Our journal - Spring/Summer 2022

Our journal

Written by clinicians, for clinicians

Edition 1: Spring/summer 2022

Contents Welcome

3

Focus on mortality improvement at PAHT

4

PAHT team participate in groundbreaking COVID-19 research

7

Enhancing the paediatric epilepsy service

9

Going green: Think inhalers

10

Improving patient experience in the rheumatology department: biologic medications

11

PAHT hosts prestigious international educational event

13

Occupational therapy assistant speaks at national conference on integrated care

15

Developments in antenatal care for women, birthing people and families

16

Articles published by our #PAHTPeople

17

Welcome

We are pleased to introduce Our journal - a publication written by our clinical people, for our clinical people, at PAHT.

Dr Fay Gilder

Sharon McNally

Our journal will be published four times a year and the content will include: y Focus features on clinical issues/ improvements and the impact on patient care. We would like to reflect new thinking/ national changes to care pathways as well as updates on key clinical areas where improvements are being made e.g. the Summary Hospital-level Mortality Indicator (SHMI)/ mortality and national maternity continuity of care and Local Maternity and Neonatal System (LMNS) network y PAHT 2030 – celebration relating to care pathways and measurable improvements to patient care y Quality and safety agenda – progress and updates on the implementation of the quality and safety strategy y Research updates – new trials being undertaken at PAHT and results of clinical trials nationally and their meaning to patient care at PAHT y Awards/clinical recognition – about our people and their teams y Summary of research contributions and papers published by PAHT clinicians y Conference reviews/updates y Clinical leadership successes (e.g. appointments to leadership roles and why that is important for PAHT) y Clinical audit projects y Clinical transformation updates y Charitable work and charity events linked to PAHT y We also intend to seek input from external contributors (e.g. local stakeholders, regional and central leads and others connected with health and education) This edition features a focus on mortality improvement at PAHT; our participation in groundbreaking COVID-19 research; the work to enhance the paediatric epilepsy service; how we can support our Green Plan through education about inhalers; and improving patient experience in the rheumatology department with biologic medications. We also cover a prestigious international education event hosted at The Princess Alexandra Hospital; an occupational therapy assistant participating in a national conference; developments in antenatal care for women and families; and more.

This is an amazing opportunity for us to showcase the wonderful work we do – please share it widely and let the communications team know which developments we can profile in the next edition of Our journal at paht.communications@nhs.net.

Best wishes Dr Fay Gilder Medical director Sharon McNally Director of nursing, midwifery and allied health professionals and deputy chief executive

3 3

Focus on mortality improvement at PAHT

By Lindsay Hanmore, lead nurse - quality improvement

PAHT was an outlier for hospital standard mortality (HSMR) rates for more than 36 months. This indicates that patients who were admitted to our trust had a higher chance of dying from certain conditions, as compared with those patients admitted to similar organisations. It is expected that patients in high risk groups are more likely to die of their condition, but we were experiencing deaths from those in lower risk groups as well.

In November 2018, we were alerted as an outlier with higher than expected deaths, and we made it the number one priority to improve patient outcomes this was shared throughout the organisation.

The leadership teams from each of the then clinical healthcare groups worked collaboratively across boundaries to drive forward these improvements and a Mortality Improvement Programme was launched in December 2018. The trust’s quality improvement methodology was used to approach this. A governance and reporting structure was implemented with the Mortality

Improvement Board reporting progress and impact to the Quality and Safety Committee, a sub committee of the board, to ensure openness and transparency.

The driver diagram above shows the breakdown of the programmes and projects. The care bundle programme primarily focused on delivering improvements in those conditions that were demonstrating the highest risk to our patients at the time.

Each of these projects had an identified lead and project team who drove forward the changes required. By using the quality improvement methodology they each had a clear aim, measures of success and tests of change that needed to happen to achieve the improved outcomes.

The overarching aim of the Mortality Quality Improvement

Programme was to achieve “as expected” patient outcomes across all specialities, with no more than two outlier alerts, over a 12 month rolling period

by March 2021 and to be sustained by March 2021 with no more than two outliers.

