Weeks 5&6:

Posted on September 16, 2014 by njh54

12/09/14

Monday morning I joined Dr Doulton on his ward round, lasting around 3 hours. I feel like it put the whole picture together for me. From my day in the lab, to the clinic session that I sat in on, I feel like this joined all the gaps in the process of testing, analysing, diagnosing/ looking at results and then the decided treatment/ next steps for the patients. In total we saw about 10 patients, with varying levels of kidney disease/damage and varying causes.

Overall it was a really good experience, and I enjoyed observing the Doctors at work, seeing how their decisions directly impact the patients. However, as someone who has not been particularly exposed to anything like this before I found it emotionally quite hard. Seeing patients who had been treated and were ready to leave in the next day or so was great and must feel like a great sense of achievement for the Doctors involved. But seeing those whose health had deteriorated or were left with a lesser chance of leaving fit and healthy was hard. One particular patient, the last one I saw, had Vasculitis (a disorder that leads to inflammation and destruction of blood vessels) and had suffered a cardiac arrest the day before. He was still in the intensive care unit, though due to move back down to the kidney ward within a day or so. He was suffering short term memory loss, due to the arrest, and was in a state of slight confusion, understandably. His daughter was there with him. I’ve lived with only my dad since the age of 15 and we have a really close relationship, so to see that situation was really hard. But, admittedly I’m a very emotional person that sort of wears my heart on my sleeve! Nevertheless, dealing with the emotional side of medical care is something that Doctors have to find their own way to cope with and it’s a big part of the job. They do amazing work and without some sort of detachment from the emotions of it all I’m confident they wouldn’t be able to perform as they do. On the whole a good experience and one that will definitely stay with me.

The rest of the week was final collations of the data, which was a bit of a slow process due to awaiting some results from another Hospital. However, we are nearly there and it’s almost ready to be sent to the statistician for analysis.

Whilst waiting on this I’ve begun work on the manuscript as a whole, title page, introduction etc that will become the basis of the paper should it be published. I am also using the data set to do some descriptive statistical analysis that will be used in the results section.

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KSS AHSN Newsletter – 10 September 2014

Posted on September 10, 2014 by gr226

In this week’s edition:

Towards the end of last week the King’s Fund published A new settlement for health and social care. It’s the final report of the independent Commission on the Future of Health and Social Care in England chaired by Kate Barker. It’s different to another commission – the one led by Sir John Oldham on which Marion Dinwoodie from Kent Community Health NHS Trust participated in and which I wrote about recently.

The Barker commission focuses particularly on the funding challenges facing the government arising from the growing and ageing population, rising rates of long-term conditions and increasingly expensive treatments.

It finds that if the government does nothing “fewer people will receive publicly funded social care as further cuts are made to local authority budgets and more NHS organisations find themselves unable to provide timely access to acceptable standards of care within budget.”

People needing access to care will also be forced to continue to navigate the complexities and inconsistencies of the current fragmented systems of funding and entitlement. To quote the report, “the costs of this care will fall increasingly to individuals and families, creating worry, uncertainty and inequity on a scale that would be unacceptable.”

Complexity

We often refer to the complexity and confusion surrounding current provision of services. The Barker report highlights the difficulties for patients, carers and families in navigating the complexities of health and social care finances.

It sets out proposals to introduce a simpler path for the public to navigate through the current maze of cash benefits, and health and social care funding. Its major recommendation is integrated health and social care commissioning.

I’m sure that between now and the general election there will be further reports and policy proposals about future funding for health and social care; this one is well worth a read.

KSS EXPO and awards

This will be a major event for the region and an outstanding opportunity for new collaborations to begin and for innovation to spread. It takes place in London on 13 January 2015.

Registration will open shortly and by way of appetiser, I’d like to share with you the thoughts of some attendees at our Partnership Day earlier in the summer – which also gives me the chance to publicly thank everyone who agreed to be interviewed in our new video; thank you!

Kind regards,

Guy Boersma
Managing Director, KSS AHSN

***

Kent Surrey Sussex Patient Safety Collaborative Bulletin

The third edition of the Kent Surrey Sussex Patient Safety Collaborative (KSS PSC) Bulletin was published last month. Through these bulletins the KSS PSC aims to keep you informed about developments regarding the new KSS PSC. You can access the bulletin here: KSS PSC Bulletin 3 – August 2014

The Sir Jules Thorn Award for Biomedical Research

[The Sir Jules Thorn Trust]

One grant of up to £1.5 million is offered annually to support a five-year programme of translational biomedical research selected following a competition among applicants sponsored by the leading UK medical schools and NHS organisations.

