• Nutrition and malnutrition in liver disease: an overview.

      Mortimore, Gerri; University of Derby (Mark Allen Group, 2019-07-17)
      The term malnutrition is generally understood to refer to a deficiency of nutrition, and it is rarely appreciated that malnutrition can also result from excesses in nutritional status. Relatively recent clinical practice guidelines (CPG) from the European Association for the Study of the Liver (EASL) (Merli et al, 2019) acknowledged that malnutrition includes both nutritional surplus and deficiency, but stated that, for the purpose of the CPG, malnutrition would be referred to as undernutrition.
    • Primary Biliary Cholangitis: an update on treatment.

      Mortimore, Gerri; University of Derby (Mark Allen Group, 2019-07-17)
      Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic but progressive disease that, over many years, causes damage to bile ducts, leading to cholestasis and, in some patients, cirrhosis. The rate at which PBC progresses varies from person to person, but significant damage takes decades to occur. It predominately affects women aged 40–60 years with a female to male ratio of 9:1, but can affect anyone from the age of 20. There is no cure for PBC other than liver transplant, but medications can be given to slow down disease progression and for the treatment of symptoms. Health professionals should monitor for complications, including the development of osteoporosis, vitamin deficiencies and liver cirrhosis, which caries the associated complications of portal hypertension, varices and ascites
    • Liver ultrasound scans.

      Mortimore, Gerri; Mayes, JP; University of Derby (Mark Allen Group, 2019)
      Ultrasound scans can be used in a variety of settings to examine internal organs, muscle, joints, tendons and lesions or to monitor foetal growth and development during pregnancy. Ultrasound, is arguably the most frequently requested form of imaging especially within the gastroenterology department. However, to elucidate a cause of abdominal pain, distension, jaundice, abnormal liver function tests; abdominal ultrasound is one of the easiest, quick and cost-effective ways to do so. In addition, ultrasound can assist the practitioner to rule out other considered differential diagnoses. Since the advent of advanced clinical practitioner roles, nurses are increasingly taking on advanced clinical roles within the field of gastroenterology. With these advanced roles, nurses and other allied health professionals, can act autonomously in the assessment, diagnosis and treatment of patients, which includes the ability to order different tests and investigations, which can comprise of radiological and ultrasound requests. However, it is not just the ordering and requesting of radiological and ultrasound scans, but the requirement to understand the scan report and the ability to deal with the findings in an appropriate and timely fashion, that is vital for improving patient care. This article will focus on abdominal ultrasound, with emphasis on liver ultrasound scans. It will discuss what an ultrasound scan is, and some of the terminology used in liver ultrasound reports. In addition, it will compare ultrasound images of normal liver to abnormal and explore the importance of background information which should be presented on the request form, to aid the sonographer or radiologist in their interpretation of the scan.
    • Online learning as a vehicle for social change.

      Robertshaw, David; University of Derby (2016-07)
      Online learning as a vehicle for social change, how education can change lives. David looks at how the introduction of MOOCs (Massive Open Online Courses is changing the face of education and making it accessible for everyone to learn.
    • Changing attitudes with a MOOC on dementia

      Kotera, Yasuhiro; Robertshaw, David; University of Derby (Sciendo, 2019-07-12)
      Dementia is one of the most significant issues of our time and there are varying prevailing attitudes towards dementia, including negative stigma and perception. Massive open online courses (MOOCs) are a widely available online learning resource accessed for free which may present an opportunity to address prevailing attitudes. We conducted a questionnaire before and after a six-week MOOC where participants learned about dementia. We collected data using a survey instrument and analysed them with statistical testing. Although there was no statistically significant change between pre- and post-MOOC questionnaires, the change was observed in some questions and for particular groups. Our findings indicate this MOOC has a greater effect on changing the attitudes of non-healthcare workers, older people and those living in the United Kingdom. We recommend further analysis of MOOC as a change intervention and consideration of their application in other disciplines.
    • Primary biliary cholangitis: symptoms, diagnosis and treatment

      Mortimore, Gerri; University of Derby (MA Healthcare, 2019-06)
      Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic but progressive disease that, over many years, causes damage to bile ducts, leading to cholestasis and, in some patients, cirrhosis. The rate at which PBC progresses varies from person to person, but significant damage takes decades to occur. It predominately affects women aged 40–60 years with a female to male ratio of 9:1, but can affect anyone from the age of 20. There is no cure for PBC other than liver transplant, but medications can be given to slow down disease progression and for the treatment of symptoms. Health professionals should monitor for complications, including the development of osteoporosis, vitamin deficiencies and liver cirrhosis, which caries the associated complications of portal hypertension, varices and ascites.
    • Are we missing a trick? Why is occupational therapy not talking about the role and development of assistant practitioners?

