive care unit admission in all ward patients: protocol for a prospective observational cohort study

IntroductionTraditional early warning scores (EWSs) use vital sign derangements to detect clinical deterioration in patients treated on hospital wards. Combining vital signs with demographics and laboratory results improves EWS performance....

Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients—a feasibility study protocol

BackgroundIntravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal...

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. Current Controlled Trials ISRCTN48152791. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.

220.7: Human intestinal tissue-resident memory CD8 T cells comprise two transcriptionally distinct populations

Introduction: Tissue-resident memory (TRM) T cells, long-lived effector T cells in tissue that do not recirculate, are critical in inflammatory, infectious, and neoplastic conditions1. However, the study of human TRM cells has been hampered by an inability to prove long-term tissue residency. We hypothesised that intestinal transplantation could present an opportunity to study long-lived donor-derived TRM cell populations. Methods: Adult intestinal transplantation recipients were identified via longitudinal cohort studies at Oxford University Hospitals NHS Foundation Trust. Thirteen samples of intestinal graft biopsies were obtained from eight patients (Table 1). Donor- and recipient-derived T cells in intestinal transplant mucosa were identified using flow cytometry and antibodies to discordant HLA Class I proteins (Fig 1A)2. Proposed residency markers CD69 and αE integrin (CD103) were included in the panel. Fluorescence-activated cell sorting was used to sort donor- and recipient- derived intestinal T cells for 5’ single-cell RNA sequencing using the 10X Genomics platform. Results: The proportion of donor-derived T cells was negatively correlated with time post-transplant, and was highly variable between subjects, with some subjects maintaining significant donor-derived populations up to 5 years post-transplant (Fig 1B). Donor-derived T cells uniformly expressed CD69 (>99%), and CD103 was highly expressed (84%), with increased expression at late times (Fig 1C). Single-cell RNA sequencing was performed on cells sorted from a single healthy subject 1 year post-transplantation. Data from 974 cells were of sufficient quality for analysis. Analysis of gene expression revealed conventional CD4 T cells, CD4 TREGS, and 2 distinguishable CD8 T cell populations within the graft-resident donor-derived cells (Fig1D). The CD8 clusters differed in expression of key residency (CD103) and functional markers (GzmB and HLA class II) (Fig 1E). Conclusion: Donor-derived TRM cells can persist in the graft for at least 5 years post-transplant, with highly variable dynamics between patients. Single-cell transcriptomic profiling and flow cytometry indicates two transcriptionally and phenotypically distinct CD8 TRM populations within the human intestine. Further study of the regulation, differentiation, and biology of these populations is warranted, as well as their role in intestinal transplantation. Mueller & Mackay (2015) Nat Rev Immunol Zuber J. et al. (2016) Sci Immunol

P2.32: Dynamics of recipient-derived T cell populations infiltrating intestinal transplant mucosa, and their expression of gut-homing chemokines and integrins

Introduction: Early infiltration of recipient-derived T cells into an intestinal transplant graft is associated with rejection, which can lead to graft loss and death1. However, the infiltration dynamics of different T cell subsets are poorly understood, as are the mechanisms of entry. With the development of anti-integrin and -chemokine therapeutics, understanding whether pathways involved in gut-homing could be targeted for the prevention or treatment of early rejection is of significance. Methods: Adult intestinal transplantation recipients were identified via longitudinal cohort studies at Oxford University Hospitals NHS Foundation Trust. Fifteen samples of intestinal graft biopsies were obtained from ten patients (Table 1) at various times after transplantation (23 days to 5 years). Donor- and recipient-derived T cells in intestinal transplant mucosa were identified using flow cytometry and antibodies to discordant HLA Class I proteins (Fig 1A)1. Gut-homing molecules CCR9 and β7 integrin, and markers of conventional and innate-like T cell subsets were examined. Results: The relative frequencies of key T cell subsets altered following transplantation (Fig 1B & C). Early post-transplant, CD8 and non-Vδ2 γδT cells dominated (28% and 49%, respectively). These early non-Vδ2 γδT cells were predominantly donor-derived. Innate-like MAIT and Vδ2+ γδT cells were rare (<1%) early post-transplant but recovered with time (6% and 2%, respectively). The fraction of recipient-derived T cells in the graft increased with time, with highly variable kinetics between subjects. Early post-transplant, expression of CCR9 and β7 integrin was low on recipient-derived T cells, with 29% of CD8 and 48% of CD4 T cells negative for both markers. In contrast, 52% of CD8 and 31% of CD4 donor-derived T cells co-expressed CCR9/β7 (Fig 1D). CCR9/β7 co-expression increased in recipient-derived T cells with time. Conclusion: Following intestinal transplantation, the relative abundance of T cell subsets within the graft is dynamic. Innate-like T cells were near-absent in the first year post-transplant, whilst early post-transplant, donor-derived non-Vδ2 γδT cells were over-enriched. Fewer recipient-derived T cells infiltrating the graft expressed putative gut-homing molecules. This questions whether pharmaceutical targeting of these pathways is appropriate in graft rejection, but samples from a rejection episode are needed for validation. 1. Zuber J. et al. Sci Immunol 1, eaah3732 (2016).

