• 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)
    • Perioperative nimodipine and postoperative analgesia

      Casey, Gerri; Nortcliffe, Sally-Ann; Sharpe, Paul; Buggy, Donal, J.; University of Derby (Wolters Kluwer, 2006-02)
      Opioids are the mainstay of treating acute postoperative pain. However, they are associated with a number of adverse events, including nausea and vomiting, respiratory depression, mood alteration, and pruritus. Treatment with adjunctive analgesic drugs can have a morphine-sparing effect, thereby reducing these side effects. This has been demonstrated with nonsteroidal antiinflammatory drugs, such as diclofenac (1), but these drugs are associated with their own adverse event profile, including gastrointestinal hemorrhage and renal impairment. There is growing evidence suggesting that voltage-gated calcium channels have an important role in the transmission of nociceptive impulses. Subtypes of voltage-gated calcium channels include L-, N-, and T- Ca2+ calcium channels. Calcium influx and efflux from sensory neurons appears to facilitate nociceptive neurotransmitter release in the spinal cord (2). Acute opioid exposure decreases intracellular calcium levels and Ca2+ binding to synaptic membranes (3). Conversely, increases in intracellular Ca2+ are associated with development of central sensitization after a noxious insult (4). L-type voltage-gated Ca2+ channels have been shown to have a functional role in morphine antinociception in a diabetic rat model (5). It seems logical to hypothesize, therefore, that inhibition of Ca2+ into sensory neurons using calcium antagonists might reduce pain and requirement for morphine in clinical situations. Nimodipine is a dihydropiridine calcium channel antagonist, which binds to the L-type voltage gated calcium channel. It crosses the blood-brain barrier and is demonstrably effective in the prevention of secondary ischemic neurological damage after subarachnoid hemorrhage (6). There are case reports of its efficacy when administered epidurally in reducing pain and opioid requirement in patients receiving palliative analgesic therapy (7). However, a placebo-controlled cross-over study in cancer patients failed to demonstrate any analgesic benefit of oral nimodipine (8). We tested the hypothesis in a randomized, double-blind, placebo-controlled clinical trial that perioperative nimodipine commenced preoperatively and continued for 48 h postoperatively would reduce pain and morphine requirements.
    • Potential implications of degree apprenticeships for healthcare education

      Baker, Denise; University of Derby (Emerald, 2018-12)
      Purpose The purpose of this paper is to critically reflect on evidence relating to the development and delivery of apprenticeships and its potential implications for pre-registration healthcare education. Design/methodology/approach An iterative review of English language literature published after 1995 to date relating to apprentices and apprenticeships was undertaken. In total, 20 studies were identified for inclusion. Only three related to the most recent apprenticeship initiative in the UK, and the majority were UK based. Findings Three key themes were identified: entering an apprenticeship, the learning environment and perceptions of apprenticeships. Successful completion of an apprenticeship relies heavily on both understanding the role the apprentice is seeking to inhabit, as well as well-structured and comprehensive support whilst on the programme. These findings are then discussed with reference to professional body requirements and pre-registration education in healthcare. Practical implications Appropriate work experience and support for learning are critical to apprenticeship success and apprenticeships should be given equal status to traditional healthcare education routes. Originality/value The introduction of the Apprenticeship Levy in April 2017 (Finance Act, 2016), acknowledgement that all National Health Service Trusts will be levy payers and the introduction of targets relating to apprenticeships for public sector employers have all contributed to growing interest in the apprenticeship agenda in health and social care.
    • 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.
    • Preceptorship pays off

      Whitehead, Bill; Chesterfield Royal Hospital; University of Derby; Keele University (RCN Publishing Company Ltd, 2014-02-19)
      A recent literature review focused on supporting newly qualified nurses through their transition from student to registered nurse.
    • Preceptorship support is an effective way to invest in NQNs

      Whitehead, Bill; University of Derby (EMAP, 2018-12-03)
    • A preceptorship toolkit for nurse managers, teams and healthcare organisations

      Owen, Patricia; Whitehead, Bill; Beddingham, Elaine; Simmons, Maxine; University of Derby; Chesterfield Royal Hospital NHS Foundation Trust (RCNI, 2020-07-08)
      The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.
    • Preparing students to care for patients at the end of life

      Westwood, Stacey; Brown, Michelle; University of Derby (EMAP Publishing, 2019-10)
      Student nurses complete placements in a variety of clinical settings and it is not possible to predict what situations they may encounter, which makes adequate preparation a challenge. They are likely to encounter death and dying during clinical placements from the very start of their education, without necessarily having adequate preparation for the experience. At the University of Derby, 59 first-year students in adult nursing who had completed their first placement evaluated their preparedness to encounter patients at the end of life. They generally found that they lacked training, support and confidence. This article discusses the results of the study and explores how pre-registration nursing education could be improved in this area.
    • Primary biliary cholangitis: An update on treatment

      Mortimore, Gerri; University of Derby (MAG Healthcare, 2020-01)
      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.
    • 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