Some of the actions that have been implemented by our teams to achieve improved patient outcomes are: Sepsis y Clinical and nursing leads for sepsis identified y Implementation of Sepsis 6 care bundle y Training on early recognition and intervention through the Sepsis 6 care bundle y Implementation of Procalcitonin test in the emergency department (ED) for early identification of 4 sepsis 4

Acute kidney injury (AKI) y Clinical and nursing leads for acute AKI identified y Development and implementation of AKI care bundle y Introduction of improved fluid balance charts and training on completion and importance of AKI care bundle y AKI stickers to record and prompt interventions Fractured neck of femur (NOF) y Refresh and implementation of #NOF care bundle y Focus on expediting patients from ED to the orthogeriatric ward through an escalation bed being available, early identification of patients and fast track process agreed y Prioritisation of these patients on trauma lists y Training and early administration of appropriate pain relief Acute respiratory pathway including aspiration pneumonia y Implementation of noninvasive ventilation (NIV) outside of critical care y Focus on compliance with pneumonia and chronic obstructive pulmonary disease (COPD) admission care bundle with early identification and interventions y Development of assessment tools and care to reduce risk of aspiration pneumonia Acute abdomen y Implementation of acute abdomen care bundle y Improved compliance with data capture on National

Emergency Laparotomy Audit y Booking form for emergency laparotomies updated and implemented Vital sign recording y Standardised process for the undertaking of vital signs observations implemented y Improved compliance with timely recording of vital signs to promote early detection of deterioration Treatment escalation plans (TEPs) y Treatment escalation plans developed and implemented for all adult inpatients to improve timely discussion and decision making about ceilings of care Antibiotic stewardship y Antibiotic prescribing best practice guidance available on microguide App for all prescribers y Antibiotic compliance dashboard developed and shared Hospital at night y Hospital at night task management system implemented y Process for doctor handover standardised and implemented Reporting and recording y Training on accurate recording of care and coding requirements y Coding reviews for all outlier diagnoses and any alerts End of life quality improvements y Seven day working for specialist palliative care team implemented

y Enhanced training on recognition of the dying patient and implementation of individualised care y Simulation end of life training implemented y Ward based resources and local training enhanced y Volunteer and spiritualist support for patients and carers y Focus on improving referral process and compliance to local hospices y Improved communication between providers with use of TEPs, PEACE (Proactive Enhanced Advance Escalation Care Plan) document and individualised care plans y Improved specialist palliative care coding Learning from death process y Process implemented across the organisation to ensure we learn from all deaths y Standardised process for mortality and morbidity meetings implemented with excellent improvements in reviews and learning y Role of medical examiners embedded into the organisation y Lead medical examiner appointed y Lead nurse for mortality and quality appointed y Structured judgement reviews undertaken and findings shared y Mortality dashboard developed and supported by SMART software

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Impact to date

On analysis with the tool Dr Foster, it has been confirmed that there are three main drivers for our sustained improvement.

These are our improved recording, documentation and coding of care, changes in our activity with increase in 0-1 day length of stays and improvements in our quality of care.

The improvements in our quality of care are demonstrated through reductions in our levels of harm and complications recorded and also the fact that we now have a greater proportion of our higher risk patients in our monthly deaths which is as expected.

This improvement work has been made possible by the commitment and dedication of all the teams involved including clinical, operational and administration.

We continue to focus on these reports and our learning from death process. This is to ensure that we have early warning of any new outliers or risks to inform priorities of the quality improvements required. For more information, please Robbie Ayers, deputy director, quality improvement and transformation, at robert.ayers@nhs.net.

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PAHT team participate in groundbreaking COVID-19 research

By Chris Cook, head of research, development and innovation

22 May 2020, PAHT were recognised for being in the top 20 recruiters over the previous two week period – this was out of 190 active sites.

Abstract from the study

“Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care or hospitalisation after infection with SARSCoV-2. The GenOMICC On 23 March 2020, at the (Genetics of Mortality in Critical beginning of the pandemic, the Care) study enables the research team at PAHT were comparison of genomes from contacted by the GenOMICC individuals who are critically Study team at The University ill with those of population Court of the University of controls to find underlying Edinburgh and Lothian Health disease mechanisms. Here we Board, to see if we had the use whole-genome sequencing capabilities to deliver the study, in 7,491 critically ill individuals as this was a National Institute compared with 48,400 controls for Health Research (NIHR) to discover and replicate priority activity. The study 23 independent variants was able to be set up quickly that significantly predispose as we just needed to identify to critical COVID-19. We a principal investigator – Dr identify 16 new independent Raj Saha, Intensive Care Unit associations, including variants (ICU) consultant – and once in within genes that are involved place the team were called to in interferon signalling (IL10RB the ICU to consent the patients and PLSCR1), leucocyte and take a single DNA sample differentiation (BCL11A) and which was sent back to the blood-type antigen secretor study centre for processing. status (FUT2).