      Biggam, Amanda; University of Derby (2019-06-17)
      The aim of this poster is to present a scoping of recent literature around the role of assistant practitioners within healthcare, and to present the argument that as a profession we need to be more proactive in developing the skills and knowledge of our support staff. Recently, there has been a drive to develop the nursing associate role to help fill the gap between healthcare support workers and registered nurses. Clear guidance on standards of proficiency have been developed; with the role being registered by the NMC aligning it with the nursing family (NMC, 2018). Within allied health professions, literature reviews highlight that Radiography have embraced the formal development of their support workers, with the Society of Radiographers producing a scope of practice (Johnson, 2012) and a clear career pathway from assistant practitioner to registered radiographer. Occupational therapy, however, does not appear in the recent literature to be researching the impact and benefits of the assistant practitioner role. This poster will allow consideration of the barriers and opportunities for a more defined role of assistant practitioners within occupational therapy. Evidence suggests that the formalisation of an occupational therapy based assistant practitioner, with a coherent training and development opportunities, ensures the success of this role (Wheeler, 2017). This poster will aim to generate discussion about how empowering existing staff to complete a foundation degree will not only recognise our existing workforce but will positively impact on our clients’ clinical outcomes.
    • Primary biliary cholangitis: symptoms, diagnosis and treatment

      Mortimore, Gerri; University of Derby (MAG Healthcare, 2019-06)
      Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic but progressive disease that, over many years, causes damage to bile ducts, leading to cholestasis and, in some patients, cirrhosis. The rate at which PBC progresses varies from person to person, but significant damage takes decades to occur. It predominately affects women aged 40–60 years with a female to male ratio of 9:1, but can affect anyone from the age of 20. There is no cure for PBC other than liver transplant, but medications can be given to slow down disease progression and for the treatment of symptoms. Health professionals should monitor for complications, including the development of osteoporosis, vitamin deficiencies and liver cirrhosis, which caries the associated complications of portal hypertension, varices and ascites.
    • Right hypochondrial pain leading to a diagnosis of cholestatic jaundice and cholecystitis: a review and case study.

      Redfern, Vicky; Mortimore, Gerri; University of Derby (MA Healthcare, 2019-06-19)
      The gallbladder stores bile from the liver and releases it into the duodenum. Imbalance in bile components (typically, cholesterol) can lead to cholelithiasis, the crystallisation of choleliths (gallstones). Cholelithiasis is common, affecting a fifth of people in Western countries. The stones can become lodged in the biliary duct and obstruct bile flow. Bile obstruction affects levels of bilirubin, causing cholestatic jaundice. Associated symptoms include nausea, dark urine and pale stools. Gallstones can also cause cholecystitis, the inflammation of the gallbladder. They also often cause pain (biliary colic), especially sudden-onset, episodic, radiating right hypochondrial pain, and biliary pathology is the main cause of upper abdominal pain. Diagnosing these presentations requires a multispectral, holistic assessment comprising numerous investigations, including clinical history, liver function tests, Murphy's sign and abdominal ultrasound. Treatment is usually gallbladder removal surgery (laparoscopic cholecystectomy), with either bile duct exploration or endoscopic retrograde cholangio-pancreatography (ERCP). Good nurse–patient communication is essential to ensure quality of care. The case study presented here covers the assessment and biliary diagnosis of a female patient presenting with severe right hypochondrial pain. The review of existing evidence and the case study should help hepatobiliary nurses deliver quality care for patients presenting with symptoms of gallstones.
    • The experiences and meanings of recovery for Swazi women living with ‘Schizophrenia’

