• 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 programmes in the UK: A systematic literature review

      Beddingham, Elaine; Henshaw, Lorraine; Owen, Patricia; Simmons, Maxine; Walker, Carl; Whitehead, Bill; Chesterfield Royal Hospital NHS Foundation Trust; University of Derby (Chesterfield Royal Hospital NHS Trust, 2012-01-19)
      This is a systematic literature review of the existing published research related to the development of preceptorship programmes in the UK. It has been known for some time that newly qualified nurses experience a period of unsettling transition at the point of registration. In the UK preceptorship has been the professional body’s recommended solution to this for over 20 years. Searches were made of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and AMED. A systematic review was carried out based on the following questions: What is the experience of the preceptee? What is the experience of the preceptor? What are the ways of measuring the outcome of the preceptorship process? What are potential ways of measuring the outcome of other transitional periods in industries outside of the nursing profession? What are the ways of assessing the learning environment and learner needs? Papers were critically reviewed and relevant data were extracted and synthesised. A results table is presented of the 39 sources generated by the systematic search. Eight themes were identified from the empirical evidence base: ‘Managerial Support Framework’; ‘Recognition and Status of Role’; ‘Protected Time for Preceptor and Preceptee’; ‘Education Preparation of Preceptors’; ‘Recruitment and Retention’; ‘Competence of Preceptees’; ‘Reflection and critical thinking in action’; and ‘Efficacy of Existing Measurement Tools’. There is strong evidence that the newly qualified nurse wants and benefits from a period of structured preceptorship. This translates to improved patient care and benefits recruitment and retention for the employing organisations. Recommendations for Practice: The existing literature provides an evidence base upon which to construct a preceptorship programme and a means by which to measure its efficacy and monitor its future development. Recommendations for Future Research: Case study research projects should be considered for future preceptorship programmes in order to find the most effective methods of delivery.
    • Preceptorship Research Project Report: Chesterfield Royal Hospital NHS foundation trust

      Barton, Merryn; Beddingham, Elaine; Henshaw, Lorraine; Owen, Patricia; Simmons, Maxine; Whitehead, Bill; Chesterfield Royal Hospital NHS Foundation Trust; Keele University; University of Derby (Chesterfield Royal Hospital NHS Trust, 2014-02-19)
      Nurse education in the UK has been solely university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for Newly Qualified Nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over this transition period from student to registered nurse and it is recognised that this can be a stressful and difficult time for NQNs. This project developed from work already undertaken by the clinical placement learning team at Chesterfield Royal Hospital NHS Foundation Trust and was led by the University of Derby in partnership with them and took a case study approach to evaluating how preceptees and their preceptors are supported in practice; what their expectations are and what factors in the clinical area support or inhibit transition to qualified nurse. A systematic review was conducted as part of this project (Whitehead et al 2012 and 2013). The evidence suggests that properly resourced and organised preceptorship is a positive and essential experience for NQNs and their employers. Negative experiences come from an absence of preceptorship; preceptorship being offered but not fully delivered; and feelings of poor self-confidence despite having sufficient competence. The implication of this is that organisations can improve their likelihood of producing reliable and competent registered nurses (RNs) by the introduction of properly resourced and organised preceptorship frameworks. Recommendations for practice and for further research are made. A modified version of Lincoln and Guba’s Naturalistic Inquiry (1985) was used. This provided an authoritative and reliable ontological framework upon which to base the project. A qualitative case study method was developed and consisted of a multistage approach to data collection including semi-structured interviews with key personnel; documentary analysis of preceptorship material and focus groups with key actors. Ten interviews and five focus groups were undertaken with a total of 40 focus group participants. The participants were purposively sampled from representative groups within the Trust. NVivo was used to support analysis and ethical approval was attained for the project. Findings are grouped under the headings of: preceptor training; preceptor support; experiences of preceptorship; what the nurse should be like at the end of a period of preceptorship and the use of the tool. In addition further themes emerged from the findings in relation to indicators for successful transition; formal recognition of preceptor role; confidence and resilience; culture of support including peer support and management structure to support preceptorship; selection and preparation of preceptors and clinical skills. It is evident that there are a range of factors which are seen to affect the success or otherwise of the preceptorship period and the transition to confident RN. The findings indicate that there are a range of factors which are reported to affect the successful transition from student to NQN with the period of preceptorship in this case. These are : the selection and preparation of preceptors; a need to formally recognise the preceptor role; specific time to engage with preceptorship ; a management structure to support preceptors and preceptorship; the individualisation of preceptorship needs and ways to ensure successful preparation of students and NQNs ; the acquisition of the right clinical skills for the job; the culture of support; peer support for preceptees and preceptors; the confidence and resilience of preceptees and technological support processes. Based on these factors recommendations are made for this case in practice and for further research generally.
    • 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
    • Primary biliary cholangitis: symptoms, diagnosis and management

      Mortimore, Gerri; University of Derby (2017-07-20)
    • 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.