UK medical schools and NHS organisations are eligible to submit one application annually.

Prospective applicants should note that:

  • The closing date for Preliminary Applications is 3 October 2014
  • Only one application per institution is permitted
  • The Award may not be used for Cancer or HIV/AIDS related research.

For more details, please click here.

NHS and PHE South Region’s sustainability conference: Putting Sustainability into Practice

[The South Regional Network (SRN)]

Where: Reading Town Hall, Blagrave Street, Reading RG1 1QH

When: 10.00 – 16.00 on Wednesday 1 October 2014

The overall aim of this event is to share good practice and inspire us to new more sustainable ways of working and living.

The day will include participative workshops on the topics below:

  1. Adaptation and Resilience
  2. JSNA – sustainability chapter
  3. Pharmaceuticals and Medicines – green bags, inhaler recycling
  4. Optimising Social Value
  5. Commissioning and Procurement
  6. Active Transport
  7. Sustainable Carbon Emissions – measurement and modelling of carbon for providers and commissioners
  8. Health Co-benefits – making it real

To apply, please click here or email Georgina Dove: georginadove@nhs.net

NHS patients could benefit from new models of care used around the world

[Monitor]

The health sector regulator is looking into how important acute services are provided by hospitals in other countries including France, Germany, Canada and America to see what lessons the NHS can learn.

Monitor will examine how other countries set clinical standards and set out to achieve good quality care in a range of services including stroke, maternity, and A&E.

The analysis will lead to examples of models of care which can be adapted by the NHS to deliver equivalent or better services more efficiently.

Read the full press release here.

Research scan alert

[The Health Foundation]

August’s research scan alert from the Health Foundation featured highlights of the latest studies about healthcare improvement. Focusing on studies in four areas:

  • Person-centred care
  • Patient safety
  • Value for money
  • Approaches to improvement.

Read the selection of highlighted articles, here.

Update on Urgent and Emergency Care Review

[NHS England]

NHS England has published an update on the Urgent and Emergency Care Review, which builds on NHS England’s future vision for urgent and emergency care in Transforming urgent and emergency care services in England. Urgent and Emergency Care Review End of Phase 1 Report. This work will make it easier for patients to get the right care, in the right place, first time.

For more information, please click here.

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Week 7: Continuing On

Posted on September 9, 2014 by erp3

This week we have continued to collect patient files and enter their data into the spreadsheet (about 70% have been filled in now). We have also started going into the other two health record sites at the hospital that we hadn’t yet visited. It can be quite difficult to actually get the key to these sites sometimes though (with there being only one copy of each) and walking across the hospital site with a wobbly trolley and piles of files can be quite an effort when it’s hot (at least for me!). Luckily the file classification systems are the same as within the site that we’ve already visited so our searches for patient files have been quite easy. We have also been making a list of the files that other staff are using for research so hopefully we can ask to borrow them for a day once we finish collecting those stored in record sites and hopefully minimise our finishing amount of missing data. However, there’s still some files that we just can’t seem to find even after double checking their location.

In regards to the data itself we noticed that often patients’ 3 month follow up letters  (and thus 3 month mRS scores) often aren’t included within their files. We have therefore started searching for the results of these follow-up clinics using an online database. Even so, some patients still don’t seem to have attended a clinic, meaning that these patients will have to be phoned up in order to establish their current levels of independence. It’s interesting to see how these clinic letters can be used for another function, having previously used them within the OSA project to establish TIA symptomology. Clinicians also appear to use some stroke classification systems more often than others when writing inpatient notes – although I’m not sure that there’s much that we can do to fill in these gaps post- patient discharge. For example, the Oxford classification system is almost always recorded. This consists of ‘total anterior circulation infarcts’, ‘partial anterior circulation infarcts’,  ‘lacunar infarcts’ and ‘posterior circulation infarcts’. It is assigned based on the initial presentation of a patient’s stroke in order to predict factors such as its prognosis. On the other hand, the TOAST classification system also requires information from further testing and seems to be recorded less often. This system is used to describe the cause of a stroke (see below for examples) and consists of ‘atherosclerosis of a large artery’, ’embolism of cardiac origin’, ‘occlusion of a small blood vessel’, ‘other determined cause’ and ‘undetermined cause’.

In regards to the OSA project, after having matched patients that had both attended the neurovascular clinic with a TIA and had been giving a diagnosis of OSA last week we have now been looking at these patients in more detail. All of the TIA patients that we’ve looked at (around 250) have now been entered into one spreadsheet and any queries in regards to categorizations (such as how to define their recurrent episodes) have been highlighted. The sleep study results from those patients who also have a diagnosis of OSA has additionally been entered alongside in order to more specifically detail their AHI results and OSA severity. There still seems to currently be a number of gaps in patient AHI figures however, which may mean that further investigation needs to be done in order to clarify the relationship between patients’ OSA and TIA presentations.