      Nxumalo Ngubane, Siphiwe; McAndrew, Sue; Collier, Elizabeth; University of Salford (Wiley, 2019-05-01)
      Globally, twenty-four million people live with schizophrenia, 90% living in developing countries. While most Western cultures recognise service user expertise within the recovery process this is not evident in developing countries. In particular, Swazi women diagnosed with schizophrenia experience stigma from family, community and care providers, thus compromising their recovery process. This study aimed to explore the experiences and meanings of recovery for Swazi women living with schizophrenia Interpretive Phenomenological Analysis was used. Fifteen women were recruited from Swaziland National Psychiatric Hospital out patients’ department, and face to face interviews were conducted. Four super-ordinate themes were identified: (1) The emotionality of ‘illness of the brain’; (2) Pain! Living with the illness and with others; (3) She is mad just ignore her; and (4) Being better. Discussion focuses on the findings of this study and a number of positive and negative implications emanating from them; labelling, stigma and the roles of family, culture and religious beliefs on the process of recovery. This study provides practitioners with insight into the importance of the socio-cultural context of the lives of women diagnosed with schizophrenia and how, in understanding this, mental health care could be improved.
    • Patient experience of venesection: results from a small cohort study

      Mortimore, Gerri; university of Derby (RCN, 2019-04-12)
      Small qualitative cohort study looking at patients perceptions of living with genetic haemochromatosis from diagnosis to treatment.
    • Applying best practice: the venesection clinics of the future

      Mortimore, Gerri; university of Derby (University of Derby, 2019-04-13)
      Discussed patient experiences of venesections and trying to get it right first time across venesection departments across the country.
    • Pre-nursing care experience and implications for its role in maintaining interest and motivation in nursing

      Whiffin, Charlotte; Baker, Denise; Nichols, Julia; Pyer, Michelle; Henshaw, Lorraine; University of Derby; University of Northampton (2019)
      In response to the Government’s mandate to give aspirant student nurses front line care experience before commencing a programme of nurse education, the East-Midlands participated in a national pilot programme to recruit aspirant nurses into HCA roles. Here, we discuss research evaluating our programme of pre-nursing care experience and explore the findings relating to how this programme maintained participant’s interest and motivation in nursing. We then discuss these findings within the context of current policy drivers within the NHS today.
    • Alcohol- is it all that bad?

      Mortimore, Gerri; University of Derby (The Hypocratic Post, 2018-02-05)
      According to a YouGov poll, 3.1 million people in the UK planned to take part in Dry January this year and give up alcohol. With January now behind us, how many people will continue to abstain or cut back on their alcohol intake, and who will choose to hop back off the wagon? The answer to this question is very dependent on how much we drink or, in other words, the total amount of alcohol units we consume. Of course, many of us who regularly consume alcohol don’t really think about the units we drink unless we are contemplating driving. I think many people will be shocked to realise that they are drinking many more units than is recommended by the Department of Health.
    • Genetic Haemochromatosis: research question

      Mortimore, Gerri; Woodward, Amelia; University of Derby (RCN and haemochromatosis society, 2019-04-12)
      There is little research which examines patient’s thoughts and feelings of being diagnosed with a life-long disorder which requires life-long treatment in the form of venesection and which may lead to cirrhosis of the liver. Exploring patient symptoms prior to, and after venesections has not been studied fully, nor the implication if they are diagnosed with cirrhosis. In the initial phase of the disease venesections are undertaken weekly for many weeks/months. This may have a huge impact re time off work to attend treatment, cost of parking at the hospital etc. Understanding the effect of this on patients will enable the NHS to improve patient care.
    • Ludwig's angina: a multidisciplinary concern.

      Parker, Emma; Mortimore, Gerri; University of Derby (MA Healthcare, 2019-05-09)
      Although relatively uncommon, Ludwig’s angina is a potentially life-threatening infection of the floor of the mouth and neck. There is a danger of airway obstruction by swelling in the area and displacement of the tongue, and patients are at risk of deterioration. There are many factors thought to place patients at an increased risk of developing the condition. These include recent dental treatment, dental caries or generally poor dentition, chronic disease such as diabetes, alcoholism, malnutrition, and patients with compromised immune systems (eg AIDS, organ transplantation). This article examines the aetiology of Ludwig’s angina and considers the presentation, diagnosis and treatment of a patient who presented to an out-of-hours streaming area of a local emergency department, with an emphasis on the importance of a multidisciplinary approach. It also considers the need for ongoing education and awareness of health professionals to ensure the successful diagnosis, management and treatment of this condition, particularly in the context of patients with poor access to dental care presenting first to the emergency department.
    • Acceptability of intrapartum ultrasound by mothers in an African population

