Our Journal - winter 2022-23

Written by our clinical people, for our clinical people

Contents

Welcome

New Virtual Hospital supports modern approach to patient care

Nurse specialist publishes clinical practice review of glove use

Endoscopy team trial new test to diagnose early oesophageal cancer

Showcase your work in the next edition of Our Journal

Educational event includes supporting medical trainees with neurodiversity

Medical education team holds prestigious training session

Integrated Care System pharmacy medicines optimisation strategy: our next steps

Research study: Pain management for older adults with a hip fracture

Learning from error: conference update

Join our event to highlight the importance of research and training opportunities at PAHT

Maternity team focus on research at new group

Articles published by our #PAHTPeople...

Welcome

We are pleased to share the third edition of Our Journal - a publication written by our clinical people, for our clinical people, at PAHT.

Our Journal, published four times a year, includes the below, with reference to the articles in this edition:

y Focus features on clinical issues/ improvements and the impact on patient care: a clinical practice review of glove use from a clinical nurse specialist

y PAHT 2030: pharmacy medicines optimisation across the Integrated Care System (ICS)

y Research updates – our endoscopy team trialling a new test to diagnose early oesophageal cancer; a research study for older adults with a hip fracture; an event on the importance of research and training opportunities; and our maternity team's focus on research at their new journal club

y Conference reviews/updates: the latest sessions from the medical education team and a conference update on learning from error

y Clinical transformation updates: the new Virtual Hospital

y Summary of research contributions and papers published by PAHT clinicians

y Quality and safety agenda

y Awards/clinical recognition

y Clinical leadership successes

y Clinical audit projects

y Input from external contributors

Our Journal provides an amazing opportunity for us to showcase the wonderful work we do – please share it widely and let the communications team know which developments we can profile in the next edition of Our Journal at paht.communications@nhs.net

New Virtual Hospital supports modern approach to patient care

We have long spoken about the deconditioning that occurs during prolonged hospital stays. The reach of a hospital is no longer defined by the physical constraints of its walls. Delivery of care in patients' homes through virtual wards is becoming the expected standard; allowing continuing acute care whilst keeping patients at home.

Remote monitoring systems with the capabilities of providing continuous observations allow us to review patients' vital signs in the community, with the option for teams to perform physical reviews and delivery of medications at home as required. Patients will take home the necessary equipment for monitoring and be shown how to on-board/ set-up to ensure a smooth transition of care. Systems used locally currently allow for intermittent observations.

Locally, virtual wards are delivered by community providers; Hertfordshire Community Trust (Hertfordshire patients) and

now Essex Partnership University NHS Trust (EPUT) has established the Virtual Hospital for west Essex patients. The primary goal is to allow an early supportive discharge, as well as admission prevention from the community with referrals also from GPs and the East of England Ambulance Service. Both routes are aimed at creating capacity in acute hospitals. Virtual wards are specifically an alternative for patients who would have otherwise needed to be in an acute hospital bed. For west Essex, the Virtual Hospital capacity will be gradually increased over the next 12 months. In Hertfordshire, systems to optimise patients pre-operatively and care for them post-operatively are being developed.

Referral to the Virtual Hospital is through the West Essex

Care Co-ordination Centre. Entry criteria are purposefully kept as broad as possible; including patients residing in west Essex, with a NEWS score < 4, with more details on AlexNet > The rationale behind this was not to be condition specific and appeal to as broad a group as possible.

The multi-disciplinary team consists of consultants, advanced clinical practitioners and nurses. It is anticipated that patients would not need to remain in a virtual ward beyond two weeks. Processes are in place to allow care to be escalated if required following deterioration, with links into Same Day Emergency Care (SDEC), the Adult Assessment Unit (AAU) and the Older Person's Assessment and Liaison (OPAL) Unit.

To make a referral into the Virtual Hospital or to discuss any case you feel may be suitable to be managed in this service, to avoid a need for admission to hospital, please call 07581 013636 from 8am until 8pma dedicated professional hot line number.