Although I only have a few days till the end of my placement we’ve decided to stay on longer than the initial eight weeks in order to finish data collection and carry out the statistical analyses. Hopefully it will be very fulfilling to see all this work come to fruition (and will keep me busy whilst looking for my next job!).

stroke causes

Image retrieved from: http://www.medtogo.com/stroke

Posted in Emily Pettifor | Leave a comment

Week 8 and it’s all over (for a bit!)

Posted on September 9, 2014 by cls205

So it’s the end of my placement here at the William Harvey and these past eight weeks have flown by. It’s been such a great opportunity and I’ve learnt so much.

Over the past week we’ve really been picking up speed. We went to two other casenote storage areas and picked up over 50 files so now the SUTO database is now over 70% complete. We haven’t been able to finish the project, but that’s fine as after taking a bit of a break, we’ll be back in a few weeks to pick it straight back up! After the database is complete, I’ll then get onto the more tricky but more exciting part of analysing our data. There’s a lot of information that we’ve put into the database, so we’re really hoping for some good results. Last years placement student went to the European Stroke Conference this year to present his results and we’ve been told that we might have the opportunity to go to a conference as well, which would be amazing!

On the TIA-OSA project, we’ve completed filling in the data and are just sorting  it out so that we can begin analysing it too.

At the start of this placement I had very little knowledge of stroke. Although they are not that uncommon, I’ve been lucky enough to not have anyone near me suffer from one. Over these past two months my knowledge about them has grown rapidly, and not just about the areas that I’ve been looking into. I now know about stroke treatment, why they happen, how they happen and perhaps most importantly how you can go about trying to lower your risk of having one, because as I’ve learnt there is so much that you can do!

The Stroke of Unknown Time of Onset project has been specifically about assessing the effectiveness of the the usage of thromoblysis in the treatment of strokes where the onset time is unclear. Onset time may be unclear if a patient woke up with the symptoms, or if the symptoms have been gradually worsening over hours or days. Currently the only direct treatment for ischaemic stroke is thrombolysis, where a drug called Alteplase (rtPA) that breaks down blood clots is administered intravenously. It has only been fully tested for usage in patients where the time of onset is within 4.5 hours of treatment time. In SUTO patients, this may not be posssible as the onset is unknown and therefore the drug must be used off licence. The admistration of Alteplase to SUTO patients is based on the results of a CT Perfusion scan, where contrast is injected into the brain and various measurements are taken. From these, it can be decided whether there is a penumbra, an area of tissue within the brain that has reduced oxygen supply so is at risk of irreversible damage, but could potentially be saved. The hope is that from our data, we can assess the effectiveness of thrombolysis as a treatment for stroke in SUTO patients.

Here are a few statistics about stroke from the NHS Choices website:

  • Over 150, 00o people each year suffer from a stroke in England.
  • 25% of strokes occur in people under 65.
  • Stroke is the biggest cause of adult disablity in the UK.
  • Smoking doubles your risk of having a stroke.

I thought that I would leave you with these, to highlight the importance of research into stroke treatment and prevention.

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Week 3- Conclusions and Planning.

Posted on September 8, 2014 by ezm3

Today marks the end of my third week of my clinical research experience.

This week I have continued my work with analysing the ultrasound scans of the thoracolumbar fascia- over halve way through now, getting there!
I have found that I have had to take regular breaks whilst analysing the ultrasound scans- this is because I want to keep the consistency of detailed analysis for each and every scan, it will all be worth it in the end. This categorization will be used to select material for our planned focus group later this month. In order to gain a range of different opinions on the categorization of the scans, we are going to hold a focus group with different experts in reading ultrasound scans. This is to see if a general consensus can be reached regarding the organisation. It will also provide us with a solid base moving forwards to correlate the organisation with pain. I am really looking forwards to attending these focus groups, and seeing if any of the opinions agree with my own!

With regards to the theoretical models work I mentioned last week, significant progress has been made in that area of research. We have found that a whole new category involving genetics needed to be added, along with collapsing the spinal control category into movement/treatment based model. These new developments showed me that in research thoughts and ideas are constantly changing with new knowledge that has been gained. In the latter part of the week me and Kyra sat down to discuss the results of this task. We wanted to start to discuss if the current theoretical models are outdated, and where her PhD study would fit into the models…or indeed if we have to suggest new sub categories.