      Wiafe, Yaw Amo; Whitehead, Bill; Venables, Heather; Dassah, Edward T; University of Derby; Kwame Nkrumah University of Science and Technology, Kumasi, Ghan (Springer, 2019-05-08)
      Intrapartum ultrasound is gaining high acceptance by many women as another method for assessing labour progression. Despite growing evidence of the effectiveness of ultrasound in labour, the acceptance of intrapartum ultrasound has not been previously investigated in black Africans. This study aimed to determine women’s acceptance of intrapartum ultrasound and their preference for transperineal ultrasound or digital vaginal examination (digital VE) in Ghana. An analytical cross-sectional study was conducted among mothers who had had both digital VE and transperineal ultrasound during labour in a tertiary hospital. Information about their sociodemographic characteristics, experience with, and preference for ultrasound or digital VE in labour using a pretested structured questionnaire was obtained. Their experiences were categorised as ‘tolerable, ‘quite uncomfortable’ or ‘very uncomfortable’. Categorical variables were compared using Fisher’s exact test. A p value < 0.05 was considered statistically significant. Altogether, 196 women were recruited into the study. The mean age of the women was 26.7 years (standard deviation, 4.6 years). Nearly half (47%) of the women had never delivered before. Significantly more women considered transperineal ultrasound to be more tolerable than digital VE (66% vs. 40%; p < 0.001). Almost all the women (97.5%) described their experience with transperineal ultrasound to be better than digital VE, and would choose transperineal ultrasound over digital VE in the future (98.5% vs. 1.5%; p < 0.001). The findings of this study are comparable to those of other related studies reported recently. This research confirms high acceptance of ultrasound in labour by mothers from different countries and across continents, implying that cultural differences do not influence women’s responses to and interest in intrapartum ultrasound. Most women found ultrasound in labour to be more tolerable than digital VE. Whenever possible, transperineal ultrasound should be provided as an alternative to digital VE during labour.
    • 20 Real talk - beyond advanced communication skills: outcomes of a residential workshop for palliative care doctors

      Whittaker, Becky; Watson, Sharan; Loughborough University, University of Derby (BMJ, 2019-03-19)
      Analysis of filmed data of patient consultations at a UK hospice provides the materials for ‘Real Talk’; a novel and flexible education intervention containing real-life film clips. Communication skills training is more likely to be effective in changing behaviours when it is experiential and interactive, being relevant to trainees’ practice. Methods Experienced palliative care doctors attended a three-day residential workshop in which they explored the Real Talk intervention in facilitated small groups. Discussions linked to the evidence relating to communication strategies, whilst reflective diaries and action planning provided opportunity for linking learning to their clinical and educator roles. The workshop was attended by 29 experienced palliative care doctors who completed a pre and post questionnaire we adapted from a validated tool. Pre-workshop questions asked for workshop expectations; 19 delegates identified all their expectations had been met, 10 did not indicate an answer. Narratives from the expanded answers noted the workshop had exceeded expectations and the ‘train the trainer’ approach was welcomed. Delegates identified the most effective aspects of learning included experiential small group work relating to the content of the Real Talk film clips, opportunity to critique underpinning evidence of how clinicians communicate in relation to conversations in end of life care and having an opportunity to reflect on learning and application to practice in a safe and stimulating environment. Engagement in, and feedback on, the workshop has provided a foundation on which to build our research in understanding complex communication and skills training. Providing interactive experiential learning, embedded in the emerging evidence base underpinning Real Talk, is crucial for clinicians seeking to explore complex communication skills with patients facing the end of life. Ensuring skilled facilitation, a safe environment and programme flexibility are crucial to the learning process.
    • Confronting social risk factors for liver disease

      Mortimore, Gerri; University of Derby (2019-02-01)
      This presentation will explore the social risk factors for liver disease and how, as health professionals, we can confront these factors, to enable behavioural change. This session will also explore and reflect on our own social behaviours and how by understanding the complexity of changing our own behaviour, can assist in changing the behaviour of others.
    • Real talk facilitator manual: Engaging patients with end of life talk

      Parry, Ruth; Whittaker, Becky; Pino, Marco; Land, Vicky; Faull, Christina; Feathers, Luke; Watson, Sharan; Loughborough University, LOROS Hospice Leicestershire, University of Derby; University of Nottingham, The Health Foundation, NIHR (Real Talk, 2019-03-01)
      Video-based communication training- engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.