Reducing attendance at trauma clinics by providing first-point-of-contact treatment.

In 2016, the urgent and ambulatory care service in Oxfordshire formed part of a cross-organisational partnership working group. The group consisted of Oxford Health NHS Foundation Trust community minor injury units (MIUs) at Abingdon and Witney, and Oxford University Hospitals NHS Foundation Trust (OUH) trauma and orthopaedic specialties and emergency department (ED). The aim was to redesign fracture management pathways and delivery of definitive care at patients' first point of contact with the NHS. This article discusses the implementation of the trauma pathways in two of Oxfordshire's community MIUs. In total, a range of seven common fracture pathways seen in the ED and community MIUs were redesigned so that patients were treated definitively at the first point of contact and discharged with a safety net supported by leaflets; a direct contact facility to OUH trauma specialties was part of the safety net allowing patients to self-refer to the trauma clinic if they had any concerns. In total, 513 patients were treated and discharged on see, treat and discharge fracture pathways in the first year of pathway operation, which represented a 21% decrease in patient referral rates to the trauma clinic at OUH compared with the previous year.

Interventional bundle for venous thromboembolism prevention: ensuring quality and effectiveness

Hospital-associated thromboses (HATs) are a potentially preventable cause of morbidity and mortality. Oxford University Hospitals NHS Foundation Trust was designated a Venous Thromboembolism (VTE) Exemplar Centre by NHS England in...

Pancreas transplantation — a week in the Pancreas Transplant Unit at the Churchill Hospital, Oxford University Hospitals NHS Foundation Trust

Pancreas transplantation — a week in the Pancreas Transplant Unit at the Churchill Hospital, Oxford University Hospitals NHS Foundation Trust

Corrigendum to "The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach" [Pregn. Hypertens. 12 (2018) 161-168

© 2019 The Author(s) The authors regret the omission of the following In the Acknowledgements: “Lucy Mackillop was supported by the NIHR Oxford Biomedical Research Centre.” In the Affiliations: “NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust.” The authors would like to apologise for any inconvenience caused.

Evaluation of potential implementation of proposed 28-day cancer waiting time standard at Oxford University Hospitals NHS Foundation Trust

Evaluation of potential implementation of proposed 28-day cancer waiting time standard at Oxford University Hospitals NHS Foundation Trust

Abstract LB-025: A decision support system for the treatment of esophageal cancer

Abstract Introduction In oncology deciding which treatment to use and when to apply them in an optimal way can be challenging. Currently there are no global approaches available to optimise the treatment path for an individual patient. Focusing on esophageal cancer, we have developed a prototype of a model-based Decision Support System (DSS). It integrates a novel range of drug, tumour and patient data to better plan clinical treatment, optimise the patient care path, and ultimately deliver improved cancer care. Methods This tool was developed using data from an historical cohort of patients with operable esophageal cancer. This cohort comprised 465 patients who were treated at Oxford University Hospitals NHS Foundation Trust between 2007 and 2014. An initial data analysis focussed on using un-supervised learning methods to identify key variables that differentiated groups of patients. These variables were then used to analyse their correlation to survival and key decision points using parametric statistical models. The final models were then used to create a web-based DSS prototype. The prototype allows users to see throughout a patient's treatment journey what factors influence prognosis including key interventions such as surgery. Results The key results within the analysis centered around treatment effects on FDG-avid nodal status, using positron emission tomography-computed tomography (PET-CT). We found that change in nodal avidity due to chemotherapy is a key prognostic factor. Furthermore, this change correlated with the change in avidity and size of the primary tumour i.e. there is a degree of correlation between the primary tumour and nodes. No difference was found between the four chemotherapy regimens analysed in their ability to reduce tumour size and also change nodal status. However a hypothesis that might be tested through further research is that titrating duration of treatment and doses to the achievement of change in avid nodal status may have a significant impact on individual patient prognosis. The above key results as well as others pertaining to attempted and successful surgery can all be explored using the dynamic web-based interface developed. Conclusion We have created a DSS tool using historical data to support Cancer Multidisciplinary Teams in understanding how key variables affect treatment choices and how these in turn relate to disease outcomes. The tool has the potential to be used to support the optimisation of treatment for individual patients based on the characteristics of their disease. Thus the DSS tool developed is a first step to personalised treatment of cancer. Citation Format: Hitesh Mistry, Fernando Ortega, Frances A Brightman, John M Findlay, Mark R Middleton, Christophe Chassagnole. A decision support system for the treatment of esophageal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-025.