The PAHT team participated in groundbreaking research focused on whole-genome sequencing to reveal the host factors underlying critical COVID-19.

The study has been designed to collect DNA from emerging infections, and continues today, not just for COVID-19, but also sepsis, pancreatitis, burns and other disease processes. The study was set up and active by the end of April 2020; by

"Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes — including reduced expression of a membrane flippase

(ATP11A), and increased expression of a mucin (MUC1) — in critical disease.

Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease.”

The study was led by Dr Raj Saha, ICU consultant, as the principal investigator, and the team on ICU. They would identify the potential participants at the time, of which there were many, and alert the research team.

At this point, either the ICU team and/or the research team would consent the participants and take their bloods. During the second wave of COVID-19, patients were contacted retrospectively once they were home safe and well.

7 7

Essex Partnership University NHS Foundation Trust (EPUT) staff were supporting PAHT with data for COVID-19 studies during the first wave, with Lara Horraz, mental health research nurse, supporting the study.

On 24 November 2020, 2,363 patients had been recruited nationally, with 82 participants recruited at PAHT.

Conclusion of the study

“These genetic associations identify biological mechanisms that may underlie the development of lifethreatening COVID-19, several of which may be amenable to therapeutic targeting. Furthermore, we demonstrate the value of WGS for fine-mapping loci in a complex trait. In the context of the ongoing global pandemic, translation to clinical practice is an urgent priority. As with our previous work, biological and molecular studies - and, where appropriate, large-scale

randomised trials - will be essential before our findings can be translated into clinical practice.”

Next steps

The study has also been designed to collect DNA from other emerging infections.

The UK Health Security Agency (UKHSA) is continuing to investigate and confirm cases of sudden onset hepatitis in children aged 10 and under that have been identified since January 2022.

Working alongside Public Health Scotland, Public Health Wales and the Public Health Agency, active investigations have identified a further five confirmed cases since the last update on 23 June, bringing the total number of confirmed cases in the UK to 263, as of 4 July.

Of the confirmed cases,186 are resident in England, 36

are in Scotland, 19 are in Wales and 22 are in Northern Ireland. The cases are predominantly in children under five years old who showed initial symptoms of gastroenteritis illness (diarrhoea and nausea) followed by the onset of jaundice.

As part of the investigation, a small number of children over the age of 10 are also being investigated as possible cases. No children have died.

An invitation letter is now available to include the option of writing to parents of children affected by hepatitis. The child health team are aware and will notify the research team if these patients are admitted to PAHT. Thank you to everyone involved in this extremely important work.

The research was published in full in Nature.

8 8

Enhancing the paediatric epilepsy service

By Eme NugentCruse, paediatric epilepsy clinical nurse specialist We have made some exciting advancements in the last few months. We have regularly participated in the national audit ‘Epilepsy 12’. This helps services measure against national standards, and those who achieve those standards are approved to claim a best practice tariff.

This means that we secure additional funding for each eligible patient that we care for, and this enables us to continue providing the best support for our patients.

In addition, we have created a new fast track referral pathway for patients that attend our emergency department (ED). This ensures that they are seen by the epilepsy team within two weeks of presentation. This launched in late October 2021 and we have received 36 referrals to date.

Of these referrals, 13 have resulted in a new diagnosis of epilepsy. Previously these patients may have waited months for an appointment and this caused significant delay and distress for families.

We are also just about to launch a new diagnostic tool across paediatrics that will

“I was so worried and I was attending several hospitals seeking urgent help.

When the nurse from The Princess Alexandra Hospital called, I knew straight away that we were in good hands. She walked us through the process of tests, diagnosis and medication and this all happened within weeks, we cannot thank you enough."

"We were seen in A&E and we were so scared to take our child home, then the epilepsy nurse called and spoke to me for ages, she answered all of my questions and put my mind at ease. We were seen four days later by the nurse and consultant, it was all so quick and reassuring."

Feedback given help clinicians quickly identify abnormal electrical brain activity. Cerebral function monitoring is already used in the Neonatal Intensive Care Unit (NICU), and we will be one of the first hospitals to use the equipment in paediatrics in

the UK (this is widely used in Europe already).

We plan to collate some data for publication – look out for more details in a forthcoming edition.

9 4 9

Going green: Think inhalers

By Steven De-Giovanni, medication safety officer and deputy chief pharmacist In pharmacy, we are playing our part in supporting the Green Plan for PAHT, our commitment to protect the environment.

A particular focus across PAHT is on asthma inhalers, from educating staff and patients on the most environmentallyfriendly inhalers, to encouraging patients to dispose of their inhalers correctly.