In order for analysis of the Theoretical models to begin, I had to count up the total number of studies put under each model and calculate percentages. (That took me back to my maths class days!)

Interestingly the results of this task are different to the ones expected- the Neurophysiological model contained the lowest amount of studies…whereas the Movement/Treatment based model contained the most studies by far. It will be interesting to see what conclusion Kyra reaches using her in-depth knowledge and expertise when analysing the results further.

As well as providing Kyra with new data for her research, this task also helped me to recognize the vast variety of treatments and approaches to diagnosing/reducing lower back pain. The difference in opinions of some research also intrigued me- one study suggested that the most common cause of back pain was the Intervertebral Disks, however another study totally disagreed with this. This made me think that this is still an area which is very much in debate still, even after all the research done- It has also strengthened my view that new research such as Kyra’s is very much needed to provide new possible explanations for lower back pain in some individuals.

This week me and Kyra also sat down and discussed my role for the next couple of weeks, we are going to start organising the recruitment of more participants and begin the next stage in data collection. This is really exciting for me as a student, because I will get to see first hand the collection of data, and this will give me great experience for when I start my Dissertation.
This is because I will gain experience in communication with participants, data coding and data storage.

Posted in Emma Mundy, Uncategorized | Leave a comment

Week 7 and I’m almost finished

Posted on September 2, 2014 by cls205

So my initial 8 weeks are almost up! The projects are still going strong and we’re pushing to do as many files as we can a day. Last week I was averaging about 12 files a day and we’ve now completed over 300 entries so the numbers are going up very quickly! We’ve now collected almost all of the files from health records downstairs so this week we will have to brave the outside and go on a bit of an adventure to the other areas where records are held at the hospital.

Last week we had multiple people coming up to the office looking for files that were tracked to us. Tracking files means that their location is always known but that doesn’t mean that they don’t get mislaid sometimes (though thankfully we haven’t had that happen to us!) People come looking for files when the patient has been newly admitted or if the have an appointment, and luckily we seem to be tracking our files well as we’ve always been able to find them!

With the OSA project we have completed all of the TIA data and now we will be able to get onto the interesting bit of analysing the data, and hopefully we’ll get some useful statistics and be able draw some good conclusions.

These past 7 weeks have gone past so quickly and I can’t believe I’m on my final week (even though I’ll be coming back!).

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Weeks 3 & 4: Clinics, meetings & spreadsheets.

Posted on September 1, 2014 by njh54

So picking up from the last blog, Wednesday morning I went to K&C hospital for the Advanced Kidney Care Clinic and the X-ray meeting. First off was the meeting. Apart from seeing some X-rays I wasn’t really sure what to expect from this. With the X-rays projected in front of us, the gathered Doctors (roughly 10) would discuss each patient in turn to gain advice/a second opinion on the suitable treatment. Some of it was a little over my head when looking at the X-rays as you would imagine but I learnt a lot and really enjoyed it. It was great to see the Doctors working in that way and really makes you appreciate their level of expertise!

I went straight from the meeting to the clinic where I joined Dr Abass. It lasted about 3 hours and we saw roughly 12 patients. Dr Abass discussed with the patients how they were, checking their current medications and discussing the next steps. I learnt an awful lot here too, and how the scientific knowledge you study and gain from textbooks actually works at the patient level. There was a range of patients, some deciding against dialysis, some being prepared for it and even someone being prepared for a transplant. It was much like how you would speak to your GP on a visit, but obviously more specific. Again very enjoyable and I feel like I really picked up a lot from this particular experience.

Thursday morning I went in for a Biopsy meeting. Lasting 2 hours it was very similar to the X-ray meeting but looking at patient biopsy’s instead. Once again some of the detail was a little over my head, but due to doing tissue preparation and staining in one of my modules last year I understood much more, making it easier to follow and understand the advice that was being given.

I spent Friday and all of the following week working on the data at the Hospital. On the Tuesday I went to William Harvey Hospital in Ashford (as this is where Dr Doulton was for the day). All the data manipulation was finished by Friday meaning we could hand it to the statistician to work his magic and give us back all the figures that we need to analyse the data and put into words what it means.

Monday morning I will be joining Dr Doulton on his ward round which I think will be a real eye opener into the patient care side of things and allow me to appreciate how the science and medicine works in reality.

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Week 2- Categorization

Posted on September 1, 2014 by ezm3

The theme for this week was categorization, whether it was sorting studies or scans.

Through the beginning part of the week I spent my time perusing a new avenue of research that I mentioned in my blog last week- this included putting the 188 studies on the World Health Organization (WHO) site under different current theoretical models to see if we can further confirm the need for fascia exploration and the addition of sub categories to update the categorization of lower back pain.