Please ensure that you refer patients to the Virtual Hospital as soon as possible

Nurse specialist publishes clinical practice review of glove use

prevention and control clinical nurse

Glove use plays a vital role in infection prevention and control (IPC). However, the misuse and overuse of non-sterile gloves are commonplace in healthcare settings, putting patients at increased risk of acquiring infections.

It is a complex issue and has been linked to multiple factors, including:

y A lack of time between procedures;

y A lack of knowledge, leading to a false sense of security;

y Internal drivers such as emotion and socialisation

The fear and anxiety caused by the COVID-19 pandemic is increasing the use of gloves, further exacerbating the problem.

For this reason, there needs to be an improvement in healthcare workers’ understanding of when to use personal protective equipment (PPE), such as non-sterile gloves, and why it is needed.

The desire to protect themselves from possible SARS-CoV-2 exposure and the

focus on transmission-based precautions have led many healthcare workers to believe that standard precautions are inadequate, causing them to use gloves for almost everything, without appropriate risk assessment e.g. potential exposure to blood, body fluids, mucous membrane and nonintact skin, or the need for contact precautions for patients who are suspected or known to have infectious conditions.

Non-sterile gloves must be used to not only safeguard healthcare workers, but –equally importantly – to protect patients as well. To reduce the risk of cross-contamination and transmission, it is essential to:

y Risk assess the appropriateness of glove use;

y Understand the indications for changing gloves;

y Perform hand hygiene immediately before and after glove use

This clinical practice review article that I co-authored, published by the Nursing Times, explores the complex issues of glove misuse and inadequate hand hygiene, their implications on patient safety, as well as actions to encourage the appropriate use of non-sterile gloves to protect both healthcare workers and patients.

The opportunity came about a year ago when I was approached by Professor Jennie Wilson, president of the Infection Prevention Society, who is also the course leader of the masters programme that I am currently undertaking.

I was asked if I would be interested to write an article for the Nursing Times regarding glove use, which is one of the aspects of IPC that I have always been passionate about. This was in line with the increase in healthcare associated infections and outbreaks reported during the COVID-19 pandemic which were associated with glove misuse.

I wrote this article with a colleague from King’s College Hospital and it went through a

strict process of reviewing and revising (the article was double blind peer reviewed), before it was finally approved and published.

Writing an academic article like this takes time, patience and a lot of studying. I did this on top of working full-time, covering our on-call service out of hours and fulfilling my university requirements.

I was therefore fortunate to have the support of Dr Shico Visuvanathan, consultant microbiologist and director

of infection prevention and control, and the IPC team in all my endeavours.

I would also like to thank our fantastic library team for the excellent support they offer in finding evidence, not just for writing articles like this, but also for ensuring that we utilise evidence-based practice in providing the highest quality of care for patients.

It was an amazing learning opportunity for me and has provided me a wider platform to educate healthcare workers

on IPC and its impact on the safety of our patients and our people. I am hoping that this is the first of many IPC papers that I write.

For more information, please contact me at kimberly. cabiles@nhs.net.

You can read more in the Nursing Times here >

Endoscopy team trial new test to diagnose early oesophageal cancer

In April 2022, our endoscopy team successfully completed a gastrointestinal study, in collaboration with Cambridge University, as part of the DELTA Study (Integrated Diagnostic Solution for Early Detection of Oesophageal Cancer) (1).

The aim of the DELTA study was to improve the diagnosis of oesophageal cancer by using validated algorithms for patient identification, Cytosponge to collect samples, validated analysis techniques and economics as to how the test fits within healthcare services.

The Cytosponge had already undergone laboratory and patient-based trials to prove efficacy and safety (2, 3). PAHT were involved with the clinical part of DELTA work, which has already been published (4).

The Cytosponge is a singleuse ‘sponge on a string' device. It comes as a capsule on a string, which is swallowed with water, down into the stomach.

The other end of the string stays outside the mouth. After 5-7 minutes, when the capsule has dissolved, the string is

withdrawn back through the mouth, collecting cells as it gently brushes the lining of the oesophagus.