Emissions from inhalers have been assessed as responsible for approximately 3.9% of all NHS carbon emissions. The NHS Long Term Plan includes an ambition to reduce the carbon footprint through the shift to using lower carbon inhalers. There is a great variation in carbon emissions between different inhalers, and our goal is to make that part of the decision-making process when prescribing. The majority of inhalers can be divided into two types: Pressurised meter dose inhalers (pMDIs) and drypowder inhalers (DPIs). pMDIs contain hydroflurocarbons as a propellant. Although they are not ozone depleting (like CFCs which were phased

out in the 1990s) they are powerful greenhouse gases in their own right. On average, pMDIs have a carbon footprint 18 times greater than that of DPIs. Some are even greater.

For example, salbutamol MDIs have the same carbon footprint as a 172 mile car journey (the equivalent of driving from Harlow to Liverpool).

Examples of inhalers with a low carbon footprint

Salbutamol easyhaler

The Accuhaler range

In addition, we are working to educate patients that the correct way to dispose of used or unwanted inhalers Alternatively, a dry powdered is by returning them to the inhaler containing the same community pharmacy. This is active ingredient is certified by because hydrofluorocarbons the Carbon Trust as ‘carbon are often still present even after neutral’. DPIs can also have the drug has been used. a range of other benefits, including ease of use (they are The next step will be a ‘breath-actuated’, not needing promotional campaign a spacer device or breathing in combining clinical information and pressing a button together and regarding the at the same time) and contain environmental impact. The a counter letting you know local hospital formulary will when you are running low. also be reviewed, taking into account carbon emissions.

Not every patient would benefit from dry powder inhalers, and Should you wish to find out optimising patient care should more information, please remain the number one priority. contact your ward pharmacist, All patients that come into The medicines information, or Princess Alexandra Hospital me, Steven De-Giovanni, should have their inhalers and medication safety officer, at inhaler technique assessed, steven.de-giovanni1@nhs. ensuring they are on the right net. treatment for their condition, minimising the environmental impact where possible.

Examples of inhalers with a high carbon footprint

Salbutamol pMDI

Flutiform pMDI

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Improving patient experience in the rheumatology department – biologic medications

By Dr Shameem Ahmed Narikkoottungal, specialty doctor in rheumatology

This is based on a scientific article by the department of rheumatology at The Princess Alexandra Hospital, sent for publication to the Annual European Congress of Rheumatology – EULAR 2021. The article was accepted as a poster presentation and was published in the Annals of Rheumatic Diseases – The Eular Journal 2021, as an abstract. The article was authored by myself; in association with Dr Amir Siddiqui, specialty doctor; Dr Alexandra Constantin, locum consultant; Dr Sarah Farrow, consultant; and Dr Khalid Ahmed, consultant. It was also presented at the Essex Rheumatology Association (ERA) regional meeting in Chelmsford.

other viruses. It indeed left humanity in dark, unchartered waters; particularly in the early months of the pandemic.

We have reflected on our experience of managing patients on biologic (b) and targeted synthetic (ts) DMARDs at the rheumatology department, in the midst of the COVID-19 pandemic.

All rheumatology patients at The Princess Alexandra Hospital newly started on a biologic or targeted synthetic DMARD between 3 July and 3 Oct 2020 were identified.

These patients had active inflammatory arthritis. Each patient was discussed in a The COVID-19 pandemic caught us all by surprise – from dedicated multi-disciplinary team (MDT) meeting and a governments to individuals; the medical fraternity being no consensus on treatment was reached in line with local and exception. It has affected all national guidelines. walks of life; with its immense contagiosity, diverse and Results: intriguing pathogenesis and Of the 50 patients identified; manifestations differing from

39 had rheumatoid arthritis, 6 had ankylosing spondylitis and 5 had psoriatic arthritis. Of these 50 patients, 5 patients decided against treatment during the stage of enhanced verbal consent. These patients were flaring recurrently and were in regular contact with the department. However, they were afraid to start new biologic treatment because of the risks of COVID-19. The breakdown of the biologic agents used in the remaining 45 patients were as follows: y y y y y y y y y y y

Adalimumab: 11 Rituximab: 10 Etanercept: 9 Tofacitinib: 11 Tocilizumab SC: 3 Tocilizumab IV: 1 Sarilumab: 2 Secukinumab: 1 Infliximab: 1 Baricitinib: 1 Apremilast: 1 11 11

Conclusion: The overriding principle that guided the department during the COVID crisis was: primum non nocere (first, do no harm). The adherence to the case based discussions (CBDs) positively impacted on decision making, ensuring safe initiation of biologic DMARDs even during the height of the pandemic. This is vital to achieve early disease remission.