The impact of patient age on toxicity and efficacy of immunotherapy agents.

e15116 Background: Little data exists for the use of immune checkpoint inhibitors (ICI) in patients ≥80y old. Ageing is associated with immunosenescence, which may impact the efficacy and toxicity of immune-based therapies. Here we provide efficacy and immune related adverse event (irAE) data for patients ≥80y old and younger patient cohorts treated in routine clinical practice at 3 UK Cancer Centres: Guy’s and St Thomas’ NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust and University Hospitals of Leicester NHS Trust. Methods: Melanoma, renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) and urothelial carcinoma (UC) patients treated with ICIs between March 2016 – August 2018 were identified, and divided into five age-defined cohorts: &lt; 50y, 50-59y, 60-69y, 70-79y, ≥80y. Median progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method with data censored on 5th February 2018. Frequency and severity of five common irAEs were determined: hepatitis, endocrinopathies, immune-related gastrointestinal, skin and rheumatological. Results: 386 patients aged 22 – 98y (median 67y) received single-agent nivolumab (21%), pembrolizumab (62%), ipilimumab (10%) or combination ipilimumab and nivolumab (7%). 12% of patients were aged &lt; 50y, 18% were 50-59y, 29% were 60-69y, 28% were 70-79y and 13% were ≥80y. Response rates (partial + complete response) were similar across all age groups (53% &lt; 50y, 29% 50-59y, 48% 60-69y, 43% 70-79y and 47% ≥80y). Median PFS was 10.6, 10.3, 10.0, 5.8 and 19.7 months and OS was not reached, not reached, 29.0, 18.3, and 20.9 months for patients &lt; 50y, 50-59y, 60-69y, 70-79y and ≥80y, respectively. The rate of any grade irAEs was lowest in patients ≥80y (59%), and highest in patients &lt; 50y (92%). Grade 3-5 irAEs were also less frequent in patients ≥80y (10%) than those &lt; 50y and 60-69y (both 18%). Conclusions: Of 386 patients 13% were ≥80y with response rates comparable to younger patient cohorts and rates of irAEs lower than younger patient cohorts in this retrospective analysis of a heterogenous patient population. Our data suggests that ICIs are well-tolerated and efficacious in elderly patients and that age alone should not preclude ICI use.

Real-world refractive outcomes of toric intraocular lens implantation in a United Kingdom National Health Service setting

BackgroundWith increasing availability of toric intraocular lenses (IOL) for cataract surgery, real-world refractive outcome data is needed to aid the counselling of patients regarding lens choice. We aim to assess the outcomes of toric intraocular lens use in the non-specialist environment of a typical United Kingdom NHS cataract service.MethodsA retrospective cohort study conducted at the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, UK. All patients who received a toric IOL implant over a 10 months period. Patients underwent pre-operative corneal marking, phacoemulsification and toric IOL implantation. Biometry was obtained using a Zeiss IOLMaster 500 and the toric IOLs were selected using the manufacturers’ online calculators. Post-operative refractions were obtained from optometrist’s manifest refraction or by autorefraction. The outcome measures were post-operative unaided visual acuity (UVA), spherical equivalent refraction, cylindrical correction and all complications.ResultsThirty-two eyes of 24 patients aged 21–86 years (mean 66.4, SD 14.5) were included. UVA was superior to pre-operative best-corrected visual acuity (BCVA) in 81% of eyes, same in 16% and inferior in 3%, resulting in a median improvement of 0.20 LogMAR (IQR 0.10 to 0.30). 56%, 81%, 94% and 100% of eyes were within ±0.5, ±1.0, ±1.5 and ±2.0 D of predicted spherical equivalent, respectively. Three (9%) eyes required further surgery to rectify significant IOL rotation.ConclusionsReduced cylindrical correction and improved UVA could be expected in the majority of patients undergoing toric IOL implantation. Patients should be counselled about the risk of lens rotation.