Once removed, the sponge is cut off the string and sent for analysis. This test can, in a lot of cases, avoid the need for a more invasive gastroscopy (camera test to look at the oesophagus, stomach and duodenum).

The Cytosponge aims to pick up cell changes in the oesophagus (gullet) due to Barrett’s oesophagus, a condition that increases the risk of oesophageal cancer. The test can help decide which patients need an urgent endoscopy.

At PAHT, our patients with Barrett's oesophagus were invited to take part in the DELTA study, rather than their usual surveillance gastroscopy,

and 99 patients were successfully recruited.

The Cytosponge identified two patients with very early oesophageal cancer who had endoscopic treatment at University College London Hospitals (UCLH) and their cancer was cured. A further two patients with highly abnormal cells were also identified and have gone on to have successful treatment.

I (Dr Rosemary Phillips, former consultant gastroenterologist at PAHT), was the principal investigator for the study, which was carried out by Ita Boyle, clinical nurse endoscopist, and Nikki White, lead research nurse.

In July 2022, following the success of the DELTA study and positive patient feedback, PAHT was selected as part of an NHS England and NHS Improvement National Pilot Scheme to trial the use of Cytosponge further in patients with low-risk gastrointestinal reflux symptoms, surveillance of patients with known Barrett’s oesophagus, and more recently patients with dyspepsia symptoms without weight loss or anaemia.

The pilot is a nurse-led clinic managed by our newly appointed Cytosponge nurse Binsy Biju and Cytosponge co-ordinator Amanda Zakir, with support from Ita Boyle, the gastroenterologist team and the Cancer Alliance team.

Pictured above: the Cytosponge team, from left to right; Ita Boyle, clinical nurse endoscopist; Nikki White, lead research nurse; and Binsy Biju, upper gastrointestinal (GI) nurse specialist.

Pictured below: How the cytosponge works.

Pictured: Dr Rosemary Phillips.

Other team members that are supporting the Cytosponge pilot include Leanne Summersell, endoscopy service manager, and Anthony Hale, senior transformation manager, Hertfordshire and West Essex Integrated Care Board.

To date, the team have delivered this to 37 patients.

We will update on our progress in future editions of Our Journal - thank you to all involved.

For more information about the project, please contact Ita Boyle at ita.boyle@nhs.net

You can find out more about the Cytosponge on the Medtronic website >

References:

1. https://www.deltaproject.org/

2. BEST 2 Trial. Fitzgerald RC, di Pietro M, O’Donovan M, et al. Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet 2020; 396: 333–44.

4. Pilonis ND*, Killcoyne R*, Tan WK, O’Donovan M, Malhotra S, Tripathi M, Miremadi A, DebiramBeecham I, Evans T, Phillips RH, Morris DL, Vickery C, Harrison J, di Pietro M, Ortiz-FernandezSordo J, Haidry R, Kerridge A, Sasieni PD, Fitzgerald RC. Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett’s oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot. Lancet Oncol 2022; 23: 270–78.

Pictured: From left to right, Leanne Summersell and Amanda Zakir.

3. BEST 3 Trial. Ross-Innes CS, Chettouh H, Achilleos A, et al. Risk stratification of Barrett’s oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study. Lancet Gastroenterol Hepatol 2017; 2: 23–31.

Educational event includes supporting medical trainees with neurodiversity

We were delighted to host an Educator Faculty Autumn Development Meeting at the Learning and Education Centre on 3 November. The session covered topics including: y Impact of the trainee in difficulty

y Supervision of the trainee with neurodiverse conditions

y General Medical Council (GMC) survey resultssharing good practice from paediatrics

y Health Education England (HEE) update and exception reporting

Dr Jacqueline Gratton, principal clinical psychologist and clinical lead for Here for you in West Essex, opened the evening with a thoughtprovoking discussion on the trainee in difficulty. Some interesting points were raised that led to a lively discussion and requests from the attendees for this important topic to be addressed in greater detail at future events.