We decided to use 6 current theoretical models:

1.) Peripheral nociceptive generator –based.
– Anything that acts on mediating pain caused by the nervous system.

2.) Movement-based/ Treatment-based.
– Source of pain associated with types of movement and mechanical loading.

3.) Psychosocial.
– Any study associated with psychology, the mind, or social stresses such as finance, relationships, jobs etc.

4.) Neurophysiological.
– Any study that is looks at mechanisms of pain/evaluating source of pain by neurological testing.

5.) Biopsychosocial.
– Any study that involves a combination of the movement/treatment based category and psychosocial category.

6.) Spinal Control.
– Exercise where the source of pain is neuromuscular, not just neurological.

Categorizing the different studies was quite a difficult job at times as I sometimes found that the study may fit two particular categories, in which case, I put them in both. I am yet to discuss my results with Kyra, this will be a job for first thing Monday morning- I can already see an interesting pattern forming, and I plan to discuss this on my blog next week after more detailed analysis.

Looking through these different studies in detail throughout the sorting process enabled me to learn about new techniques/modalities and grow as a student sports therapist. In order to gain an understanding of each study I had to research words I was not familiar with. For example – Electroencephalography, SPECT-CT imagery and Centralization Phenomenon.

In the latter part of the week I spent my time starting to analyse the scans from the database as planned- to see if we can correlate the perceived ‘organised’ and ‘unorganised’ fascia with the level of pain the participant reported. It was really interesting to analyse the different echogenicity for separate structures, notice how different the scans were for each individual, and how the left and right side can differ so greatly on the same participant. In order to provide consistency I used the written criteria for ‘organised’ and ‘unorganised’ fascia for the survey done last week.

I have attached an example image of an ultrasound scan of Thoracolumbar Fascia so you can have a go at pointing out the Thoracolumbar Fascia. It is fascinating how scans that have the same measured echogenicity and thickness, can differ in their appearance to the human eye in their layout… how would you describe the layout of the fascia in the image?

I am still in the process of analysing all the scans, when I have finished me and Kyra plan to analyse the results.

Posted in Emma Mundy, Uncategorized | Leave a comment

Week 6: Lots of Data Entering

Posted on August 29, 2014 by erp3

This week we have been continuing to collect the paper patient files and enter the SUTO data into the spreadsheet. In order to keep in track of all of the different files and where to find them (there’s files that you can order, files that require email requests and three patient record sites at the hospital) we have got a number of lists that need updating every day. We are finally getting confident with where to find each of the files, having found out this week that some files are kept in completely different places to where we thought. We are also now able to use the various file classificatory systems used within the record sites – not that this always means that the files are where we expect them to be! This has allowed us to finally get into a good daily routine of collecting files, returning files, entering (a lot) of data and catching up with any corresponding research – making a nice change from the waves of incoming work that we had upon starting.

We have also continued work with the OSA project, categorising patients who presented at the neurovascular clinic with TIAs. In addition to this, we also went through all of the TIA patients from 2011 to 2013 (over 4000!) and identified which of these patients had also received a diagnosis of OSA. Luckily we were able to work out a formula that could automatically identify which patients appeared on both the TIA and OSA lists, saving us from going through them all of them manually and a good few days work! Once we have finished the remaining patient categorisations then we are due to start analysing the data within the next week or so, something that I expect to be very interesting and will hopefully show us the outcome from our work over the past few weeks.

1370555_lots_of_files_2

Image retrieved from:  http://www.medical-specialists.co.uk

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Data Analysis – Week 8

Posted on August 29, 2014 by mw434

This week I really became one with Microsoft Excel to analyse the final data as I added, formalized, multiplied and filtered the data. In the end there was a total of 472 entries although there were less cases in 2012 which we have assumed is because some evaluation sheets are missing. Despite this fact, the data from 2012 and 2013 seem to steadily correlate with the previous years in terms of gender and age distribution, the number of weeks HTS were involved with clients and how many professionals worked per case. Data slightly fluctuated in reference to client location and mental health beds but this correlates with the aims of the HTS taken on within the two years where they aimed to help more clients out of mental health beds or prevented them for being placed in them in the first place. My preferred method of displaying the data was pie-charts whilst I used tables to compare the recent data with the last 5 previous years, I also met with David regularly so we could discuss the data and identify trends or patterns we found interesting. Next week we will start to finalize the data and prepare for the official report to be completed!

See you soon,

Melissa

Posted in Melissa Wills, Placements 2014 | Leave a comment