Trafford General Hospital Research Articles

1304 LAXATIVES PRESCRIPTION MONITORING FOR AN OVERLOOKED PROBLEM

Abstract Introduction Constipation is a common diagnosis among hospitalized patients. It results in considerable morbidity in elderly patients, healthcare utilization and economic burden. Laxatives are commonly prescribed but poorly monitored due to benign side effect perception. Aim We undertook a review of the quality of laxative prescribing and subsequent monitoring amongst an inpatient cohort. We propose new standards: - Medication review at least once weekly; - Documented rationale for choice of medication - Specified timeframe review and outcome documentation We reviewed current hospital trust policy of laxative prescribing and produced a new constipation management guideline in response to early audit data. Method Data collected across medical wards in Trafford General Hospital, Manchester. Data was collected on types of laxatives, reason for prescription, date of review, length of course, compliance and effect of laxatives. Two rounds of audit were performed 6 months apart, with an interim intervention of staff education and local introduction of a new constipation management guideline. The guideline consisted of decision algorithm and suggested treatment. Results 47 individual prescriptions were audited in round 1 and 72 prescriptions in round 2, this represented 23 and 32 patients respectively. Review of medications within first week of prescription improved from 17% to 83.7% across the two cycles. Documentation of constipation diagnosis improved from 52.2% to 97.2%. There were large percentage improvements in documentation of specified treatment outcomes across all audited fields, despite overall poorer medication compliance among patients in round 2 (56.9% versus 66% in round 1). The average length of laxative use decreased from 18.6 days to 15.3 with overall percentage of patient with constipation resolved increased from 65% in round 1 to 73% in Round 2 Conclusion Staff education and implementation of treatment guidelines made a substantial improvement to the medical management of constipation in hospitalized patients.

Management of Children Referred to ENT with Suspected Obstructive Sleep Apnea Following Overnight Oximetry.

Background: Obstructive sleep apnea (OSA) has been associated with increased risk of respiratory complications after adenotonsillectomy in children. Not all such children require overnight admission, and same-day surgery is appropriate for some patients. Selection of those that are suitable for same day discharge relies on accurate identification of OSA severity.Guidelines about ‘Day Care Adenotonsillectomy in presence of Sleep Apnea’’ provided by Nottingham Children’s Hospital, the UK, published in 2014, and applies to those children who had a sleep study performed pre-operatively.A typical cost-effective practical sleep study entails at-home overnight pulse oximetry.Aim: The aim of audit study was to see if suspected OSA is appropriately managed at Trafford General Hospital (TGH), the UK, according to the standards provided by Nottingham Children’s Hospital, in addition to taking one standard from the Royal College of Pediatrics and Child Health report, on Standards for Services for Children with Disorders of Sleep Physiology, published in 2009.Study Design: This is a retrospective local audit study focused on children who were referred to ENT at TGH for suspected OSA or who were suspected of OSA during ENT follow-up for another non-OSA reason.Conclusion: There is good practice in excluding insufficiently analyzed oximetry.Non-compliance was mostly due to mild OSA being ruled in on an inconclusive study. The listing and referral for adenotonsillectomy is appropriate despite conflicting local practice to refer all children with suspected OSA to a specialized centre.

Alan Edward Andrew Ridgway

Alan Edward Andrew Ridgway attended Downside School, from where he won a place to study medicine at Jesus College, Cambridge, in 1958. He qualified in 1964 after undertaking his clinical...

AB0864 Fatigue in Fibromyalgia Syndrome and Patients with Osteoarthritis

BackgroundCompared to other clinical groups with chronic pain, people with fibromyalgia syndrome (FMS) report higher levels of fatigue. It is not known whether this is driven by pain, psychological mechanisms...

Trust fends off mrsa for two years.

Trafford Healthcare NHS Trust in Manchester has gone two years without a single case of MRSA infection. Among Trafford General Hospital staff who gathered to celebrate the achievement were (from left) domestic Joanne Morton, microbiologist Barzo Faris and matron Julie Treadgold. In the foreground, infection control nurse Paula Halsall demonstrates a specialised microbe testing machine.

BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies

Inhibitors of TNF-a represent important treatment advances for a number of inflammatory conditions, including RA. TNF-a inhibitors offer a targeted strategy that contrasts with the non-specific immunosuppressive agents traditionally used to treat most forms of systemic inflammation. Information on who benefits from these agents and on their adverse effects continues to be collected through clinical studies, case series and reports and through national registries. In 2001 and 2005, the British Society for Rheumatology (BSR) established and updated guidelines for the use of anti-TNF drugs in RA [1, 2]. These guidelines have indicated which adult patients with RA should be eligible for treatment with anti-TNF therapies, precautions that need to be taken in their use and action that should be taken in the event of adverse effects. The previous guidelines applied to the then-available anti-TNF therapies {etanercept and infliximab in 2001 [1], and etanercept, infliximab and adalimumab (first-generation anti-TNF agents) in 2005 [2]}. Due to the large volume of information now available on these agents the BSR has, in 2010, produced separate guidelines on eligibility for anti-TNF treatment in RA (in press) These current guidelines cover the safety aspects of anti-TNF treatment in RA and apply to the first-generation products but also to the newly licensed second-generation anti-TNF drugs, certolizumab pegol and golimumab. There are relatively little safety data specifically for these second-generation agents but there are no data thus far to suggest that their side-effect profile would differ significantly from the first-generation agents. This is a rapidly changing field with new data emerging each month, so it is vital that clinicians keep up to date with this area of practice. These guidelines have Rheumatology Department, Royal Derby Hospital, Derby, Rheumatology Unit, Queen Alexandra Hospital, Portsmouth, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Rheumatology Department, Poole Hospital, Poole, ARC Epidemiology Unit, University of Manchester, Manchester, Rheumatology Department, St George’s Healthcare, London, Rheumatology Department, Royal Lancaster Infirmary, Lancaster, Rheumatology Department, St Helens Hospital, St Helens, National Rheumatoid Arthritis Society, Maidenhead, Rheumatology Department, Addenbrooke’s Hospital, Cambridge, Rheumatology Department, Trafford General Hospital, Manchester, Rheumatology Unit, Worthing and Southlands NHS Trust, Worthing and Rheumatology Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.

A qualitative investigation of expectant and new mothers' understanding of the model of a stand-alone midwifery-led birth centre

ObjectiveTo determine understanding of the model of a stand-alone Midwifery led unit, in order to inform and develop education programs for potential users.DesignQualitative study using interviews.SettingDistrict General Hospital Maternity service.Participants10...

Adverse incidents in gynaecology: anything for doctors?

PurposeThe purpose of this study is to determine the effectiveness of incident reporting within the Department of Gynaecology at Trafford General Hospital.Design/methodology/approachA list of all reported clinical incidents in relation to gynaecology at the Trafford General Hospital over a period of two years (January 2005 to December 2006) was obtained. The complaints and claims related to gynaecology were also obtained for the same time period. All complaints and claims were correlated with the reported adverse incidents.FindingsOf the reported 111 adverse incidents, none resulted in either complaint or claim. None of the complaints resulted in claims but there was no corresponding incident reporting. All the claims were directly related to surgical procedures but no incident reporting was done either. The nursing staff filled in all the 111 adverse incident forms.Research limitations/implicationsThis study is only limited to adverse incidents in gynaecology over a short period of time (two years) at a District General Hospital.Practical implicationsThis study demonstrates the need to stress the importance of incident reporting to the doctors. It is suggested that a session be dedicated to incident reporting as a part of in‐house training for medical staff of all grades.Originality/valueThis paper highlights the need to impress on the medical staff about the importance of adverse clinical incident reporting.

Single-use wash bowls help reduce the risk of infection.

Nurses have stopped using plastic washbowls in Trafford General Hospital in a bid to fight infections.

Serological prevalence of herpes simplex virus type 2 amongst GUM clinic attenders in a district general hospital setting.

Our objective was to determine the seroprevalence of herpes simplex virus (HSV) type 2 infection amongst genitourinary medicine (GUM) clinic attenders at a district general hospital using a commercially available enzyme immunoassay (EIA). In a prospective study, heterosexual patients attending the Department of GUM at Trafford General Hospital attending with a new clinical problem and having a blood sample taken for routine syphilis serology had the same sample tested for HSV type 2 antibodies. The prevalence of HSV type 2 seropositivity amongst participants was 9.9% (24/242) for men and 18.7% (46/246) for women. With respect to undiagnosed, asymptomatic infection the seroprevalence was 8.6% and 17% respectively. For those attenders locally resident the seroprevalence was 10.1% and 17.5% respectively, and undiagnosed, asymptomatic infection 8.5% and 17.1% respectively. Although seroprevalence figures in this study are lower than the only previous report in the UK, these results, nevertheless, show that seropositivity is not confined to large urban centres. Patients attending GUM clinics are likely to have high rates of undiagnosed HSV type 2 infection.

Stomach cancer — is it a lost cause?

A retrospective study of 7 years of endoscopy at Trafford General Hospital from 1986-1993 identified 143 patients diagnosed as having gastric cancer, of whom 13 cases were identified as early gastric cancer. Epigastric pain was the main symptom (66%) of those presenting with resectable disease. Weight loss (70%) was the most common symptom of patients presenting with advanced disease. Forty-seven patients had no surgery and 25 had palliative non-resective surgery. These two groups account for 50% of cases. With such a small detection rate of early gastric cancer and consequent curative surgery rate one must debate whether treatment of stomach cancer in the Trust hospital of the future is a lost cause.