The session on neurodiversity covered the range of neurodiverse conditions (attention deficit hyperactivity disorder (ADHD), autism,

Tourette's syndrome, dyspraxia, dyslexia, acquired neurodiveristy and mental health needs).

Two of our trainees were joined by two trainees from Cambridge; each presented independently on how their disability impacts their training and how they have developed mechanisms to overcome the obstacles and any prejudices that arise. The educators were both moved and impressed by the quality of each presentation and commented on how brave the trainees were to open up. One said: "It was so humbling to hear the honesty of the trainees, who explained so eloquently their conditions; they have shown me a new perspective and from now on when interacting with a trainee who is struggling, I will take a more considered approach."

This is a topic that has rarely been aired in educational forums, and we hope that

this event will launch a lively discussion throughout the region and raise awareness of these disabilities, ultimately improving support and understanding for trainees.

Dr Neha Khanna, Royal College Tutor for Paediatrics, shared good practice from the department and presented some helpful hints and tips on how paediatrics have strived to turn around some of their GMC negative outliers and improved their overall GMC survey results. I then thanked all involved in medical education for their support and dedication to the training of our doctors. I gave an overview of the GMC enhanced monitoring process along with recent HEE updates. Dr AlRamadhani, guardian of safe working hours, gave a lively update and presented some interesting statistics from the various departments.

Thank you to everyone who participated in this event (pictured).

Medical education team holds prestigious training session

In addition to the educational event including supporting medical trainees with neurodiversity (detailed on the previous page), our team has continued to provide excellent learning opportunities for our educators.

On 18 November, under the leadership of Dr Nik Cholidis, foundation training programme director, and me (pictured, right, from left to right) we ran our first ever Health Education England (HEE) Clinical Hub Event at the Learning and Education Centre. This prestigious event was arranged under the HEE banner and aimed at upskilling our consultant educators and supporting them with their accreditation as educators.

Topics covered were:

y Induction/educational contract

y Peer to peer learning

y Quality update from HEE

y Less than full-time training

y Clinical/educational supervisor report

y Support for the trainee returning to work after a long period of absence (SuppoRTT)

y Trainee in difficulty

y Exception reporting

We had 27 of our consultants attend the lively day, which was supported by speakers from HEE and our own consultant leads.

It was great to see the consultants meeting up and enjoying interacting in a faceto-face session again.

The feedback we have received has been fantastic. It included: "The exceptional effort put in to organising the day showed in every detail, and I am both happy and proud that such a good educational experience is being delivered at The Princess Alexandra Hospital."

We look forward to running further events for the Integrated Care System (ICS) this year.

Pictured below: one of the group work sessions.

For more information about our work in medical education, please contact me at preethi. gopinath@nhs.net

Integrated Care System pharmacy medicines optimisation strategy: our next steps

Medicines are the most common intervention in medical care. Medicines play a crucial role in maintaining health, preventing illness,

managing chronic conditions and curing disease. In an era of significant economic, demographic and technological challenge, it is crucial that patients get the best quality outcomes from medicines.

Medicines optimisation ensures a patient-focused approach to getting the best from and use of medicines, focusing on a holistic approach, an enhanced level of patient centred professionalism, and partnership between clinical

professionals and the patient.

In order for medicines optimisation to flourish, it must be patient-centred, based on the most up-to date available evidence, and work collaboratively across the whole Integrated Care System (ICS). This is the underpinning framework of our medicines strategy.

The Hertfordshire and West Essex medicines strategy is defined by four key challenges:

1. Living well and preventing ill-health

2. Transforming primary and community services

3. Improving urgent and hospital services

4. Providing health and care more efficiently and effectively

With the vital role medicines play in these challenges, and with pharmacy teams already recognised as highly performing and having a successful track record of delivery, the ICS have placed seven key workstreams to deliver these challenges.

1. Optimising on the use of digital technology: Harnessing the potential of digital technology to offer care in radically different ways and optimise the flow of information and communication across the system.