The multidisciplinary team (MDT) meetings comprising doctors, specialist pharmacist and nurse specialists ensured prompt risk stratification of individual patients. It gave patients the opportunity to be part of the decision-making - evident in the five of the 50 patients who opted to defer the start date of their treatments.

The choice of the new biologic agent was based on the latest national COVID-19

guidelines. The agents with the shortest half-life were selected. Moreover, patients for Rituximab were given one pulsed infusion, as opposed to two infusions. Only one of the 45 patients started on a biologic agent over this period, either tested positive or had symptoms suggestive of COVID-19.

Though the CBD MDT meetings for case by case discussion via Microsoft Teams were time consuming, it was the right decision during the peak of the pandemic. We are continuing to build on this improvement in patient experience.

us medical teams ought to be patient-centred care, involving them in informed decision making which would give them more insight and autonomy on their treatments.

This has enhanced the patient/doctor relationship and improved compliance to treatment strategies.

Additionally, sharing our practice with the rest of the fraternity and being published was a boost to the team, amidst our busy routine clinical activities.

Currently, we do not regularly convene MDT meetings, instead we hold them only for complex patients requiring outof-the box treatment regimen and management plans. The bottom line is – COVID or nonCOVID times, the priority for

The rheumatology team, from left to right, Dr Bobby Hariharadas, locum specialty doctor in rheumatology; Dr Shameem Ahmed Narikkoottungal, specialty doctor in rheumatology; Dr Adil Gatia, locum rheumatology consultant; Sachini Amarasekera, rheumatology specialist pharmacist; Dr Amir Siddiqui, specialty doctor in rheumatology; Aishwarya Dev, rheumatology clinical nurse specialist; Mary Surendran, rheumatology clinical nurse specialist; Dr Khalid Ahmed, rheumatology consultant; Janet Bell, rheumatology secretary; Nichola Stevens, rheumatology typist; Rosie Hart, rheumatology secretarial assistant and Mona Kamal-Zou, 12 rheumatology clinical nurse specialist. The photo was in line with COVID-19 guidance at the 12 time.

PAHT hosts prestigious international educational event

By Dr Zaid Aldin, consultant interventional radiologist; Dr Maha Khan, radiology registrar; Dr Josephine Weaver, interventional radiology fellow; Dr Eric Auyoung, radiology registrar; and Dr Mina AlJanabi, radiology registrar Chronic venous disease refers to a group of common conditions caused by veins that become incompetent, causing reflux. Lower limb superficial venous insufficiency affects about 30–40% of adults in Western countries. Chronic pelvic pain accounts for up to 10-40% of the referrals in the gynaecological outpatient clinic. Varicocele is seen in approximately 15% of the general male population.

Left untreated, these chronic venous disorders can lead to serious complications such as venous leg ulcers, debilitating pain and infertility. Minimally invasive endovascular therapy has evolved and become the main treatment for chronic venous disease.

Given this development, endovascular specialists need to familiarise themselves with the clinical assessment of this group of patients and the current treatment devices available on the market.

We were proud to host the European Society of Interventional Radiology (ESIR) Course, Multidisciplinary Endovenous Management of Varicose Veins, Varicocele, and Pelvic Congestion, organised by me (Dr Zaid Aldin, consultant interventional radiologist) and the endovascular team at The Princess Alexandra Hospital from 24-25 March.

Attendees learnt about the fundamentals and techniques for treating varicose veins, pelvic congestion syndrome and varicocele. The course covered the current status of endovascular treatments including patient selection, ultrasound assessment of varicose veins, devices selection and types of embolic agents and scleroants used.

Illustrative cases were used to show teaching points, including complications

and how to avoid them.

A large part of the course was dedicated to hands-on experience, with various devices currently available on the market, and ultrasound assessment of patients with varicose veins by each candidate. There was plenty of time for questions and participants were encouraged to bring cases for discussion.

We had 30 delegates from Europe, Asia, Africa and Australia, a mix of interventional radiologists and vascular surgeons. The course involved hands-on ultrasound examination of patients with vein disease.

In addition, the practical sessions involved training on kits used in the treatment of venous disease. Thank you to everyone who supported this event, including the Learning and Education Centre team for facilitating a very successful course. Thanks go in particular to Margaret Short, medical education project manager, and Judith Butcher, medical education manager. The feedback from the delegates and from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) office, who were also involved in the event, was fantastic well done all.

