• Narratives of family transition during the first year post-head injury: perspectives of the non-injured members

      Whiffin, Charlotte Jane; Bailey, Christopher; Ellis-Hill, Caroline; Jarrett, Nicola; Hutchinson, Peter J.; University of Derby; University of Derby Derbyshire Chambers and Business Link; Canal Wharf Chesterfield UK; Faculty of Health Sciences; University of Southampton; Highfield, Southampton UK; University of Bournemouth; Poole Dorset UK; Faculty of Health Sciences; University of Southampton; Highfield, Southampton UK; et al. (2014-10-23)
      Aim To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury. Background A head injury is a potentially devastating injury. The family responds to this injury by supporting the individual and their recovery. While the perspective of individual family members has been well documented, there is growing interest in how the family as a whole makes sense of their experiences and how these experiences change over time. Design Longitudinal narrative case study using unstructured in-depth interviews. Methods Data were collected during an 18-month period (August 2009-December 2010). Nine non-injured family members from three families were recruited from an acute neurosurgical ward and individual narrative interviews were held at one, three and 12 months postinjury where participants were asked to talk about their experience of head injury. Analysis was completed on three levels: the individual; the family and between family cases with the aim of identifying a range of interwoven narrative threads. Findings Five interwoven narratives were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the year posthead injury was a turbulent time for families, who were active agents in the process of change. Conclusion This study has shown the importance of listening to people's stories and understanding their journeys irrespective of the injured person's outcome. Change postinjury is not limited to the injured person: family members need help to understand that they too are changing as a result of their experiences.
    • Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle-income countries: A qualitative study protocol

      Whiffin, Charlotte, J.; Smith, Brandon, G.; Ignatius, Esene, N.; Karekezi, Claire; Bashford, Tom; Khan, Muhammed, M; Solla, Davi, JF; Hutchinson, Peter, J.; Kolias, Angelos; University of Derby; et al. (BMJ, 2020-08-13)
      Low-and middle-income countries (LMICs) face the greatest burden of neurotrauma. However, most of the research published in scientific journals originates from high-income countries, suggesting those in LMICs are either not engaging in research, or are not publishing it. Evidence originating in high-income countries may not be generalisable to LMICs, therefore it is important to nurture research capacity in LMICs so that a relevant evidence base can be developed. However, little is published about specific challenges or contextual issues relevant to increasing research activity of neurosurgeons in LMICs. Therefore, the aim of this study was to understand neurosurgeons’ experiences of, aspirations for and ability to, conduct and disseminate clinical research in low- and middle-income countries. This is a pragmatic qualitative study situated within the naturalistic paradigm using focus groups and interviews with a purposive sample of neurosurgeons from LMICs. First, we will conduct asynchronous online focus groups with 36 neurosurgeons to broadly explore issues relevant to the study aim. Second, we will select 20 participants for follow-up semi-structured interviews to explore concepts in more depth and detail than could be achieved in the focus group. Interviews will be audio-recorded and transcribed verbatim. A thematic analysis will be conducted following Braun and Clarke’s six stages and will be supported by NVIVO software. The University of Cambridge Psychology Research Ethics Committee reviewed and approved this study in January 2020 (REF PRE.2020.006). Participants will provide informed consent, be able to withdraw at any time and will have their contributions kept confidential. The findings of the study will be shared with relevant stakeholders and disseminated in conference presentations and journal publications.
    • Non-invasive assessment and prediction of clinically significant portal hypertension

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; Royal Derby Hospital (BMJ Publishing Group Ltd., 2011-03-13)
      Hepatic venous pressure gradient (HVPG) predicts variceal development, bleeding, clinical decompensation and death. Measurement is invasive, time-consuming and performed in few centres. Reduction of HVPG to ≥12 mm Hg or by >20% significantly reduces bleeding risk and mortality. Detection of non-responders requires repeated HVPG measurement as conventional non-invasive assessment is not accurate in predicting haemodynamic response. Cirrhotics have a hyperdynamic circulation and impaired baroreceptor sensitivity (BRS). The authors assessed whether non-invasive measurement of systemic haemodynamics and BRS detected clinically significant portal hypertension (CSPH, HVPG ≥12 mm Hg).
    • Non-invasive measurement of Systemic Haemodynamics by Finometry in patients with Cirrhosis

      Freeman, Jan G.; Rye, Kara; Mortimore, Gerri; Austin, Andrew; University of Derby (2015-01)
    • "Nurses who become ACPs should not be mini-medics"

      Whitehead, Bill; University of Derby (EMAP, 2016-05-16)
      There is a pressing need to enable registered nurses to reach their full potential at higher-than-basic-registration level in clinical practice. This would fulfil two requirements: personal professional advancement and workplace clinical need.
    • Nurses' recognition of domestic violence and abuse.