What this means at PAHT: We will continue to explore how the use of technology can make medicines management safer within the hospital, including upgrading our robotic dispensing, expanding environmental monitoring and introducing automated dispensing cabinets.

2. Clinical leadership: Ensuring senior pharmacist representation on all pathways and delivery boards.

What this means at PAHT: Through our workforce strategy, we will ensure there is pharmacy leadership within each division, and there is a clear development pathway for pharmacists and pharmacy technicians, including exploring the introduction of consultant pharmacist posts.

3. Reducing unwarranted variation through use of national benchmarking tools: Utilising business intelligence to benchmark nationally and then identify and improve shortcomings.

What this means at PAHT: Utilising business intelligence software such as QlikSense to monitor key medication safety themes such as antibiotic use, venous thromboembolism (VTE) prevention and community referrals.

4. Ensure the appropriate governance and framework to underpin care pathways: Establish the evolving integrated governance model, to facilitate the effective and timely implementation of priority workstreams.

What this means at PAHT: We will continue to ensure a robust and well defined framework is present for the services we provide, consistently reviewing practice using audit and exploring any opportunities to enhance patient care.

5. Enhance, integrate and optimise use of the pharmacy workforce:

Enhance patient care through expanding and benefiting from the full potential of our teams, including independent prescribers, consultant pharmacists, and enhanced interface roles.

What this means at PAHT: We will explore opportunities for consultant pharmacists, expand pharmacist roles through the introduction of an enablement policy, and utilise independent prescribers safely and effectively.

6. Ensure sustainability is at the forefront of decision making: Reducing the carbon impact medicines have, include reducing inhaler emissions, medicines waste, medical gases and single use plastics.

What this means at PAHT: We will educate and reiterate the environmental impact of carbon emissions in medical gases and inhaler therapies, ensuring the environmental impact is an important consideration during the development of clinical guidelines.

7. Deliver a vision for pharmacy across the ICS footprint: A clear and concise vision to be shared between all sectors of pharmacy, with defined and measurable benefits.

What this means at PAHT: Continue to build on relationships between hospital pharmacists, community pharmacists, primary care

network pharmacists and the Integrated Care Board such as pharmaoutcome referrals, area prescribing committees, local intelligent networks and joint trainee posts.

With this strategy, patients within the ICS will receive the very best, most up-to-date and optimised care, fulfiling

the potential of our teams, in a free flowing system where knowledge, expertise and ability are all shared to achieve the best possible outcomes for our people.

These workstreams all run alongside our PAHT2030 strategy, with a timeline of 5-8 years.

For more information, please contact me at steven.degiovanni1@nhs.net

Research study: Pain management for older adults with a hip fracture

I am carrying out a research study to evaluate and improve how well pain is managed for an older person who has a hip fracture.

The study focuses on older people who have been admitted via our emergency department (ED), and whether any risk factors such as frailty and cognitive problems affect their recovery.

Often, this particular group of patients can be under-treated for pain and discomfort, which leads to poor patient outcomes.

The study will help to understand the barriers in providing effective pain relief and identify how we can improve care and experiences for our patients.

I have been recruiting nurses and doctors who work in ED and on Tye Green Ward. This has included taking part in an online questionnaire that evaluates knowledge of pain, and joining an interview panel to discuss experiences of looking after patients with acute pain.

Your insights are invaluable to the success of this research study - thank you for getting involved and helping to make a difference.

I will update on the study in a future edition of Our Journal

For more information, please contact me at darryl. desouza@nhs.net, or call 01279 278085

Learning from error: conference update

theatres,

Anaesthetic Care Unit (PACU), pre-assessment and acute pain service

I presented at the annual National Conference for the Association for Perioperative Practice on 10 September (pictured).

I discussed the evolution and benefits of a no blame culture and how teams can learn from previous errors. I was pleased that the session was very well received by attendees.

At the conference, I explored that when an error occurs, it is very easy and often natural for the first reaction to be “it’s my fault” or finger pointing; "it’s your fault" and attributing blame. However, the reality is that errors occur through many influencing factors.