Incidentally detected testicular lesions

To investigate the pathology of excised testicular lesions <10 mm in size. The pathological reports of 2 681 patients with testicular lesions from Barts Health NHS Trust and Oxford University Hospitals NHS Foundation Trust were reviewed as part of a service evaluation audit from January 2003 to May 2016. Cases in which the lesion had a maximum diameter of <10 mm were selected. Clinical features were also accessed, where available, to examine patient demographics, prediagnostic levels of serum markers, ultrasonographic findings and clinical details. A total of 81 patients with a lesion size <10 mm on histology were identified and, of these, 16 (20%) had a lesion diameter <5 mm. Of the 81 patients, 56 (69%) had benign lesions. Of 16 patients with a benign lesion <5 mm in diameter, 15 underwent orchidectomy and just one underwent partial orchidectomy. Preoperative tumour markers were available in 47/81 patients. None of the 16 malignant tumours in these 47 patients were associated with raised tumour markers, while seven of 31 remaining patients with benign lesions had raised α-fetoprotein and lactate dehydrogenase levels. In total there were 25/81 malignant cases (31%), which were all germ cell tumours (GCTs): 15 seminomas (60%) and 10 non-seminomatous GCTs (40%). Only one GCT had a diameter of <5 mm, and this was a regressed tumour within an 18-mm area of granulomatous inflammation. Only one GCT relapsed: a clinical stage I, embryonal carcinoma of 6 mm in maximum diameter. The 56 'benign' cases included 34 sex cord stromal tumours, including 23 Leydig cell tumours (41%), eight Sertoli cell tumours (14%) and three mixed sex cord stromal tumours (5%). None showed any malignant features. The remaining 22/56 lesions (40%) were lesions with no further follow-up. Benign lesions seemed to be associated with a small diameter, and we found <5 mm to be the best threshold for predicting benign vs malignant lesions (P = 0.002). The majority of testicular lesions <10 mm, identified by radiology, were benign, although approxmiately one-third were malignant. In the present study, 100% of lesions <5 mm in diameter were benign. Tumour markers appear to be unhelpful in the distinction of these small tumours. We suggest that regular ultrasound surveillance be more widely used for testicular lesions of this size. Testicular tumours now have a very high cure rate and changes in size of lesions may be monitored prospectively with minimal risk of increased morbidity. Patients who undergo an orchidectomy for lesions <5 mm are 'victims of modern imaging technology'. If surgery is undertaken in lesions 5-10 mm, patients should be counselled that two-thirds of cases are benign.

The oral education clinic: A pharmacist- and nurse-led clinic to support patients starting oral systemic anti-cancer treatments.

With the increased number of oral systemic anti-cancer treatments available, patients need to be managed safely and effectively in line with national guidance. In response to guidance in 2011, Oxford University Hospitals NHS Foundation Trust implemented an 'Oral Education Clinic'. This nurse- and pharmacist-led clinic facilitates the delivery of patient education, highlighting key safety aspects of drug administration and management, and ensures follow-up is arranged as per protocol. Patients have found this service to be effective and it has had a positive impact on the running of outpatient units, the volume of triage calls, emergency admissions and workload associated with consenting patients to an oral systemic anti-cancer treatments.

Developing and evaluating a foundation preceptorship programme for newly qualified nurses.

In 2014, an innovative, three-tiered foundation preceptorship programme for newly qualified nurses was developed in Oxford University Hospitals NHS Foundation Trust. The programme was to be mandatory for newly qualified nurses commencing Band 5 posts in the trust, and has a structured curriculum that integrates skills development, preceptorship and clinical supervision. Aim To evaluate the Oxford University Hospitals NHS Foundation Trust foundation preceptorship programme for newly qualified nurses commencing Band 5 posts in the trust. Method Data were collected through questionnaires and focus groups with newly qualified nurses and nurse managers in the trust. Findings Respondents indicated the foundation preceptorship programme had positive value and improved the experience of newly qualified nurses during their first year of clinical practice. Newly qualified nurses wished to regularly reflect with experienced nurses and obtain feedback on their practice from clinical experts to develop their clinical skills. A professionally-regulated agreed percentage of preceptor-preceptee supervision time may enhance preceptorship standards. Conclusion The foundation preceptorship programme had several benefits for newly qualified nurses and nurse managers, and their feedback on the programme was positive. The development and evaluation of the foundation preceptorship programme may inform the future education and training of newly qualified nurses during their first year in clinical practice.

Role Model: Tim Littlewood

Anne Gulland speaks to Tim Littlewood, a consultant haematologist and associate director of clinical studies at Oxford University Hospitals NHS Foundation Trust

Making collaboration work.

The Children's Hospitals Network (CHN) was formed in 2012 following a review of national specialist services. Oxford University Hospitals NHS Foundation Trust (OUH) and the University Hospital Southampton NHS Foundation Trust (UHS) collaborated in its formation, with the CHN hosting clinical and operational networks across more than 20 district general hospitals in the Thames Valley and Wessex regions.