      Byrom, Beth; Collier, Elizabeth; Rogers, Michaela; Salford University; Staff nurse, North Manchester General Hospital; Lecturer in mental health, University of Salford; Lecturer in social work, University of Salford (Mark Allen Healthcare, 2017-12-28)
      Most literature and discourse on domestic violence and abuse (DVA) focuses on women but there is a need to be cognisant of the broader population experiencing DVA and the wide-ranging impacts that can affect anybody whatever their identity or background. Mental Health nurses are in a good position to help people who experience DVA but they need to be able to recognise it first. This paper reports on a review which aims to address the question: How can mental health nurses recognise domestic violence and abuse (DVA)?. The databases CINAHL, Medline, PsychINFO and ASSIA were searched using key terms related to DVA and nursing and recognition. The term ‘nursing’ was used as the ‘mental health nursing’ search term found only two papers. Limits for the search were English language research only papers from 2002-2017. Fifteen papers were included in the review. Most of the located research focused on health care practitioners in multidisciplinary teams with nursing literature focused on adult health nurses rather than mental health nursing. The findings are presented in the categories: education, training and organisational support, and, screening, inquiry and the therapeutic relationship, with an additional category (given the original aim of the review) ‘mental health settings’. The experience of DVA has significant consequences for mental health yet we found only two research papers focused on mental health settings. We therefore discuss and extrapolate from reviewed literature the implications for practice in the context of mental health nursing.
    • Nutrition and malnutrition in liver disease: An overview

      Mortimore, Gerri; University of Derby (MAG Healthcare, 2020-01)
      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.
    • 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.
    • 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.
    • Orthostatic hypotension: clinical review and case study

      Bailey, Rachael; Mortimore, Gerri; University of Derby (Mark Allen Group, 2020-05-14)
      Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.
    • Outcomes of a research project to identify the enablers and barriers to effective preceptorship for newly qualified nurses

      Whitehead, Bill; Beddingham, Elaine; Hickman, C.; Johnson, E.; Barrett, R.; Owen, Patricia; Simmons, Maxine; Barton, Merryn; Walker, Carl; University of Derby; et al. (European Federation of Nurse Educators (FINE) with the RCN Education Forum International Conference 2012 Cardiff City Hall, Wales, UK, 2012-10-05)
    • Overcoming the challenges of role transition for trainee advanced clinical practitioners

      Murphy, Kay; Mortimore, Gerri; Royal Derby Hospital; University of Derby (Mark Allen Group, 2020-06-18)
      Advanced clinical practitioners (ACPs) are being recruited in England to improve care continuity and safety, meet complex needs and ease workforce pressures. These roles are open to experienced, registered health professionals from a variety of backgrounds. This significant career change typically involves a transitional training programme. This article explores the challenges presented by this transition and how they can be overcome. Attaining the postgraduate qualification can be daunting for those who have been outside academic education, especially the initial degree module. The generalist ACP role can be confused with that of clinical nurse specialist, and an ambiguous role identity can cause problems for management, expectations and morale. Trainee ACPs gain wide experience from ward rotations, although they can specialise in some areas. Thus, trainees experience de-skilling as they go from being an expert in one role to a novice in another, as well as potentially developing imposter syndrome. Trainees may be anxious about being expected to fulfil the competencies of a qualified ACP, and their trainee status should be evident in their uniform. Those entering advanced practice can face interpersonal hostility and institutional resistance. Any bullying should be addressed directly, and potential misconceptions should be clarified. There is no overarching national regulatory body for ACPs, and relevant guidelines can diverge. While a clinical supervision assesses a trainee's performance, a separate mentor should support their learning and develop their competence and confidence, especially in the first year. Mentorships should be defined and structured. Trainees can be supported by experienced qualified ACPs. Flexible individual induction plans, with information spaced throughout the year, can help overcome these challenges, and these should make the most of the trainee's achievements in their previous role.
    • P16 Non-invasive detection of oesophageal varices: comparison of non-invasive assessment of systemic haemodynamics with laboratory parameters and predictive scores

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; Derby Hospitals NHS Foundation Trust (BMJ Publishing Group Ltd., 2010)
      Endoscopic screening for varices (OV) is advised in cirrhosis, repeated every 1–3 years, with primary prophylaxis given to large OV. This is costly to endoscopy units, unpleasant for patients and multiple procedures may affect compliance. Cirrhosis is characterised by a hyperdynamic circulation; novel tools make non-invasive assessment possible.
    • P24 Presence of impaired baroreceptor sensitivity is a poor prognostic marker in cirrhosis

      Rye, Kara; Mortimore, Gerri; Austin, Andrew; Freeman, Jan G.; University of Derby (BMJ Publishing Group Ltd., 2011)
      Autonomic function is essential for blood pressure control and baroreceptor sensitivity (BRS) acts as a composite marker of overall function. Both sympathetic and parasympathetic function is impaired in cirrhosis. Impaired BRS predicts death in cardiovascular diseases and chronic kidney disease.
    • P35 Long-term remission is achievable in autoimmune hepatitis using Tacrolimus or Mycophenolate mofetil and results in regression of fibrosis