Historically within the NHS there has been a blame culture, however over recent years there have been a series of papers written to demonstrate the need to move away from blame towards learning from error.

These papers identify that

staff fear being inappropriately blamed; fear of peer opinions is preventing NHS staff from sharing and learning: thereby staff are working in a culture of fear. They also explore learning from errors and provide research to support the importance of learning and the detrimental effects blame can cause.

So, what solutions and future actions do these papers present? Berwick (2013) (please see the references section) identifies the key to patient safety requires a cultural change shift from blame to learning and addressing this is fundamental for improvement to occur. A culture which is transparent, open and honest is crucial.

Staff must feel enabled and supported to learn when things do not go as expected, rather than blaming ‘who’ but investigating ‘what’ was responsible. Simultaneously, by fostering a no blame culture where there is no fear of retribution when things go wrong (Williams 2018) and creating an environment of support in raising concerns further supports a culture change.

The King's Fund (2016) identifies the management of culture and error to be conducted by collective leadership and addressing error with empathy, respect and

rigour. The cause of error is multifactorial and how error is managed is crucial for learning and mitigating risk going forward. An essential approach is to provide a supportive environment through compassionate and collective leadership. This can be done by:

y Promoting an open culture - sharing learning in staff and team meetings, newsletters, posters and communicating openly to colleagues to rectify problems

y Utilising a reflective approach to learning from error and supporting staff

y Effective debriefing after an error

y Leaders openly encourage reporting, acknowledge those who do and provide feedback

y Language - use words such as ‘us’ and ‘we’ rather than ‘you’. Team orientated language lessens the chance of staff feeling

personally affronted

y Just culture guideencourages treating colleagues involved in a patient safety incident in a consistent, constructive and fair way

These have been implemented at PAHT, with work underway to embed the Just culture guide >

Errors will always occur as we are human beings, however “the only real mistake is the one from which we learn nothing” - Henry Ford

References

y Berwick D 2013, A promise to learn - a commitment to act: improving the safety of patients in England DH

y Health Care Safety Investigation Branch 2016 https://www.gov.uk

y Francis R 2015, Learning not blaming 2015 DH

y King's Fund 2016, Culture change through collective leadership https://www. kingfund.org.uk

y National Advisory Group 2013, A promise to learn - a commitment to act, improving the safety of patients in England https:// assets.publishing.service.gov.

uk

y NHS England 2020/21 People Plan, NHS England

y NHS Improvement 2018, A just culture guide updated December 2018 patient safety learning hub

y NHS Resolution 2019, Being Fair, NHS Resolution

y Williams N 2018, Gross negligence manslaughter in healthcare, https://www.gov. uk

Join our event to highlight the importance of research and training opportunities at PAHT

development and innovation

We will be hosting a research training and awareness in medical education event on Wednesday 18 January at the Learning and Education Centre

We will be in the Lecture Theatre from 9am-5pm, with a Grand Round presentation running from 1pm-2pm.

We are working jointly with the medical education team and library services to raise awareness for all of our people, in particular for doctors in

Bibi Badal, research nurse.

training, on the importance of research.

We will also be promoting the National Institute for Health

and Care Research (NIHR) ambition for all NHS colleagues to become research active

by 2030 and what training opportunities we have at PAHT to support them with this.

Attendees will learn about the exciting current and future research at PAHT and how to get involved.

Agenda

The Grand Round presentations will include those from our team (research) and some of our amazing research active colleagues both from within PAHT and externally (please see the agenda, overleaf).

1pm: Introduction - Dr Vijay Jayaram – clinical director for research, development and innovation and Dr Preethi Gopinath, director of medical education

1.10pm: Impact and future of clinical research - Sharon Barrett, chief operating officer, North Thames Clinical Research Network

Open to all - you do not need to book a place in advance. For more information, please contact jodawnwright@nhs. net.