Please see overleaf a variety of photos from the event. 13 13

The conference team with delegates (left).

Delegates taking part in the learning activities (above and below).

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Occupational therapy assistant speaks at national conference on integrated care

By Samantha Delamotte, occupational therapy assistant

I was approached by my tutor and asked if I wanted to contribute any experiences from my placement with the adult social care housing solutions team regarding integrating learning from health and social care. This was as the University of Hertfordshire was really keen to highlight one of the great apprenticeship benefits of implementing learning from my placement in the workplace.

adaptations and solutions team, we first refer them to the community OT team, who then assess the patient in their own home, prior to referring onto the housing and adaptations team. This process can take approximately six months.

There will then then be a further delay of approximately The conference was a great 6-9 months until the referral and exciting opportunity has been allocated to an to see and learn about the occupational therapist. Whilst occupational therapy (OT) on placement with the team, profession, different usage we agreed that I can design of equipment, new outcome a referral system to be put in measures and the experiences place to enable the inpatient of different OTs. therapy team to refer straight to the housing adaptations and During my placement, I solutions team. I am currently started thinking about how in the process of organising a many of our patients at PAHT referral form to be agreed by go home either not being both teams, prior to being put The request was particularly able to access their property, into circulation. After this, the focused on integrating including the upstairs of their therapy team at PAHT will be knowledge across health and property; having to have taught via in-service training social care systems at the commodes due to limited how to use the system prior Royal College of Occupational access to the toilet or not to going live. My tutor and I Therapy (RCOT) virtual being able to access the bath/ are currently in the process of annual conference on 14 shower; or having difficulty deciding what evidence needs and 15 June. Together with preparing meals due to not to be collected, how to collect another cohort and our tutor, being able to access kitchen it and how to measure the we submitted an abstract work surfaces and cupboards. outcomes. for a poster presentation for After understanding the the conference to RCOT, referral system and how long it I'm apprehensive about what which was accepted. The takes for a patient to be seen to expect as this is completely poster shows how spending upon discharge until they are new to me, but I’m excited time with the Hertfordshire assessed by the housing and about how this will enhance housing adaptation and adaptation solutions team, I my learning. If you would like solutions team during my realised that there is a high more information about the first placement has resulted risk of further deterioration. project and our next steps, in working to implement a please contact me: samantha. service improvement within the 15 At PAHT, if a patient needs delamotte@nhs.net. therapy team. a referral to the housing 15

Developments in antenatal care for women, birthing people and families

By Lynn Lee, midwife, team coordinator, Willow team

Exciting times are ahead for the way we deliver antenatal care for women, birthing people and families.

From July, community midwife teams across family and women’s services (FAWS), are to commence group antenatal care as part of a research study called GC1000.

Group Care in the First Thousand Days (GC1000) is an international study funded

by EU-Horizon 2020.

The study will implement and evaluate group antenatal and postnatal care in seven countries (South Africa, Ghana, Suriname and Kosovo, Netherlands, Belgium and the UK).

It aims to create countryspecific blueprints for scale-up and will use crosscountry synthesis to develop an evidence-based global implementation toolkit to help existing health systems integrate this transformative model of care, particularly to reach the most vulnerable groups of women and girls.

The City, University of London research team, led by

Professor Christine McCourt, will support the implementation of group care in the two UK sites – The Princess Alexandra Hospital, Harlow and Epsom Hospital, building on work done by the REACH Pregnancy Circles trial which both sites were also involved in.

poor quality and inadequate utilisation of services by offering comprehensive antenatal and postnatal care that meets the needs of the end users, care providers and health systems by combining quality clinical care with health promotion and health information activities.

The Princess Alexandra Hospital will be implementing We can’t wait to get started. an innovative version of group care, integrating it into their continuity of care teams and focusing on geographical areas with greater socio-economic deprivation.

Care in a group changes the user(s)-provider experience, encourages self-care, is empowering and empowers end-users to learn to increase healthy behaviours for themselves and for their children.

It breaks the vicious circle of

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Articles published by our #PAHTPeople...

Take a look at some examples of the range of articles published or contributed to by our people so far this year - a fantastic achievement. Full information of authors and articles are available from the library team: paht.lib.desk@nhs.net.

11(8): 14.Alajlan, Ahmad. y Abeysuriya, V., et al.

Princess Alexandra Hospital, Department of Orthopedic (2022). "Postdischarge Harlow, United Kingdom Surgery, Security Forces outcomes of COVID-19 y Fallerini, C., et al. (2022).

