Salford Royal Hospitals NHS Trust Research Articles

Getting nosey about IBD

Catherine Stansfield, Advanced Practitioner in Gastroenterology, Salford Royal Hospitals NHS Trust, Salford, discusses the use of simple noninvasive tests, like the gas chromatograph, for early IBD detection

The effect of disease activity on body composition and resting energy expenditure in patients with rheumatoid arthritis

IntroductionCachexia is associated with rheumatoid arthritis (RA), but whether it is attributable primarily to reduced dietary intake or increased metabolism is unclear, as is the association with inflammation. To examine whether rheumatoid cachexia is related to increased energy expenditure, reduced food intake, or an inflammatory cytokine response we undertook a prospective, longitudinal study of patients with RA, during periods of relative relapse and remission of inflammation.MethodsSixteen patients admitted to hospital with a flare of RA were assessed clinically to determine disease activity and were re-examined 6 weeks later. Their fat-free mass (FFM), dietary intake, resting energy expenditure (REE), and plasma concentrations of interleukin-6 (IL-6) were also measured. Data were compared with those from 16 healthy, age- and sex-matched controls.ResultsAt baseline the body weight, body mass index, and FFM of patients with RA were significantly lower than those of controls. Disease activity scores of patients (6.39 ± 0.8) were reduced when the patients were re-examined 6 weeks later (5.23 ± 1.26) and FFM was no longer statistically different from that of controls (visit 1 = 25.8 ± 10.1 and visit 2 = 26.8 ± 9.5 versus controls = 32.3 ± 10.9). There were no differences in food intake between patients and controls or between patients studied at the 2 time points, but REE was greater in patients after correcting for FMM (visit 1 = 62.2 ± 24.7, visit 2 = 59.7 ± 26.3 versus controls = 46.0 ± 13.7). Plasma IL-6 concentrations were significantly higher in patients than controls. Although IL-6 was not significantly correlated with REE, lower REE measurements were not observed when the plasma IL-6 concentration increased.ConclusionReduced FFM in patients with RA is not attributable to reduced food intake. Energy expenditure is greater in patients when corrected for FFM, particularly in patients with acute flares of disease activity. Although clearly not the only factor involved, increased production of IL-6 may contribute to increasing REE.

Rehabilitation for Apraxia

Graeme J. Hankey MD, FRCP Section Editor Limb or motor apraxia, which can occur after a stroke, is a disturbance of the conceptual ability to organize actions to achieve a goal. It can disrupt a person’s ability to perform everyday activities and to live independently but is not due to muscle weakness or sensory loss. This systematic review examined the effectiveness of cognitive rehabilitation aimed at apraxia after stroke. The primary outcome was at the level of disability (restricted activity), specifically whether any benefits were maintained beyond the end of the intervention. Short-term effects, impairment, mood, and quality-of-life measures were also investigated. A thorough literature search up …

Phaeohyphomycosis caused by Exophiala salmonis

British Journal of DermatologyVolume 155, Issue 5 p. 1082-1084 Phaeohyphomycosis caused by Exophiala salmonis V. Madan, V. Madan The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorD. Bisset, D. Bisset The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorP. Harris, P. Harris The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorS. Howard, S. Howard The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorM.H. Beck, M.H. Beck The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this author V. Madan, V. Madan The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorD. Bisset, D. Bisset The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorP. Harris, P. Harris The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorS. Howard, S. Howard The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this authorM.H. Beck, M.H. Beck The Dermatology Centre and‡Department of Microbiology, University of Manchester, School of Medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Salford, U.K.Departments of *Pathology and†Surgery, Royal Bolton NHS Trust, Bolton, U.K. E-mail: vishalmadan@doctors.net.ukSearch for more papers by this author First published: 23 August 2006 https://doi.org/10.1111/j.1365-2133.2006.07492.xCitations: 7 Conflicts of interest: none declared. Read 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 Citing Literature Volume155, Issue5November 2006Pages 1082-1084 RelatedInformation

A case study of a preceptorship programme in an acute NHS Trust - using the European Foundation for Quality Management tool to support clinical practice development

To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme. Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust. The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers. Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change. This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

Patient‐centred improvements in health‐care built environments: perspectives and design indicators

To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space around the bed area, supportive of privacy and dignity, ward noise and other disturbances. Patients perceived sustainable health-care environments to be supportive of their health and recovery. The design indicators developed from their perspectives and from their considerations for improvements to the health-care built environment were based on their visions of the role of the health-care facilities. These were homely environments that supported normal lifestyle and family functioning and designs that were supportive of accessibility and travel movements through transitional spaces.

Patient-friendly hospital environments: exploring the patients' perspective.

To investigate the perceptions and attitudes of patients to the built environments of NHS Trust hospitals, in order to inform design excellence so as to make future hospitals places and spaces responsive to patient needs. An exploratory study of patients perceptions based on qualitative semi-structured personal interviews. Fifty one-to-one interviews held with hospital in-patients across the four directorates of surgery, medicine, care of the elderly and maternity at Salford Royal Hospitals NHS Trust, Salford, UK. The research found that there was much similarity in the priorities, issues and concerns raised by patients in each of the four directorates. Patients perceived the built environment of the hospital as a supportive environment. Their accounts in each area pointed to the significance of the factors that immediately impacted on them and their families. Patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggest that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. The findings have important implications for capital development teams, clinical staff, managers and NHS Estates personnel. Although the study has immediate relevance for Salford Royal Hospitals Trust, findings and recommendations reported provide NHS Estates and other relevant stakeholders with evidence-based knowledge and understanding of patients' perceptions and expectations of and preferences for particular facilities and estates provision in NHS hospitals.

An investigation of the suitability of the EFQM Excellence Model for a pharmacy department within an NHS Trust.

Explores whether the EFQM Excellence Model provides a suitable framework for quality management within the pharmacy department at Hope Hospital, Salford Royal Hospitals NHS Trust. Research involved a literature search of the work of authors in the field of quality, generically and in healthcare, the development of quality awards, and practical cases of implementation of the model in NHS Trusts. Common themes were identified from this search. Interviews with staff and customers showed high levels of customer awareness, customer satisfaction and generic training. This was compared with the data from the literature search and the researcher's observations. The Excellence Model was seen to be a suitable framework for quality management provision, although there was little knowledge of it in the pharmacy department. A quality service was still being provided in spite of this, but the model could build further on this good work and provide a more structured approach.

Developing a culture of quality within the United Kingdom healthcare system

It is established that there are three levels of quality, technical, generic and systemic with systemic being the preferred goal for Salford Royal Hospitals NHS Trust (SRHT). In an effort to achieve their goal SRHT embarked on using the EFQM Excellence Model to provide one overarching framework for all their quality initiatives. The article explains SRHT’s approach to implementation and integration in addition to providing a flavour of the outcomes observed from the journey so far. In essence, many benefits were realised, some aspired to, some unexpected and all worthwhile and welcomed. However, even after seven years the organisation still does not have full deployment, which confirms that efforts to assure excellence need to be relentless if there is to be a sustainable culture change that puts quality at the heart of day‐to‐day decision making.

Un title.

Nurses fought off competition from more than 160 colleagues to win two out of four research awards presented by health secretary Frank Dobson to staff at Salford Royal Hospitals NHS Trust last month. A&E nurses Olive Goodall and Gabrielle Lomas received a joint award for their research showing that trauma teams improved patient outcome, while Michael McEachern, charge nurse in elderly care, revealed that Do Not Resuscitate (DNR) orders are not being put into effect.