1.20pm: Associate Principal Investigator Scheme - Chris Cook, head of research, development and innovation Proms Opac Study - Gabby Jenkinson, trainee advanced clinical practitioner, and Janice Bernardo, frailty lead

1.35pm: Hertfordshire and West Essex Integrated Care System Research Network Development Programme - Kevin Hallahan, health inequalities lead, NHS Hertfordshire and West Essex Integrated Care Board (ICB)

1.45pm: Research as part of a programme of education - Shahid Sardar, associate director of patient engagement

1.55pm: Questions and answers

We look forward to seeing you there.

Maternity team focus on research at new group

The Maternity Journal Club is a monthly session introduced in November for all of the maternity workforce to review a chosen article.

We met on 25 November at the Tulip Room, Birth Centre, and on Microsoft Teams and reviewed Winfield, S. and Booker, M., 2021. "Personalised care in maternity", British Journal of Midwifery, 29(8), pp.472-474.

We chose this as the first article to increase awareness of the importance and process of providing personalised care in maternity. A personalised approach to the care of women, pregnant people and their families is central to delivering the best experience through the antenatal and postnatal journey and beyond. This article was reviewed for information sharing, as it is not a research article. We enjoyed very productive discussions as a group.

The aim of the journal club is to increase colleagues’

interest and knowledge about research. We also wish for all to have a better understanding of how research contributes to the formation of both national and local guidelines, policies and recommendations. In addition, the journal club is an opportunity to remind practitioners of the importance of evidence-based practice.

The long-term aim is also to support midwives and nurses who would like to participate in research and become research midwives or nurses in the future.

Our next meeting is on 27 January. The proposed article is: Rodríguez-García, M.C., Martos-López, I.M., Casas-López, G., Márquez-Hernández, V.V., Aguilera-Manrique, G. and Gutiérrez-Puertas, L., 2022., "Exploring the relationship between midwives’ work environment, women's safety culture, and intent to stay", Women and Birth.

We have selected this article as having a positive work environment and culture contributes to the provision of clinical safety, enabling our teams to learn about the effect this has on the care they provide. We will also review the research process.

We welcome all who are interested in attending to come along. For more information, please contact me at o.akinlaja@nhs.net

Articles published by our

#PAHTPeople...

Take a look at some examples of the range of articles published or contributed to by our people since the last edition of Our Journal - a fantastic achievement. Full information of authors and articles are available from the library team: paht.lib.desk@nhs.net

y Abdemalek, E., et al. (2022). "The role of biopsy protocol in inflammatory bowel disease: getting the diagnosis right first time." Internal & Emergency Medicine. 2022 Dec 20. PAHT authors: (Abdemalek, Bose, Phillips). Department of Gastroenterology, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Chapman, R. and S. Shah (2022). "Improving the clinical handover of patients discharged from the intensive care unit to inpatient wards at a district general hospital: a quality improvement project." Future Healthcare Journal 9 (Supplement 2): S121. PAHT authors: Chapman, Shah). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Chapman R., et al. (2022). "Nanoporebased metagenomic sequencing: a diagnostic tool in respiratory tract infection." Journal; Erj Open Research. 8(4), 2022 Oct. PAHT author: (Chapman, Robert). The Princess Alexandra Hospital NHS Trust, Harlow, Essex UK.

y Hartland, A. W., et al. (2022). "Clinical

effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis." BMJ Open 12(10) (no pagination). PAHT authors: (Hartland, Islam, Teoh). Department of Trauma and Orthopaedic Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Khalil, M. I., et al. (2022). "Asymptomatic Bacteriuria: a Contemporary Review." Current Bladder Dysfunction Reports. PAHT author (Alnoomani, M. N.). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Konar, N., et al. (2022). "Dignity at work in the NHS." Future Healthcare Journal 9 (Supplement 2): S12. PAHT author: (Konar) The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y McCahill C., et al. (2023). "Prostate cancer." Medicine 51 (1): 48-52. PAHT authors: (McCahill, Chowdhury, Waldron). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Mechie, H., et al. (2022). "Breastfeeding in paediatric doctors: identifying breastfeeding

rates and barriers to ongoing continuation of breastfeeding in paediatric trainees in the East of England Deanery." Archives of Disease in Childhood 107 (Supplement 2): A342-A343.