Hospital, Saudi Arabia patients from South Asia: "Common, low-frequency, y Al-Tawil, K., et al. (2022). a prospective study." rare, and ultra-rare coding "Gram stain microscopy Transactions of the Royal variants contribute to in septic arthritis." Acta Society of Tropical Medicine COVID-19 severity."

Orthopaedica Belgica & Hygiene 28: 28.

Human Genetics 141(1): 87(3): 553-556.(Al-Tawil) y Aggarwal, D., et al. (2022).

147-173.

Kings College Hospital, "Genomic assessment y Gualdi, G., et al. (2022).

Denmark Hill, London, of quarantine measures "Molluscum contagiosum United Kingdom (Quiney) to prevent SARSin pediatric patients: to Colchester General Hospital, CoV-2 importation and treat or not to treat? Could Colchester, Essex, United transmission." Nature a personalized imiquimod Kingdom (Pirkis, Rooney) Communications 13(1). regimen be the answer to Ipswich Hospital, Heath University of Cambridge, the dilemma?" Journal of Road, United Kingdom Department of Medicine, Dermatological Treatment (Birkett) Princess Alexandra Cambridge, UK 33(1): 443-448.Gualdi, Hospital, Hamstel Rd, y Aggarwal, D., et al.

Giulio. Dermatologic Clinic, Harlow, United Kingdom (2022). "Genomic Department of Medicine and y Ash, J. and D. Sanwu epidemiology of SARSAgeing Science, University (2022). "Medical CoV-2 in a UK university G. D'Annunzio Chietireconciliation in acute identifies dynamics of Pescara, Chieti, Italy surgical patients-arewe transmission." Nature y Hartland, A. W., et letting our patients Communications 13(1). al. (2022). "Clinical down?"

British Journal of University of Cambridge, Effectiveness of Various Surgery 109(SUPPL 1): Department of Medicine, Surgical Reconstruction i72.(Ash, Sanwu) Princess Cambridge, UK Modalities for Acute ACJ Alexandra Hospital, Harlow, y Akter, N., et al. (2022).

Separation: Protocol for United Kingdom. J. Ash, "Student-centered” a Systematic Review Princess Alexandra Hospital, versus “teacher-centered” and Meta-Analysis."

Harlow, United Kingdom teaching in human International Journal of y Ash, J. and N. Wolff (2022). anatomy: correspondence: Surgery Protocols 26(1): "Gentamicin guidelinesSRA: SRA." Surgical and 22-26.Hartland, Alexander Available but are they Radiologic Anatomy 44(4): W. Northampton General followed?

A retrospective 501-502 Hospital, Cliftonville, audit." British Journal of y Alajlan, A., et al. (2022).

Northampton, UK. Surgery 109(SUPPL 1): "Joint-Preserving Nayar, Sandeep Krishan. i72.(Ash, Wolff) Princess Surgery in Varus Ankle Royal London Hospital, Alexandra Hospital, Harlow, Osteoarthritis." Journal Whitechapel Rd, London, United Kingdom.

J. Ash, of Clinical Medicine UK. Teoh, Kar Hao. Trauma 17 17

and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex, UK. Rashid, Mustafa S. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Windmill Road, Oxford, UK. y Kiakou, M., et al.

(2022). "Laryngeal solitary fibrous tumour: diagnostic challenge in a rare presentation."

Annals of the Royal College of Surgeons of England 21: 21.Kiakou, M. Mid and South Essex NHS Foundation Trust, UK. Puvanendran, M. Mid and South Essex NHS Foundation Trust, UK. Philpott, J. Mid and South Essex NHS Foundation Trust, UK. Ali, A. Mid and South Essex NHS Foundation Trust, UK. Paulucci, B. The Princess Alexandra Hospital NHS Trust, UK. y Lord, S. (2022). "Obstetric and Intrapartum Emergencies: A Practical Guide to Management."

The Journal of Perioperative Practice 32(4): 64-65.

Practice Development Nurse Theatres, Princess Alexandra Hospital, Harlow ; Practice Development Nurse Theatres, Princess Alexandra Hospital, Harlow y Manchery, N., et al. (2022).

"Episodic foresight in multiple sclerosis."

Neuropsychology 36(2): 140-149. School of Dentistry, University of Queensland, Brisbane, QLD, Australia ; School

of Psychology, University of Queensland, St. Lucia, QLD, Australia; Department of Neurology, Princess Alexandra Hospital, Harlow, United Kingdom ; Department of Neurology, Princess Alexandra Hospital, United Kingdom ; School of Psychology, Australian Catholic University, NSW, Australia ; Henry, Julie D.,St. Lucia, Australia, 4072, School of Psychology, University of Queensland y Mansukhani, S. A., et al.