      Scott, Robert; White, Jonathan; Atwal, Gurprit Suni; Taylor, Nicholas; Mortimore, Gerri; Freeman, Jan G.; Lawson, Adam; Austin, Andrew; University of Derby (BMJ Publishing Group Ltd., 2011-09-06)
      Introduction 10–20% of patients do not respond to conventional treatment of autoimmune hepatitis, or are intolerant of azathioprine. There is no established second line treatment. Experience with transplant immunosuppressive agents such as Tacrolimus (TAC) and mycophenolate mofetil (MMF) is limited to small numbers and short-term follow-up. Aim To describe the progress of all patients who had failed conventional therapy and were treated with second line agents with at least 12-month follow-up. Method An audit of patients identified who received second line agents for at least 12 months on maintenance dose <10 mg prednisolone. Patient records were reviewed and treatment endpoints based on aminotransferase changes defined as; Complete response (CR) - sustained normalisation for at least 12 months, partial response (PR) - improvement by >50% but not always normal over a 12-month period. Where applicable, interval histology was reviewed by a single pathologist to assess ISHAK fibrosis scores at the start and at least 18 months after commencing second line agents. Results A total of 26 patients were identified. 9 were treated with TAC for a median 81 months (21–137), 16 with MMF for a median 81 months (30–114) and one on a combination of TAC and MMF. Median age is 56 (28–68) and 64 (40–79) respectively. The median dose of TAC is 3.5 mg/day (1–6) and MMF 1 g/day (1–2). All patients on TAC achieved CR. Two patients discontinued treatment; one renal impairment and one rationalising treatment after 27 months CR. 11/16 patients on MMF achieved CR, 5/16 achieved PR. Five patients no longer take MMF; two due to toxicity (recurrent chest infections at 60 months, GI disturbance at 78 months), one successfully withdrew treatment after 39 months CR, one switched to TAC as a treatment failure of MMF after 103 months and one was withdrawn after a diagnosis of larynx SCC. The combination patient achieved CR and has received 50 months dual treatment with confirmed histological remission. Four patients on TAC and five on MMF had interval biopsies. 3/4 patients on TAC (median 87 months) exhibited stable or reduced grades of fibrosis compared to 2/5 patients on MMF (median 101 months). Conclusion Effective long-term maintenance of remission at 10 years is achievable on MMF and TAC in the absence of significant toxicity. Achieving prolonged CR seems to confer disease control and can result in histological regression of fibrosis.
    • P37 identifying cirrhotics at risk of paracentesis-induced circulatory dysfunction (PICD): The significance of an early fall in stroke volume

      Grant, Claire; Rye, Kara; Scott, Robert; White, Jonathan; Mortimore, Gerri; Freeman, Jan G.; Austin, Andrew; University of Derby (Elsevier, 2014-04)
    • Patient experience of day case liver biopsy: Prospective audit

      Li, Ka Kit; Mortimore, Gerri; Jackson, Michelle; Clarke, Dominic; Freeman, Jan G.; Austin, Andrew; Royal Derby Hospital (Wiley, 2006-10-01)
      Background: Percutaneous liver biopsy remains an important toolin the diagnosis and staging of chronic liver disease. There is oftenreluctance to use wider bore needles because of potentially highercomplication rates. There are no good prospective studies of thepatient experience and morbidity associated with the procedure.Aims: To describe the patient experience and compare two differ-ent biopsy needles. Patients and Methods: Data collected prospec-tively was available for 83 ultrasound-sited percutaneous biopsiesfor chronic liver disease. Subjects were regularly offered analgesiaand asked to rate pain on a visual analogue scale (0-10). Patientswere contacted 30 days post-biopsy. Results: Indications for bi-opsy were alcoholic liver disease (21%), NAFLD (21%), HCV(14%), HBV (8%), haemachromatosis (10%), autoimmune hepatitis(8%), other (22%). Data are expressed as mean (CI) and comparedusing t-test and ANOVA. Within the first 6 hours, 28 took parac-etamol only, 8 required codeine-based analgesia, and 1 receivedpethidine. There were no episodes of bradycardia, hypotension orpyrexia and only one re-admission (for recurrent ascites). Therewere no serious adverse events in either group. Conclusions: Themajority of patients experienced only mild discomfort after liverbiopsy and 45% did not require analgesia. A small difference inpain scores was detected at one hour but did not persist to sixhours and may reflect the greater use of lignocaine by one group.
    • 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.
    • "Penny's plan" - Dying matters what can we do?

      Watson, Sharan; O'Reilly, Chris; Mortimore, Gerri; University of Derby (University of Derby, 2018-05-14)