PAHT author: (Mechie) The Princess Alexandra Hospital, Harlow, Essex, UK.

y Muscara, F., et al. (2022). "Increased incidence of gallbladder dysplasia and cancer during the COVID-19 pandemic." British Journal of Surgery 109 (Supplement 5): v47. PAHT authors: (Muscara, Jebamani, Ivanov). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Niaz, O. S., et al. (2022). "Effects of different weight loss programmes on oncological outcomes following curative resection of digestive tract cancers." Cochrane Database of Systematic Reviews 2022(10) (no pagination). PAHT author: (Parrott). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Nunn, R., et al. (2022). "2ww Colorectal referral proformas: Is the inclusion of recent bowel investigations relevant?" British Journal of

Surgery 109 (Supplement 5): v14. PAHT authors: (Nunn, Hassan, Allgrove, Vivekanandan, Vijay). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Nunn, R., et al. (2022). "Doctor-led straight to test service: streamlining the colorectal 2ww referral pathway." British Journal of Surgery 109 (Supplement 5): v145-v146. PAHT authors: (Nunn, Hassan, Allgrove, Vivekanandan, Vijay). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Patel, M., et al. (2022). "Surgical site infections: A prospective study of incidence and risk factors at a District General Hospital." British Journal of Surgery 109 (Supplement 5): v132. PAHT authors: (Anad, Warrag, Abidia). Department of General Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Shah, S. and R. Chapman (2022). "Improving documentation regarding ceilings of care upon intensive care unit discharge: a quality improvement project."

Future Healthcare Journal 9 (Supplement 2): S104. PAHT authors: (Shah, Chapman). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Shah, T. T., et al. (2022). "Magnetic resonance imaging and targeted biopsies compared to

transperineal mapping biopsies before focal ablation in localised and metastatic recurrent prostate cancer after radiotherapy." European Urology 81(6): 598-605.

PAHT author: Virdi, Jaspal. Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.

y Stubbs, D., et al. (2022). "Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of systemwide factors that may impact operative risk?"

BMJ Open 12(11): e064105. PAHT author: (Gilder). The Princess Alexandra Hospital NHS Trust, Harlow, UK.

y Taylor, S., et al. (2022). "On-Q local anaesthetic infusions for laparotomy surgery: A district hospital experience." Anaesthesia 77 (Supplement 4): 36.

PAHT authors: (Taylor, Thomas, Mann, Ejtehadi, Griffiths, Dutta). The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK.

y Tong, J. L., et al. (2022). "A patient with concurrent legionella and COVID-19 infection in a UK district general hospital." Case Reports Infectious Diseases 2022: 6289211.PAHT author: (Dhir). The Princess Alexandra Hospital, Harlow, Essex, UK.

y Varma, R., et al. (2022). "Cheeri: An ambition to enable more paediatric research opportunities for trainees in the east

of England." Archives of Disease in Childhood 107 (Supplement 2): A499-A500.

PAHT author: (Shekhar). Department of Paediatrics, The Princess Alexandra Hospital, Harlow, Essex, UK.

y Weaver, J., et al. (2022). "Prostate artery embolisation from radial approach: clinical outcomes and complication rate." CardioVascular and Interventional Radiology 45(Supplement 4): S922.

PAHT authors: (Weaver, Aldin, Manolas, Gharib, Khatari). The Princess Alexandra Hospital, Harlow, Essex, UK.

y Wu, F., et al. (2022). "Patterns of nerve injury and recovery rates of infraclavicular brachial plexus lesions following anterior shoulder dislocation." Journal of Hand Surgery - American Volume 47(12): 1227. e1221-1227.e1227.

PAHT authors: Tong, Long, Russell). The Princess Alexandra Hospital, Harlow, Essex, UK.