(2022). "Remote Follow-up of Shoulder Arthroplasty Patients During COVID-19 Pandemic - Is This the way Forward?"

Journal of Shoulder and Elbow Arthroplasty 6(no pagination).(Mansukhani, Gopinath, Chaturvedi, Konstantopoulos, Leivadiotou) Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom (Leivadiotou) Rivers Hospital, High Wych Rd, Sawbridgeworth, United Kingdom. S.A. Mansukhani, Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom. y Melhorn, J., et al. (2022).

"Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey."

European Respiratory Journal 10: 10.Melhorn, James. Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, UK

y Mylrea-Foley, B., et al. (2022).

"Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol." BMJ Open 12(4): e055543.MylreaFoley, Bronacha. Imperial College London, Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital London, London, UK y Nastazja, D. P., et al. (2022). "Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot." Lancet Oncology 23(2): 270-278.MRC Cancer Unit, HutchisonMRC Research Centre, University of Cambridge, Cambridge, UK ; MRC Cancer Unit, HutchisonMRC Research Centre, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK ; Department of Gastroenterology, Princess Alexandra Hospital NHS Trust, Harlow, UK ; Department of Gastroenterology, East and North Herts NHS Trust, Stevenage, UK ; Department of Surgery, West Suffolk Hospital, Bury St Edmunds, UK ; Department of Gastroenterology, Harrogate 18 18

District Hospital, Harrogate, UK ; Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK ; Cancer Prevention Group in Clinical Trials Unit, King's Clinical Trials Unit, King's College London, London, UK ; MRC Cancer Unit, HutchisonMRC Research Centre, University of Cambridge, Cambridge, UK y Nemeth, Z., et al. (2022).

"Topical treatment of Eczematous External Otitis involving the ear canal: Long term results of a trial comparing Pimecrolimus 1% Vs Clobetasone Butyrate 0.05." Journal of Laryngology & Otology: 1-14.Nemeth, Zsofia.

Ear, Nose and Throat Consultant; Ear, Nose & Throat Department, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK. Verga, Emanuele.

Consultant in Dermatology, Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK. Verdolini, Roberto. Consultant in Dermatology, Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK y Ng, A. C. T., et al. (2022).

"Autonomic dysfunction in Huntington's disease: A 123I-MIBG study." Journal of Nuclear Cardiology 29(2): 649-651.Department

of Cardiology, Princess Alexandra Hospital, Harlow, UK. The Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.

Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands y Parveen, F., et al.

(2022). "Vaccineinduced thrombosis and thrombocytopaenia with widespread abdominal venous thrombosis, venous ischaemia and bowel oedema." BMJ Case Reports 15(4): 1-4.

Emergency Medicine, Princess Alexandra Hospital NHS Trust, Harlow, UK. Medicine, Lister Hospital, Stevenage, UK. y Phillips, W. and J. Somner (2022). "A Case of Idiopathic Intracranial Hypertension/ Pseudotumor Cerebri Syndrome Cured by Myomectomy." Journal of Neuro Ophthalmology 31: 31. Phillips, Wendy.

Department of Neurology, Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom y Pilonis, N. D., et al.

(2022). "Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot."

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Dagny. MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK y Reddy, D., et al. (2022).

"Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience." European Urology 81(4): 407-413.

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"Magnetic Resonance Imaging and Targeted Biopsies Compared to Transperineal Mapping Biopsies Before Focal Ablation in Localised and Metastatic Recurrent Prostate Cancer After Radiotherapy." European Urology 31: 31.Shah, Taimur T. Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK

19 19

y Tsampoukas, G., et al.

(2022). "Atypical small acinar proliferation and its significance in pathological reports in modern urological times."

Asian Journal of Urology 9(1): 12-17.Tsampoukas, Georgios. Department of Urology, Princess Alexandra Hospital, Harlow, UK y Warne, B., et al.

(2022). "Genomic epidemiology of SARSCoV-2 in a UK university identifies dynamics of

transmission." Nature Communications 13(1) y Wiseman, O., et al.

(2022). "The challenges and opportunities for implementing group antenatal care ('Pregnancy Circles') as part of standard NHS maternity care: A codesigned qualitative study." Midwifery 109: 103333. (Wiseman, Lazar, Yuill, McCourt) City, University of London, School of Health Sciences,

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